Eating disorders in children and young people

Eating disorders are serious mental illnesses, characterised by disturbances to peoples’ relationships with food and eating. For some, this can also extend to preoccupation with movement and body size/weight/shape.

Eating disorders can be understood as a maladaptive coping mechanism. This means that they serve a function for people; an eating disorder may help someone feel safe or in control during challenging times.

Until recently, eating disorders have been rare in younger children. Unfortunately, this is no longer the case. Eating disorders have increased in children under the age of 12.

It is important to recognise that eating disorders develop through an interaction of factors – there is no one single cause.

Early warning signs of eating disorders

Some signs that a young person might have an eating disorder and that should be investigated further include:

• rapid weight loss or weight gain
• changes in shape
• body dissatisfaction - feelings of unhappiness with body shape and size, or particular body parts/areas
• an intense fear of gaining weight
• fear, avoidance or lack of interest in food and certain types of foods
• denial of being hungry
• deceptive behaviour around food – for instance, throwing out or hiding school lunches
• avoiding food and eating in social situations
• excessive physical activity
• compulsive exercising and a need to be active all the time, even when unwell or injured
• eating alone or in secret
• cutting out particular food groups, such as meat or dairy products
• developing food rituals – such as always using the same bowl, cutting food up into tiny pieces or eating very slowly
• low self-esteem, low mood, or irritability
• behavioural changes – such as social withdrawal, or not engaging in activities once enjoyed
• sleep difficulties.

Young people can become about particular foods or lose weight for lots of reasons, including other medical or physical health conditions. It is important to get any concerns checked by a health professional.

Types of eating disorders

The main types of eating disorder include:

• Anorexia nervosa – characterised by restricted eating, significant weight loos and a fear of putting on weight.
• Bulimia nervosa – periods of binge eating (often in secret), followed by attempts to compensate by excessively exercising, vomiting, or periods of strict dieting. Binge eating is often accompanied by feelings of shame and feeling a sense of being out of control.
• Binge eating disorder – characterised by recurrent periods of binge eating (including eating much more than normal, feeling uncomfortably full, eating large amounts when not physically hungry). Feelings of guilt, disgust and depression can follow binge eating episodes. Binge eating does not involve compensatory behaviours.
• Other specified feeding or eating disorder (OSFED) – feeding or eating behaviours that cause the individual distress and impairment, but do not meet criteria for the first three eating disorders.
• Avoidant Restrictive Food Intake Disorder (ARFID) – characterised by avoidance and aversion to food and eating. The restriction is NOT due to a body dissatisfaction or body image disturbance. It is the result of anxiety or phobia of food and/or eating, and a heightened sensitivity to sensory aspects of food such as texture, taste or smell, or a lack of interest in food/eating outside of low appetite.

Risk factors for eating disorders

We do not know why some older children (aged 8 years and over) develop an eating disorder and others don't. However, many factors can influence a young person to develop an unhealthy eating pattern or to become afraid of gaining weight. These factors may be psychological, social, environmental or biological.

Often, a combination of things may trigger an eating disorder in a vulnerable person. Eating disorders more commonly experienced by children and young people include ARFID and anorexia nervosa.

Psychological risk factors

Personality factors that make a person more at risk of developing an eating disorder may include:

• low self-esteem
• body dissatisfaction
• preoccupation with dieting, rigid rules around food and eating
• perfectionism
• difficulties expressing feelings, such as anger or anxiety
• sensitivity to acceptance and judgement from others, being a 'people pleaser'
• difficulties being assertive with others
• emotional changes associated with adolescence.

Social or environmental risk factors

Social or environmental risk factors in the development of an eating disorder may include:

• being teased or bullied, including appearance or weight-related bullying
• a belief that high expectations from family and others must be met
• major life changes such as transitioning to a new school, changes in friendships, family breakdown, or the accumulation of many life stressors
• peer pressure to behave in particular ways
• societal messages that promote a particular body or appearance ideal (media and advertising images, family, peers) that relate to body size, shape and weight
• a cultural tendency to judge people by their appearance.

Biological factors

Contributing biological factors may include:

• adolescence and its associated physical changes – this can be a stressful, confusing and anxious time for young people
• genetic or familial factors – for example, a family history of an eating disorder or other mental health condition.

Dieting increases the risk of developing eating disorders

Dieting is common among young people and normalised by society, but it is not a normal or healthy behaviour, and should not be considered a normal part of adolescence. Dieting is the most significant risk factor for the development of an eating disorder.

Dieting can be seen as a way of controlling changes occurring in the body, in order to attain an idealised body type that meets societal expectations of the ideal body size or shape (peers, social media messages). Young people should not be encouraged to go on a diet or engage in other weight loss behaviours.

Eating disorders and gender

Eating disorders are experienced by people of all gender identities. Eating disorders are more likely to affect females than males. However, about 25 per cent of adolescents who experience an eating disorder identify as male. Gender diverse and queer young people are also at risk of developing an eating disorder.

Young people of different genders may experience different social pressures about how they should look. Primary school-aged children are not immune to these pressures, and their attitudes and behaviours reflect adult concerns.

Parents and teachers can help prevent eating disorders

Parents, teachers and other adults can play an important role to in preventing eating disorders and promoting positive body image in children and young people.

Foster a healthy relationship with food

You can encourage older children and adolescents to develop a healthy relationship with food and eating if you:

• Avoid assigning a moral value to food. Try not to label foods as 'good' or 'bad' – this can lead to a preoccupation with foods and feelings of guilt when the 'bad' foods are eaten.
• Avoid using food as a reward, or for bribes or punishment.
• Accept that children are likely to have different eating habits from adults – for instance, adolescents may require more food more frequently during the day or may go through periods of liking or disliking particular foods.
• Avoid dieting and talking about your diet, exercise and body dissatisfaction in front of young people.
• Do not try to put your child on a diet or encourage them to restrict their food intake.
• Allow your child to eat when they are hungry and stop when they are full. Do not force your child to eat everything that is on their plate.
• Celebrate food and eating, including both the pleasure and nourishment that food brings.

Encourage young people to feel good about their bodies

There are lots of ways to help children and young people feel good about their bodies, including:

• Accept and celebrate the diversity of people’s bodies – different body shapes and sizes, including your own.
• Role model appreciation and acceptance of your body.
• Focus on how your body functions, and all the things it allows you to do.
• Demonstrate healthy eating and a positive relationship with food, and engage in physical activity for health and enjoyment.
• Don't criticise or make comments about your child’s body or appearance.
• Encourage your children to 'listen' or tune in to their bodies, and to become familiar with different physical feelings and experiences.
• Encourage sport and regular exercise that is fun/joyful, to help maintain your child's health and fitness and foster their body confidence.

Encourage self-esteem

A strong sense of identity and self-worth is important to help children and young people cope with life pressures. You can:

• Help them to develop effective coping strategies.
• Encourage them to express their needs and wants, to make decisions (and cope with the consequences) and to pursue things that they are good at.
• Teach them that it is ok to say 'no'. Encourage them to be assertive if they feel they have been mistreated.
• Help them develop a critical awareness of the societal images and messages they receive from television and social media.

Professional help for eating disorders

If your child or young person is preoccupied and unhappy with their body, seems to be developing behaviours like restricting their eating or binge eating, and/or is preoccupied with exercise, then seeking professional advice is important. See your GP (doctor) for information and support options.

Where to get help

• Your GP (doctor)
• Psychologist
• Local community health centre
• Dietitians Australia Tel. 1800 812 942
• Eating Disorders Victoria Tel. 1300 550 236
• Butterfly Foundation for Eating Disorders Tel. 1800 33 4673