Eating disorders

Worries about weight, shape and eating are common, especially among young girls.

Being very overweight or obese can cause a lot of problems, particularly with health. Quite often, someone who is overweight can lose weight simply by eating more healthily. It sounds easy, but they may need help to find a way of doing this.

A lot of young people, many of whom are not overweight in the first place, want to be thinner. They often try to lose weight by dieting or skipping meals. For some, worries about weight becomes an obsession. This can turn into a serious eating disorder. This factsheet is about the most common eating disorders – anorexia nervosa and bulimia nervosa.

• Someone with anorexia nervosa worries all the time about being fat (even if they are skinny) and eats very little. They lose a lot of weight and their periods become irregular or stop.
• Someone with bulimia nervosa also worries a lot about weight. They alternate between eating next to nothing, and then having binges when they gorge themselves. They vomit or take laxatives to control their weight.

Both of these eating disorders are more common in girls, but do occur in boys. They can happen in young people of all backgrounds and cultures.

• Weight loss or unusual weight changes.
• Periods being irregular or stopping.
• Missing meals, eating very little and avoiding ‘fattening’ foods.
• Avoiding eating in public, secret eating.
• Large amounts of food disappearing from the cupboards.
• Believing they are fat when underweight.
• Exercising excessively, often in secret.
• Becoming preoccupied with food, cooking for other people, calorie counting and setting target weights.
• Going to the bathroom or toilet immediately after meals.
• Using laxatives and vomiting to control weight or sometimes other medications/herbal remedies to lose weight.

It may be difficult for parents or teachers to tell the difference between ordinary dieting in young people and a more serious problem. If you are concerned about your child’s weight and how they are eating, consult your GP.You can also seek help and advice from other agencies.

Person with this condition can have physical and emotional problems. Some of these include:

• Feeling excessively cold.
• Headaches and dizziness.
• Changes in hair and skin.
• Tiredness and difficulty with normal activities
• Damage to health, including stunting of growth and damage to bones and internal organs.
• Loss of periods and risk of infertility.
• Anxiety and  depression.
• Poor concentration, missing school, college or work.
• Lack of confidence, withdrawal from friends.
• Dependency or over-involvement with parents, instead of developing independence.

It’s important to remember that, if allowed to continue unchecked, both anorexia and bulimia can be life-threatening conditions. Over time, they are harder to treat, and the effects become more serious.

Eating disorders are caused by a number of different things:

• Worry or stress may lead to comfort eating. This may cause worries about getting fat.
• Dieting and missing meals lead to craving for food, loss of control and over-eating.
• Anorexia or bulimia can develop as a complication of more extreme dieting, perhaps triggered by an upsetting event, such as family break-down, death or separation in the family, bullying at school or abuse.
• Sometimes, anorexia and bulimia may be a way of trying to feel in control if life feels stressful.
• More ordinary events, such as the loss of a friend, a teasing remark or school exams, may also be the trigger in a vulnerable person.

Some of the factors which increase the likelihood of having an eating disorder include:

• being female
• being previously overweight
• lacking self-esteem
• being perfectionistic.

Obsessional behaviour is often seen in young people with eating disorders.

Some people are more at risk than others. Sensitive or anxious individuals, who are having difficulty becoming independent from their families are also more at risk. Eating disorders can also run in families. The families of young people with eating disorders often find change or conflict particularly difficult, and may be unusually close or over-protective.

If you think a young person may be developing an eating disorder, don’t be afraid to ask them if they are worried about themselves. Quite often young people with eating disorders are unable to acknowledge there may be a problem, and will not want you to interfere and may become angry or upset. 

However, you may still be worried and you can seek advice from professionals in different agencies e.g. GP, Child and Adolescent Mental Health Services (CAMHS). It is important that you feel supported and not alone.

These simple suggestions are useful to help young people to maintain a healthy weight and avoid eating disorders.

• Eat regular meals  –  The British Dietetic Association recommends eating regularly throughout the day which usually means three main meals and three nutritious snacks in between such as fruit, yogurt or nuts.Too many sugary or high fat snacks should be avoided.
• Try to eat a ‘balanced’ diet – one that contains all the types of food your body needs including carbohydrate foods such as bread, rice, pasta or cereals with every meal.
• Don’t miss meals – long gaps encourage overeating.
• Take regular exercise.
• Try not to be influenced by other people skipping meals or commenting on weight.

When eating problems make family meals stressful, it is important to seek professional advice.

Your GP will be able to advise you about what specialist help is available locally and will be able to arrange a referral.  This will usually be to the local CAMHS.

If the eating disorder causes physical ill health, it is essential to get medical help quickly. 

If untreated, there is a risk of infertility. thin bones (oesteoporosis), stunted growth and even death, but if treated, most young people get better.

Two years ago it was my ‘best friend’ and now it’s my ‘enemy’ ! It no longer controls me or my family and together we’ve pushed it away. I couldn’t have done it alone. I wouldn’t have made it to uni if it wasn’t for my mum and the school nurse who convinced me to see a professional team… that took them six months! ...I was really pig-headed! I am talking about anorexia. 

It started when I was 15 and my friends and I tried the ‘south beach diet’... most of them dropped out but I stuck with it... I’ve always been competitive.

At home there was so much pressure to get ‘A’ grades; at last there was a different focus. I became obsessed with counting calories and even kept a food diary. I lost more weight but still felt huge and ‘ugly’ and wanted to lose more... my friends tried to stop me and said they were worried but I didn’t care.

Slowly, I stopped going out with them, preferring to stay in and do my sit-up regime. I thought about taking slimming pills but was too scared so I bought laxatives instead... I felt so driven to lose weight; the thought of putting on an ounce scared me to death. I remember feeling weepy and very tired. At its worst, my fingers and toes went blue!

I’m 16 now, but I think I started having a problem when I was 12. I became very worried about my weight and my body. I had put on a bit of weight and was very upset when a boy in my class called me fat. I remember feeling that even if I was doing very well in school, things weren’t quite right and I wasn’t quite good enough.

Gradually I ate less, lost masses of weight, but still believed that I was fat. Sometimes I “felt” fat and this made me feel very down. I stopped seeing most of my friends, and spent more and more time thinking about food and my body.

I was always checking the shape of my stomach and bottom – at 20 or 30 times a day, looking at them in great detail. I felt very cold at times, and found it harder and harder to find the energy to do things as I was eating less and less.

I also weighed myself at least five times a day, and if my weight had not gone down, I checked my stomach, and tried dieting even more. Sometimes I binged on cakes and chocolate. I felt very guilty afterwards and would usually be sick so that I could get rid of the food and loose some weight. It felt as if I was going round and round in circles, with no means of escape.

One of my teachers noticed that I wasn’t eating lunch and that I had become thin (or at least she thought I had). She spoke to my parents and I was taken to a clinic.

At first I didn’t want to know and I didn’t want to be helped. However, I started a treatment called Cognitive Behavioural Therapy (CBT). I learned to look at the links between my thoughts, feelings and behaviour, but more importantly, I learned that I could eat regularly - without putting on weight.

Gradually I put on some weight and worked on my checking and weighing behaviour. It wasn’t easy to get better. I slowly started to eat the foods that I used avoid. Sometimes I still find myself thinking the way I used to, but now I know I that this is only one way of thinking, one way of being, and most of the time to chose not to do this.

I love going out clubbing with my friends now and I don’t argue quite so much with my parents, well at least not about food anyway.

B-eat (beating eating disorders) - Helpline 0845 634 1414; Youth line 0845 634 7650.

YoungMinds- Provides information and advice on child mental health issue and a Parents'Helpline:0800 802 5544

King’s College London - Website with up to date information on eating and various other disorders.

Further reading

Anorexia Nervosa: a survival guide for families, friends and sufferers by Janet Treasure.

R. L Palmer, Anorexia Nervosa: A Guide for Sufferers and Their Families.

National Institute for Health and Clinical Excellence: Eating disorders: information for the public.

References

• Rutter, M. & Taylor, E. (eds) (2002) Child and Adolescent Psychiatry (4th edn). London: Blackwell.
• NICE Guideline (2004) – Core Interventions in the treatment and management of Anorexia Nervosa, Bulimia Nervosa and related eating disorders.

Credits

Revised by the Royal College of Psychiatrists’ Child and Family Public Engagement Editorial Board (CAFPEB).

With grateful thanks to Dr Virginia Davies, Dr Vasu Balaguru, and Thomas Kennedy.

This resource reflects the best possible evidence at the time of writing.