Although it is most common for eating disorders to develop during adolescence, children under the age of 12 can also be affected and cases seem to be rising.

There is no single identifiable cause for eating disorders in children. Research suggests that genetic heritability may increase risk, particularly if eating disorders have been identified in other family members. Other risk factors include being diagnosed with autism, type 1 diabetes, chronic health conditions and other mental health challenges such as depression and anxiety.

Eating disorders are particularly dangerous in young children as they can escalate quickly and stunt growth and development. They can be difficult to diagnose as children’s body weight and nutrition requirements vary as they experience growth spurts.

More common eating disorders in children

• Avoidant Restrictive Food Intake Disorder (ARFID)
• Anorexia Nervosa
• Pica

Preventative measures

Children are influenced by parents and teachers, who play an important role in modelling healthy and balanced attitudes towards food, exercise and body image. Some important guidelines for parents and teachers include:

• Try not to label foods as ‘good’ or ‘bad’ as this may lead to feelings of guilt and shame when ‘bad’ foods are eaten
• Avoid using food as bribes, punishment or rewards
• Avoid promoting unrealistic or perfectionist ideals in terms of your child’s behaviour, grades and achievements, and instead encourage self-acceptance
• Encourage children to celebrate diversity, and not place too much value on physical appearance as a measure of value
• Accept that children are likely to have different eating habits from adults — they may require food more frequently during the day or go through periods of liking or disliking particular foods
• Children learn by example — don’t skip meals, participate in fad diets or enforce diets upon children
• Encourage your child to express their feelings freely and encourage open communication in the home
• Allow your child to eat when they are hungry and stop when they are full — don’t force them to eat everything on their plate
• Model acceptance of different body shapes and sizes, including your own
• Don’t criticise or tease children about their appearance, or make comparisons to another child’s appearance
• Encourage sport and regular exercise to foster their body confidence. Model a healthy lifestyle yourself by participating in regular exercise for enjoyment and fitness
• Reassure your child that it is normal and healthy to gain weight at the onset of puberty and throughout adolescence

While eating disorders can affect people of all ages and backgrounds, the average age of onset for anorexia nervosa, bulimia nervosa, and disordered eating takes place during adolescence.

We know that there is no one reason for an eating disorder to develop, the evidence is clear — adolescents are the most at-risk group of people in developing an eating disorders. This can be due to a number of factors:

Physical change — adolescence is a time of intense change, which can bring with it a great deal of stress, confusion and anxiety for many. The physical transformation that takes place during this time is enormous and often intertwined with feelings of self-consciousness, low self-esteem and comparison with peers. In addition there are hormonal and brain changes taking place that affect a person physically, mentally, emotionally and psychologically.

Social and environmental change —the period of early adolescence is often the time when a person will change schools, friendship groups and perhaps develop an interest in romantic and sexual relationships. In addition, body image concerns and peer pressure are heightened during the period of adolescence, and are potential risk factors in the development of an eating disorder.

Emotional change — it is little surprise that an individual may struggle to deal with the whirlwind of change that accompanies adolescence. Eating disorder behaviours are often a coping mechanism for people to attempt to gain control of their situation when they feel helpless or out of control. Unfortunately, this battle for control ends up backfiring, as an individual becomes subject to the destructive needs of an eating disorder.

Other risk factors

Dieting

Dieting is the highest risk factor for triggering an eating disorder, with severe dieters 18 times more likely to develop an eating disorder than those who don’t diet at all. It is often during adolescence that young people become aware of the concept of dieting, often through parents, peers and the images set by the media which correlate thinness with beauty and popularity.

Dieting is often viewed as a way of controlling changes that are occurring in the body, in order to attain a certain idealised body shape or weight as set out by peers and/or the media. Competitive dieting is a particularly dangerous phenomenon which is most often seen in adolescents and high school environments.

Body image

Adolescence is often the time when a person becomes aware of their body — particularly in light of the changes that are taking place. Research suggests that the last couple of years before adolescence is a crucial period in establishing a person’s body image, when many young people are particularly vulnerable to developing idealised views of body image.

Body dissatisfaction (also called negative body image) often results when an individual compares their own body to that of their peers or to an idealised image of a ‘perfect’ body type, and can result in an inherent sense of low self-esteem.

Self-esteem

Although no one eating disorder is the same as the next, there appears to be one underlying factor across many eating disorders: low self-esteem. We do not fully understand all the factors underlying low self-esteem. Some studies have indicated that some children are born with low self-esteem; other studies point to psychological and external causes.

What we do know is that self-esteem problems occur in many normal young adolescents.  Adolescence is a period of great change, with associated insecurities and uncertainties and self-esteem can be vulnerable as a result.

External pressure

During adolescence, it is quite common for individuals to feel a great deal of pressure from external sources to act according to an idealised set of criteria. Common across most teenagers is the pressure to ‘succeed’ in the way of high grades, sporting achievements and popularity, and these pressures are often applied from parents, teachers, coaches and peers. There is also the added pressure to look a certain way, even if it goes against how you feel internally.

One of the primary risk factors in the development of an eating disorder is the desire to ‘gain control’ of certain aspects of a person’s life; therefore it is quite understandable that adolescents are highly susceptible to developing an eating disorder in light of the unrealistic expectations they are striving towards.

Dangers for adolescents

Because the period of adolescence is one of rapid growth and development, eating disorders are particularly dangerous for this age group as nutrition deficiency and malnutrition can interfere with crucial developments.

Severe malnutrition that result from anorexia nervosa — and bulimia nervosa to a lesser degree — affects all body tissues and organs, which can interfere with the development of brain and bone tissue of adolescents. In most cases this damage can be overcome when most people make a full recovery; however, the damage to some organs, including brain development, bone density and teeth may or may not be totally restored following replenished nourishment. The short and long term consequences of an eating disorder on an adolescent will be dependent upon the length, severity and age of onset of the eating disorder.

Adolescents with chronic diseases, as well as those in competitive sports and dance, are especially vulnerable to the development and dangers associated with eating disorders.

Early intervention is key in preventing long term impacts on adolescents, and it is important to seek professional help for the best chance of full recovery.

Despite the stereotype that eating disorders only affect adolescents and young women, the truth is that an eating disorder is a serious mental illness that can affect people of any gender, age or ethnic background.

Often stressful events that occur in midlife serve as potential triggers in the development of an eating disorder. These events may cause a relapse in some, while others may be experience eating disorder symptoms for the first time. Midlife eating disorders can have an effect on parenting, work capabilities and personal relationships, and can be accompanied by negative emotions, such as low self-esteem, depression and anxiety.

People who experience an eating disorder during midlife are at greater risk of developing serious issues with their gastrointestinal and musculoskeletal system. As such, it is important to seek professional help as soon as possible. The physical consequences that result from an eating disorder, such as malnutrition and nutrient deficiency, are particularly dangerous for older people as their bodies cannot sustain the same levels of physical strain as they could when they were younger. Older people are more at risk of developing or experiencing diabetes and osteoporosis, conditions which can be severely exacerbated by an eating disorder.

Risk factors

The common risk factors for the development of an eating disorder, such as a perfectionistic personality type, low self-esteem, external stress and a desire to gain control over certain aspects of life are prevalent for people of all ages.

There are also some unique life stressors that occur in midlife and are potential risk factors for the development or recurrence of an eating disorder:

• A loss or trauma such as the death of a loved one, a relationship ending, divorce or life-threatening disease
• Increased stress associated with caring for ageing parents as well as children and possibly grandchildren
• Menopause
• Heightened body dissatisfaction resulting from the ageing process when the body’s metabolism slows, wrinkles appear and hair turns grey. This can leave people feeling self-conscious as their appearance naturally moves away from western ideals of beauty, such as slimness and youth
• Lifestyle changes that can lead to weight gain and body dissatisfaction. These may include less regular exercise (sometimes due to physical health problems) or a change in diet (e.g. eating at restaurants more frequently or consuming more pre-prepared meals)
• Changes in family structure. Many parents feel lonely when their children leave home, or as their own parents age
• Stress associated with financing retirement
• A loss of identity as people exit the workforce and enter retirement, resulting in feelings of low self-esteem, boredom and worthlessness

Disordered eating in older adults

Many older adults experience problems with eating which may be classified as ‘disordered eating’ or ‘eating distress’. It is not uncommon for older people to experience a loss in appetite due to physical health concerns. If this occurs without psychological factors such as a pursuit of thinness, avoidance of normal weight or body image distortion, it is unlikely to be classified as an eating disorder. Below are a few reasons why a decrease in appetite may occur:

• An undiscovered illness or infection can cause loss of appetite — reflux, gastrointestinal problems
• Some medications cause loss of appetite, others cause stomach upset or pain that discourages eating
• Poor dental health and missing teeth make it difficult to eat; similarly, poorly fitting dentures may cause pain and difficulty with eating
• Poor memory may lead to confusion over whether one has eaten and result in missed meals
• Lack of energy and/or motivation for grocery shopping and food preparation can discourage eating
• Financial stress may limit a person’s ability to buy adequate amounts of nutritious food
• Depression is often associated with decreased appetite, as are associated feelings of loneliness and lack of meaningful connections with other people

Although some decrease in appetite is a normal part of the aging process, it is important to identify and treat any issues as there are many physical, mental and emotional consequences of malnutrition in the elderly. Please consult your GP if you are concerned.

Pregnancy and parenthood are wonderful and challenging times for women; physically, emotionally and psychologically. A pregnant person’s wellbeing and nutrition is critical. If nutrition is not sufficient, both the baby and pregnant person can be adversely affected.

Pregnancy can also be a stressful time and can place a lot of pressure on someone who already has mental health concerns. If you have an eating disorder and become pregnant, it is very important to seek support as soon as possible for the benefit of yourself and your baby.

Before becoming pregnant

Eating disorders, particularly anorexia, affect fertility by reducing your chances of conceiving. Many people with anorexia or bulimia have irregular or absent menstrual cycles. If you are planning pregnancy, it is highly recommended that you get your eating disorder under control or in remission before falling pregnant. Try to eat balanced meals and maintain a healthy weight for several months before becoming pregnant. Take important supplements such as folate for at least one month before falling pregnant, and during the first three months of your pregnancy.

Risks of eating disorders in pregnancy

Risks for the birthing person

• Malnutrition dehydration and possible cardiac irregularities (particularly with bulimia)
• Taking longer to heal from caesarean, episiotomy or tearing
• High blood pressure and gestational diabetes (particularly with binge eating disorder)
• Depression during or after pregnancy
• Anaemia
• Increased risk of miscarriage

Risks for the baby

• Malnutrition
• Premature birth
• Low birth weight (particularly with anorexia)
• High birth weight (particularly with binge eating disorder)
• Poor development
• Feeding difficulties
• Respiratory distress

Managing your health during pregnancy

It is relatively common for people with eating disorders to be able to manage their eating disorder while they are pregnant, but relapse after their baby is born. Others find the changes to their body during pregnancy very distressing, and struggle with their inability to fully control their eating and weight gain. Food aversions or cravings can also be troublesome if you have an eating disorder.

It is extremely important that you are upfront with your health provider about your eating disorder, and that they fully understand your situation and treat you with sensitivity and care. Your pregnancy may be classed as ‘high risk’ and you may be monitored very carefully to manage your health and that of your baby.

Consider a team approach to your pregnancy — an obstetrician/gynaecologist, mental health professional and a nutritionist or dietitian. A mental health professional or counsellor can help with any concerns you may have around weight gain, body image, food and becoming a parent. A dietitian can inform you about nutritional requirements for yourself and your baby during pregnancy, and help you with appropriate meal plans.

Tips during pregnancy

• If you find yourself worried by your weight gain during your checkups, stand backwards on the scales and ask your health provider not to share the number.
• When you are pregnant, it seems that everyone you know (and many you don’t!) feel it’s OK to comment on your body. Don’t dwell on their comments, even if they are insensitive.
• In some cases, pregnancy may trigger binge eating. Make sure your food intake is healthy in quality and quantity.
• If you are taking anti-depressants for your eating disorder, make sure your health provider knows you are pregnant so your medication is appropriate.
• Remember your weight gain is caused by a growing baby.
• Avoid social media content or magazines with unrealistic post-pregnancy weight loss stories.

After your baby is born

It is important to seek support after your baby has been born. Parenting a baby requires a great deal of time and energy, which will be affected if you are giving time and energy to your eating disorder.

Remember to look after yourself, as well as your baby. Many women with eating disorders are affected by postnatal depression, and it is very important to seek help if you are feeling vulnerable.

There is an immense societal pressure on birthing people to lose their pregnancy weight as quickly as possible after their baby has been born. Many people feel the need to start exercising excessively and dieting immediately, and this can trigger old eating disorder behaviours.

Try to take the time to enjoy your baby without focusing on your weight or body shape. Just as your body changes as you grow older, it will change after pregnancy. Be proud of what your body has done, not just what it looks like.

Breastfeeding

Many people with eating disorders are not sure if they are able to breastfeed. There is no reason you can’t breastfeed; in fact, breastfeeding provides your baby with the best start in life. If you are able to breastfeed, remember that it is normal to need more food while you are breastfeeding. Restricting your calorie intake while breastfeeding can affect the quantity and quality of your breastmilk.

If you choose not to breastfeed, don’t feel guilty. Your baby is loved and cherished, no matter what feeding method you choose. If you are able to get your eating disorder under control, you are more likely to have a normal, healthy pregnancy and a healthy baby.

EDV’s education team offer a range of training opportunities for professionals who work with high risk groups for eating disorders.

Please visit our education page to find out more.