For some children and young adults, it is not the lesson times that cause most anxiety at school, but the lunch. When your child has an eating disorder, learning comes second place to battling with food.
An eating disorder occurs when you have an unhealthy relationship or behaviours concerning food. It is a mental health condition which develops round food to cope with difficult feelings or issues and can lead to life-threatening consequences. It may involve eating too little, too much or avoiding eating certain foods. Eating disorders affect men and women of any age but are most common in girls between 13 and 17. There is recent evidence to show the number of younger children (8-12s) with anorexia is on the rise too. A quarter of people with eating disorders are male.
Signs of eating disorders
- Eating very little
- Having strict routines with food
- Disproportionate worry about weight or shape.
- Avoiding socialising when food is involved.
- Deliberately making yourself sick or taking laxatives.
- Excessive exercise.
- Mood swings.
- Physical signs, including feeling cold, tired or dizzy, problems with digestion, abnormal weight to height ratio, girls not getting periods.
- Associated mental health problems including anxiety and depression.
Anorexia, Bulimia, Binge-Eating Disorder
Anorexia, the most well-known eating disorder, is when a young person tries to keep their weight as low as possible by eating less than they need or by exercising excessively, so beginning a process of starvation. A person with Bulimia binge eats, then tries to purge themselves of food by taking laxatives or vomiting, to keep weight low. Binge eating disorder involves regularly eating a lot of food over a short period of time. It is usually planned in advance, may involve particular foods and tends to start in late teens or early twenties.
Other specified feeding or eating disorder (OSFED), when the symptoms don’t align with any particular disorder or may be a combination of them, is the most common type.
Avoidant or restrictive food intake disorder (ARFID)
Avoidant or restrictive food intake disorder is when someone avoids certain foods and/or limits how much they eat. This can co-occur with autism. Children with Arfid never seem hungry and go long periods without eating. They are highly anxious around food and unable to join in mealtimes. They display heightened sensory issues about food, e.g. Their diet may consist of only eating one type or flavour of food. Most children go through a neophobic stage (the disgust response), but grow out of it by the age of three, or five at the latest. But children with autism can get stuck at this stage because they struggle with categorisation, such as understanding that the same fruit can have different patterns of markings or colour. Others will have a restricted diet – they may be unwilling to eat foods because they have a stringy or slimy texture and will gag if they are pushed to eat them.
Samantha Wallis’s daughter Evelyn rejected and vomited food even as a baby, and was diagnosed with failure to thrive ‘which is an absolute insult’. ‘Eating was always a problem if you couldn’t find a McVitie’s Rich Tea biscuit, and it couldn’t be broken or chipped, or she would tell you “It’s disgusting” and go hungry.’
She sought treatment from Dr Gillian Harris and Dr Elizabeth Shea at the Birmingham Food Refusal Service. Children with these conditions prefer processed and branded food because it offers uniformity and takes away that fear of contamination. There is no point getting hung up about food you consider to be healthy, in the face of a child who will simply otherwise not eat at all, says Wallis.
‘One of the few things Evelyn will eat is fish fingers; but when catering staff at school dropped carrots onto them, she then refused to eat them’, said Wallis with exasperation. ‘I had to write a letter to the school to give parental permission for them to stop giving her carrots.’ It’s essential to get school on board, and to achieve this parents usually need a specialist diagnosis and to liaise with the school SENco.
Pressure around food is the biggest no-no among these families. ‘As a parent’s anxiety goes up, it increases food refusal. If you fuss, bribe, coerce, it increases the problem,’ Harris says.
Treatments for Eating Disorders
Eating disorders are manageable and there is a good chance of recovery if caught early on. For many young people the treatment includes:
- Family Therapy
- Cognitive Behavioural Therapy (CBT), with a therapist who supports the child to adopt regular eating habits
- Medication such as antidepressants.
- Emotional based interventions and sensory play therapy
How schools can help with eating disorders
Schools are ideally placed to spot the signs of an eating disorder in a child or young person, and BEAT, the eating disorder charity offers informative training for primary and secondary schools to help staff and students spot the signs. PSHE lessons accommodate the courses.
Decrease the pressure around exam time
We know that exams can be a huge trigger point for eating disorders among young people so its important not to put unnecessary pressure on a child, especially around exams. The SENco can put exam concessions in place, e.g. re-scheduling the time or place of an exam for an individual with an eating disorder – and to reiterate that they’re not the be-all-and-end-all and that they can only do the best they can.
Wellbeing Practice and Policies
Bullying is a risk factor for an eating disorder, whether it is directly about size or shape or about something unconnected. Robust health and wellbeing policies in school, followed up with preventative practices and curricular topics in PSHE is vital, as well as liaison with health services.
Moving from school to college is a time of particular vulnerability for a student, who may become anxious with an unfamiliar setting, increased academic pressures and social isolation. New friends may not pick up on the signs and family members are not there to help. Advance liaison between Senco and college can anticipate the student’s anxiety and ease transition.
How parents can help with eating disorders
‘It’s important for families to be aware that eating disorders are serious mental illnesses, for which there isn’t one sole cause,’ says Rebecca Field, spokesperson for the eating disorder charity, Beat. ‘In fact, we know that there are more biological and genetically based reasons than we ever thought there were, so if it does happen it doesn’t mean it’s your fault.’
Stop conversations about weight and dieting. ‘Eating disorders aren’t things you can catch or that come about as a result of copying others but it is helpful to talk about dieting and weight as little as possible with or around your child if you want them to have a healthy attitude towards eating,’ says Field. ‘We advocate celebrating people not for their weight, shape or what their physicality is like – but by things like how kind or funny they are and how they treat their friends.’
Consider your attitude towards your own body. If you constantly self-judge your own body – criticising it at every turn – then is it any wonder if your children start doing the same about themselves? Try to develop a healthier relationship with your own body, so you don’t perpetuate feelings of bodies not being good enough onto them.
Eat together as a family. A study of over 13,000 pre-adolescents and adolescents found that having family dinners most days decreased the risk of eating disorders. Shared family mealtimes give parents a chance to be role models for healthy eating, to monitor their child’s food intake and to talk about food in a healthy context.
Ensure you have good eating habits. It’s not just at mealtimes when you can be a good role model around eating. If you snack on fruit and carrots, they will be more likely to as well. If you constantly go for chocolate and then talk about feeling guilty, there’s a chance that they will also mirror that. Try to change to protect your child – and you will benefit from your increased health too.
Encourage healthy exercise. Adolescents who are encouraged by parents to exercise have been shown to be happier with their bodies. ‘Given that exercise is one of the best ways to cope with mental health difficulties, it makes sense for parents to get children outside and playing in the garden or nearby parks in a healthy, non-obsessive way to grow up as healthy young people,’ says Field. But be aware that excessive or compulsive exercise can be a sign of an eating disorder.
Help your child to feel positive about their body. For teenagers, this isn’t always easy. Study after study shows that many adolescent girls, as well as boys, dislike their shape. Certainly never tease teenagers about weight. Studies show up to 40 per cent of girls are teased and this doubles the risk of being overweight and increases the risk of unhealthy dieting. Even commenting on their weight can make them feel bad – if you decide your child needs to lose a bit of weight, put the whole family on a healthy eating and living programme.
Educate your child about the media. ‘There is a body ideal that is portrayed in the media and if young people don’t meet that ideal, it is easy for their self-worth to be reduced,’ says Field. ‘We work hard to promote the fact that the should be a range of body sizes – parents should do the same, as well as talk about how people with bodies that meet the body ideal aren’t any happier.’
If your child is looking at magazines, she adds, talk to them about how those images might be altered with make-up and lighting ‘and clever things that take place after the photo is taken.’ ‘Bottom line is quite often, these photos aren’t real.’
Beat offers support services including that is open 365 days a year, and online message boards and peer support groups. The helpline is available for questions or worries of any kind, from parents as well as sufferers. You can also find information about eating disorders and autism on the Beat website and a directory of services offering treatment on the HelpFinder.