Food for thought

With the frenzy surrounding Jamie’s School Dinners and the subsequent preoccupation with young people’s weight and fast-food habits, it seems we have all become obsessed with childhood obesity. But while obesity is an undeniable problem, eating disorders such as anorexia nervosa, bulimia, compulsive eating and selective food refusal continue to blight other children’s lives.

According to Hubert Lacey, professor of psychiatry at the university of London and director of the St George’s Eating Disorders Service, society is rightly concerned about children who are overweight and “tends to ignore the dangers of slimming”.

Yet those dangers are worryingly widespread. The Eating Disorders Association estimates the combined total of people diagnosed and undiagnosed with an eating disorder in the UK is around 1.15 million.

Anorexia and bulimia are most common among girls and are closely associated with puberty. As the average age of puberty drops, so does that of children suffering from eating disorders.

Research conducted by ChildLine in 2002 found that three quarters of calls to the helpline about eating disorders came from children aged between 13 and 16, with some younger children also reporting concerns about their weight. A study by the British Journal of Developmental Psychology, which interviewed 80 children aged between five and eight, found that 47% wanted to be slimmer, with most believing this would make them more popular.

The causes of an eating disorder are seldom simple. Ubiquitous images of skinny, glamorous models may give the impression that thin equals happy, but media influence is only part of the story. Low self-esteem is a common factor, as is stress caused by family problems, bullying and peer pressure. Taking control of food consumption can be a kind of coping mechanism – an attempt to gain control which spirals into a serious problem. Abuse can also be a cause. “In these cases, the child will wish to disappear, to slip away from view rather than being the controller,” explains Steve Bloomfield, director of communications at the Ellern Mede Centre, which treats 8- to 17-year-olds with eating disorders.

Nor is it only girls who are affected. One in 10 sufferers is male and this figure may be rising, perhaps due again to the increasing number of “perfect” male bodies in the media. Boys are more likely to develop a problem in their later teens and anorexia is difficult to diagnose: over exercising and developing muscle is more common among boys, making them look fit and meaning it takes longer for the body to look conventionally anorexic. Boys are also less likely to go to the doctor.

Eating disorders can have a destructive impact on family and friends – the sufferer’s natural support network. But, according to Bloomfield, recovery comes through communication, which is closely associated with confidentiality.

“It’s always advisable to go to the GP,” Broomfield says, “but a child might fear their doctor is also that of their parents. School nurses and practice nurses therefore play an important role.”

Helplines, text and email support services are available, and some self-help groups operate nationwide. Many sufferers require more professional help, though, and Lacey suggests that family-based treatments, particularly in outpatients, have been shown to be effective. However, he adds that patients at low weight often require inpatient treatment. Unfortunately, though, the availability of treatment on the NHS varies widely across the country.

Nor are there any quick-fixes. Recovery time is between five and six years, though it can be longer. The disorder can also recur, if triggered by great stress later in life, such as divorce or bereavement. There are similarities to addictions in this regard – sufferers may never be “cured” but they can recover. Of those children who do not receive treatment, one in five will die prematurely. Those who get help should recover to live a normal life.

“It’s not about vanity – it’s a form of control”

Gemma Oaten developed an eating disorder aged 11. Now 21, and after a long struggle, she is positive about recovery.

“I never worried about my weight when I was younger. I’d been close friends with the lads at school. But then suddenly they were looking at me differently and there was jealousy from girls. I was a high achiever and people would pick on me – calling me a slag.

“I couldn’t control people’s opinions but I could control my food. I felt under pressure to achieve and it was a way to escape. When my periods stopped it felt like I was a child again and that’s what I wanted… Anorexia crept up on me.

“When I first went to the doctor’s they said ‘you’re not underweight enough yet for it to be a problem’. But you don’t have to be thin to have an eating disorder. So I decided to make sure I lost enough to get help.

“Anorexia takes over everything. I went to an adolescent unit, but it treated people with all sorts of different problems. They didn’t have a clue how to help so my parents took me out of there.
“At 15 I got back to a normal weight but still felt uncomfortable. I got a stomach bug and around that time I became bulimic. It gave me a sense of release from my anger. I was in and out of hospital with low potassium and fainting. It was frightening.

“I’m doing well now. I have difficult times but I have the power not to let it beat me. I can’t imagine how I would have managed without my fantastic family. They’ve had to fight to get me help – it’s such a battle and you need funding.

“I see a psychotherapist regularly and that’s a big factor. I finally have some consistency – I trust her and she’s there for me. But there’s still so many who aren’t getting help. It’s not about vanity, it’s nothing to do with that. It’s a form of control.”

Warning signs

  • A preoccupation with calories and fat grams
  •  Frequent weighing
  •  Food rituals (eating foods in sequence, not letting certain foods touch each other; cutting food up very small)
  •  Avoiding eating in public
     A preoccupation with food
  •  Excessive exercise
  •  Disappearing to the bathroom after a meal
  •  Evidence of use of laxatives, diuretics or vomiting
  •  Wearing baggy clothes
  •  Irregular or no periods
  •  A distorted perception of their own appearance and body weight

    What can help

  • Accepting that change must come from the young person and cannot be forced.
  • Anticipating some level of denial – eating disorders can be comparable to addictions in this regard.
  • Giving the young person a chance to talk and explain their point of view.
  • Encouraging the young person to seek professional help.
  • Being consistent; parents especially should try to agree on a strategy and stick to it.

    What does not help

  • Offering bribes or rewards to make the child change eating behaviours.
  • Making threats and being confrontational.
  • Ignoring the problem in the hope it will go away without help.

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