A psychologist’s ultimate guide to eating disorders – how parents can spot the subtle signs & what they can do to help
IN the UK, thousands of teens are being diagnosed with an eating disorder every year.
In fact, it’s estimated that overall, there are 1.25million adults and children living with an eating disorder, which may include anorexia, bulimia, or AFRID.
AFRID – avoidant restrictive food intake disorder – is the eating disorder highlighted by charity BEAT during this year’s Eating Disorder Awareness week. It can be mistaken for fussy eating.
Statistics over the past few years have shown an increase in the number of people with eating disorders, including those who are young.
In 2023, eating disorders were identified in one in eight (12.5 per cent) of 17 to 19 year olds, according to The Mental Health of Children and Young People in England 2023 repor – an increase from 0.8 per cent in 2017.
Rates were four times higher in young women (20.8 per cent) than young men (5.1 per cent).
Eating disorders were identified in 2.6 per cent of 11 to 16-year-olds, compared with 0.5 per cent in 2017, and 5.9 per cent of 20 to 25-year-olds.
In a bid to help young people, the NHS invested an extra £79million into children’s mental health services in 2022, with funding being used to ensure at least 2,000 more children and young people start eating disorder treatment.
Dr Joanna Silver, a psychologist from the specialist eating disorder clinic Orri, tells Sun Health: “Whilst all eating disorders look like they’re about food, they’re actually about feelings and a way of managing feelings.”
Dr Silver shares her simple tips to help protect your child from developing an eating disorder and develop a healthy attitude towards food and body image.
1. Encourage healthy eating habits
Children can copy the behaviour of their parents.
Therefore, Dr Silver warns of the influence you may have on your child’s perception of body shapes and diet.
“You need to be a role model in terms of showing them how you know how to care for your body,” says Dr Silver.
“It’s important to be eating normally and not to be talking about diets or foods in front of children.”
She adds that it can help to encourage an understanding of hunger cues and intuitive eating.
Rather than forcing children to eat everything on their plate, let them stop when they’re full; this helps children to listen to their feelings of satiety.
As well as eating habits, try to also practise healthy exercise habits.
Move in a way you enjoy while also ensuring you take time to recover and rest.
2. Body talk
If you’re speaking poorly about your figure, then children will likely catch on and may see it as normal, perhaps even echoing how you speak.
Dr Silver says: “As parents or guardians, it’s really important to think about your relationship to your body and to not disrespect it in front of your children because that is giving them an example.
People can end up following those who are very preoccupied with their body and then compare and despair and judge themselves negatively
Dr Joanna Silver
“Think about the general conversations you have in your household about people you know, and the undertones of these conversations.
“Are you and the family talking about people and ‘the little bit of weight they’ve put on’? Think about the message that’s giving the children.”
3. Food is food
Dr Silver also adds that children’s weight will likely fluctuate as they grow up.
This is normal, however, and shouldn’t be made into an issue.
Dr Silver says: “I try not to comment too much on their eating and to see food as being food.”
It’s also best to not label foods as ‘good’ or ‘bad’.
“That’s sending very negative messages and is likely to be detrimental,” says Dr Silver.
4. Social media check
Whilst social media has its uses, for teens, it can often be problematic.
As Dr Silver explains: “It’s really important not to demonise social media.
“There are some really good pro-recovery sites out there that can be very helpful for people who are recovering from an eating disorder.
“However, the problem with social media is it’s not regulated. Anyone can post on social media.
“And people can end up following people who are very preoccupied with their body and then compare and despair and judge themselves negatively against these people on social media.”
Most social media apps including Instagram and TikTok have a minimum age requirement of 13, and these are there for a reason.
Dr Silver recommends setting boundaries and inviting your teenager to share with you what content they are looking at.
A person’s ‘explore’ page on their Instagram indicates the type of media they are consuming because it is based on algorithms.
Dr Silver says: “Talk to them about the dangers of social media and monitor what they’re looking at.
“Think about the role models that they’re looking at.”
5. Classroom influence
Children and teens can be heavily influenced by the people they spend time with at school.
As a parent, you may be unaware of who exactly they’re with, or the potential eating disorder struggles their friends may be experiencing.
While you can control how you talk about bodies, eating and health in the home, you cannot control the voices of those in the classroom.
Dr Silver says it’s really important to keep the channels of communication as open as possible within the family.
She adds that it’s vital to educate children that eating disorders are a mental health illness.
Dr Silver says: “They’re not a choice; that person is struggling in some way. It’s their way of managing their feelings.
“Explain to the young person that it is not their responsibility to help the person.
“They may need professional help and they should not take everything on.”
6. Hurtful comments
Whether it’s on the cover of a magazine – or more typically in modern times, a comment on social media – body shaming is rife.
Dr Silver says: “The amount of people I see who have had eating disorders or disordered eating who have had comments made about them or been bullied for their appearance or their size… the impact is huge.
“It sends the child a message that the way that they look is wrong and they need to fix it, and it can really, really hurt.”
Dr Silver recommends teaching your child compassion from an early age and ensuring that body shaming within the family is unacceptable, even between siblings.
“We are all different shapes and sizes and we need to be accepting and have empathy,” she says.
Signs to look out for
Dr Silver says that one of the signs that an eating disorder may be developing is if a child’s weight changes rapidly.
“If a child has always been a normal weight, and then they quite quickly lose weight, that could be a sign that they are altering their food in some way,” she says.
Another sign could be making several trips to the bathroom during or after a meal, which could signal vomiting.
Don’t think that they’ll just ‘grow out of it’ and leave it too long because the longer someone has an eating disorder, the more entrenched it can become
Dr Joanna Silver
Alarm bells may ring if your child is increasing their exercise and exercising in a very ritualistic way, not just for enjoyment, Dr Silver says.
She adds: “Often people who are developing or have eating disorders are almost obsessed with food.
“They may be cooking a lot or watching a lot of cookery programmes.
“They may seem more irritable or more withdrawn or perhaps not going out with their friends as much or not communicating as much.
“Your child might say that they’re not hungry or they might start talking about foods as being good and bad.
“They might also be saying that they feel fat, hiding their body in baggier clothes.”
Noticing changes?
If you’re worried that your child is developing an eating disorder, it’s never too early to act.
Dr Silver says: “Don’t think that they’ll just ‘grow out of it’ and leave it too long.
“Because the longer someone has an eating disorder, the more entrenched it can become.”
Timing is everything when broaching such a topic with your child. Bringing up the conversation before or after a meal won’t be helpful.
Dr Silver adds: “Do it in a non-judgmental way.
“Don’t accuse them of having an eating disorder, but perhaps say, ‘You just don’t seem yourself at the moment’, or ‘it seems like something is bothering you, I’m here if you want to talk about it’.
“It may not be one conversation; it may be something that might not go well the first time and then you come back to it at another point.”
For more information on eating disorders, visit the Beat charity website.
The six main eating disorders
Dr Silver shares some of the main eating disorders and their common symptoms.
Anorexia nervosa
Typically, anorexia nervosa involves restrictive eating which is due to an irrational fear of gaining weight.
An anorexia sufferer may also have a distorted body image, exercise to excess and go through cycles of bingeing and purging.
Purging can involve vomiting, laxative overuse, excessive exercise or fasting.
Signs of anorexia include calorie counting, anxiety around food, food ‘rituals’ such as cutting food into small pieces, eating slowly or eating foods in a set order.
They may also suffer from insomnia and low self-esteem.
Bulimia nervosa
Someone who is bulimic tends to eat extremely large amounts of food in a process called bingeing, before purging it from their system.
This can be in the form of self-induced vomiting, laxatives, excessive exercise or going for long periods without food.
Often, bulimics are a normal weight. They may eat secretly or alone, they may have OCD or other mental health issues such as depression and they may have low self-esteem.
Binge eating disorder
Bingeing is similar to bulimia in the sense that it involves bingeing on large amounts of food, often in a hurry and in secret. But it isn’t followed by purging.
A binge often involves feeling out of control.
ARFID
Avoidant restrictive food intake disorders involves restrictions around certain types or amounts of food, often due to a dislike of a specific taste or smell or even appearance.
The difference with AFRID is that it doesn’t typically involve insecurities around body image.
AFRID may be triggered because someone had a particularly bad experience – such as choking – while eating.
Orthorexia
Obsessive behaviour towards food in the pursuit of a ‘healthy’ diet is known as orthorexia.
This can often cause someone to only eat ‘clean’ foods, and they may often label foods as ‘good’ or ‘bad’, restricting certain foods from the diet.
Obvious signs can include an excessive amount of time planning meals, guilt after eating particular foods, an obsession with food social media profiles as well as the food choices of others and even missing social events if healthy food options are lacking.
OSFED
The highest percentage of eating disorders are OSFED – other specified feeding/eating disorder.
A person may be diagnosed with OSFED when they don’t fit into any of the disorders described above, based on the expected behavioural, psychological and physical symptoms.
However, they have disordered eating which needs treatment.
Examples include someone who has symptoms of an eating disorder, such as anorexia, but their weight is considered normal.