I’ve worked in the grey area of disordered eating for a while, often seeing young athletes who reluctantly come to see me with their concerned parent. It’s an area that I love, because seeing these teens get better is so rewarding.
It used to be that occasionally a parent would drag their teen along for a disordered eating consultation but, upon questioning and screening them, I actually suspected they had a full blown eating disorder.
A short explainer here: I used to think it was a continuum from healthy relationship with food to disordered eating to eating disorder, but I don’t anymore. Many people have messed up relationships with food and eat in a way that I would consider to be somewhat disordered. It’s like a side-effect of the diet culture many of us grew up with. But for a subset of people who are more vulnerable, a diet can be like a gateway drug for them. They find that, unlike their peers, not eating/binging/purging has a different effect on their brain – it relieves anxiety.
Obviously everyone’s journey is different and I’m generalizing here, but time and time again I see clients who are going through something. It might be that their parents are getting divorced, or that they’ve recently left home and are struggling with the transition, or simply that they’re feeling incredible pressure to do well in their school exams and sporting competitions. The diet comes along and it gives them that sense of control they’ve been lacking. And things snowball from there.
So whenever I came across one of these kids, I would refer them on to the public health system for more comprehensive wraparound care. But often they would find themselves last in line on a waiting list a mile long. I’m sure you can imagine how frustrating it is for everyone involved that these kids are left to get ‘sick enough’ to be seen, instead of receiving early intervention. Obviously I couldn’t leave them and their parents on their own, so I would support them as much as I could (along with their general practice team) while they waited. Thankfully, it wasn’t many of my clients.
I don’t know exactly why eating disorders have exploded since lockdowns, but they have. In both adults and children. There are a few theories out there: social isolation, parents being with their children all day so they can see what’s going on, more time on social media, people feeling out of control. Maybe all of the above. Alongside eating disorders, there’s been a huge increase in anxiety, depression, alcohol use and parasuicide. Here in New Zealand, the amount of 10-14 year old children seen in hospital for parasuicide increased by 125% after the first lockdowns.
And so I have increasingly found myself giving advice to both parents and primary healthcare professionals who are trying to manage children and young adults with eating disorders. There’s a lot of advice out there from more experienced people than me, but for my part, here are a few tips. Most of my clients are teens and most tend towards restrictive eating and/or bingeing, so that’s mainly what my tips are around:
- If you haven’t already, see your GP straight away.
- Keep in mind that eating disorders can affect all ages, genders and body types. We can’t rely on weight or BMI as an indicator, e.g. overweight people can be anorexic. People who look healthy can be engaging in very unhealthy behaviours like binging, purging, severe food restriction, over-exercising, etc. Eating disorders don’t always fit into neat little boxes and someone may cycle through different types. You know your child best, trust your instincts.
- Check out EDANZ. They’re a charity run by volunteers who all have personal experience either having an eating disorder, or being the parent/caregiver of someone who had an eating disorder. I find them to be super practical with the day-to-day stuff.
- Remember that food helps heal the mind. A starved brain isn’t functioning properly. The famous Minnesota Starvation Experiment of 1945 showed that previously healthy men who were starved came out with symptoms of depression and anxiety that they had never had before. Similarly, MRI scans of the brains of women before and after recovery from anorexia show that brain matter actually shrinks during anorexia and takes time to recover. And I’m sure this is just scratching the surface of the extremely complex relationship between food, body and mind. Feeding the body is going to feed the mind, too. Eating really is medicine.
- Stop negotiating. I see this a lot. Parents are used to their teen being smart and independent and it’s strange for a parent when I tell them to completely take over all food decisions for their child. To tell their child what to eat and when to eat it and to supervise them eating it. When their child protests, it’s easy to fall into negotiations. Their teen might spout all sorts of reasons why today they don’t need to eat that much, or maybe they just flat out refuse and hell, parents are at their wit’s end. You’re never going to get it exactly right all the time, okay? Just try to remember that you’re not really talking to your child, you’re talking to their eating disorder. And we don’t negotiate with terrorists, do we? We know from people who are recovered from an eating disorder, that having all of their food decisions taken away from them (initially) actually gave them so much relief. They say it’s the best thing that could have happened.
- Don’t attempt scientific explanations at meal times. Often they just prompt more questions, more anxiety, more arguments. The trust approach seems to work pretty well. This short video explains it but to sum up, the idea to help lessen the fear response of your child, to reduce their anxiety, by reassuring them that you know what’s best for them. It goes something like this: “Trust me. This is what you need right now. Please take a bite.” “Trust me. I know about these things. Please take a bite.” “This is safe. This is what you need. Trust me. Please take a bite.”
- When it comes to bingeing, I don’t think the amount of food really matters that much. It’s the fact they feel out of control, like they can’t stop, that matters to me. And because it’s like be a coping mechanism, I think the key for me is to think that the end goal isn’t to never binge again, but to add more tools to the toolbox to cope with whatever they’re going through.
It’s not much, but hopefully those few bullet points help.