| Q: |
I’m worried my child might be developing eating difficulties. Is there anything I can do?
| | A: |
Parents may feel alarmed by the dangers of eating difficulties
and disorders, and feel powerless to prevent them from happening, as
parental influence and control diminishes in the teenage years. However,
there are many simple and sensible steps you can take to support your
teenager’s healthy eating and perception of her weight and size.
Establishing regular
mealtimes and a requirement that your daughter eat at least one meal a
day with the family promotes both healthy eating and the opportunity to
communicate as a family. Try to make mealtimes enjoyable occasions where
you talk about interesting, amusing things in a relaxed atmosphere. If
you have to admonish her for some misdemeanor, don’t do it at the dinner
table; find another time to speak to her alone. If she appears
uncomfortable or anxious at meal times, ask her about it later, not in
front of the rest of the family. She may say she is concerned about
homework or a friend, but it may be related to eating.
Encourage your
daughter’s involvement in choosing and preparing meals for herself and
the rest of the family, if possible. Give her some freedom to choose
what she eats, help her with a healthy diet, and share your knowledge
about nutrition. She may choose to be a vegetarian, or to eat different
food from the rest of the family. This need not be a problem, as long as
she helps a little in the preparation and is having a balanced intake.
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| Q: |
What are the warning signs I should look out for?
| | A: |
Warning signs can be loss (or excessive gain) of weight, or
certain behaviors such as cutting her food up into tiny pieces, avoiding
mealtimes, or rushing through her food and leaving the table to go to
the bathroom, possibly to vomit. If she is unhappy or anxious about
food, has stopped mixing with her friends, has not had a period
recently, or has dry skin, hair loss, or itchiness and rashes, seek
professional help. It is better to get help early than try and cope on
your own. The earlier you start therapy, the more likely it is to be
successful. Your health-care provider can direct you to the most
appropriate service in your area. If your daughter would prefer not to
involve her doctor, then look for an accredited counselor with a
specialty in eating disorders.
It is not just around
eating that you can intervene. Support your daughter’s transition to
autonomy by giving her choices, encouraging independence, and promoting
her sense of herself as strong, capable, and confident. Do not undermine
her with personal slights even if you are provoked. Be careful not to
transmit your own distorted thinking about weight and size. Family
functioning affects girls’ development of satisfaction with themselves
more than boys’. So as the parent of a teenage daughter, be particularly
sensitive to the impact of marital disharmony on her. Have your
arguments in private, or show her how you both can resolve them
satisfactorily without damage to anyone.
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| Q: |
Can boys suffer from eating disorders?
| | A: |
Anorexia nervosa and bulimia nervosa are predominantly female
problems, but males do suffer from them as well. Once established, the
disorders affect male and female sufferers similarly.
However, the ratio of
males to female who have an eating disorder is 1:10–15. Among
prepubescent children, the ratio is much more equal. There is some
evidence that the incidence of so-called “manorexia” is increasing.
Presentation in boys seems to differ from girls in that boys are more
concerned with shape than weight, and fear being flabby and unfit rather
than fat. Boys may suffer from a delay in referral, diagnosis, and
treatment because of a lack of awareness that this condition occurs in
males.
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| Q: |
It’s hard to argue with someone with an eating disorder. Don’t we all think a bit like that?
| | A: |
It is true that most western females of all ages have some
dissatisfaction with their weight and shape. It is not uncommon to hear
women exclaim in highly emotive terms how bloated they feel after eating
something fattening. Teenagers are particularly self-conscious, and
commonly judge their self-image harshly, as do eating-disordered young
people. However, the distortions of thinking in someone with anorexia
are extreme. She may be emaciated to the point of starvation, but will
see a fat person in the mirror. The more her mood is affected by her low
self-esteem and distorted, unsatisfactory body image, the more likely
she is to hear and believe negative information about herself. She will
also discount and deny any positive information. Thus a negative cycle
is established and maintained. Along with feelings of depression, she
may start to experience panic when she eats and gains weight. She may
start to think that she can put on weight by touching food or thinking
about food.
A further feature of
this disordered thinking is how difficult it is to change. It is hard to
get someone with an eating disorder to think reasonably, whereas the
general population may be more willing to hear a balanced argument. It
is important to take account of the impact of starvation on the ability
to think flexibly. This is why treatment for eating disorders focuses
primarily on getting a sufferer back to a healthy weight before starting
to challenge her thinking.
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| Q: |
My daughter is a little bit chubby. Is there any danger in letting her go on a diet?
| | A: |
Dieting is pretty normal in adolescent girls, but it is
particularly common and concerning among girls with a distorted body
image. Anorexia sufferers often say they started dieting after a comment
about their shape or size from a family member. So you will have to be
very careful how you talk about her weight and shape, because your
attempts to help may be misinterpreted. In vulnerable young people what
starts as a regular diet of calorie counting and cutting out sweet and
fatty foods can turn into a campaign of food reduction and obsession
about diet and eating. She may move on to smaller and smaller portions,
skipping meals, eating very slowly, cutting food up into tiny pieces,
smearing it around her plate, in her hair, or hiding it up her sleeves
and in her pockets. When these efforts do not produce the expected
changes in her view of herself as fat and ugly, she may try excessive
exercise, vomiting, and laxative abuse. Although she may deny being
hungry, she is may be preoccupied with food and its preparation. She may
not be vulnerable, but dieting often leads to binge eating and a
vicious cycle of bingeing and purging is quite easy to establish. Rather
than start down this road, you would be safest to encourage your child
in healthy eating habits, regular exercise, and a realistic positive
attitude to her body.
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| Q: |
My daughter has an eating disorder. I feel as though it’s my fault.
| | A: |
Ironically the pressure on you as a mother to be all things to
all people and then blamed when things go wrong, may contribute to your
daughter’s eating disorder. The desire to be a perfect mother, wife,
beauty queen, career woman, and so on, often drives young women to
over-control their eating in a misguided attempt to totally manage their
lives.
Families and their
patterns of interaction are implicated in the development or maintenance
of eating disorders, but this does not mean that parents or families
cause the disorder. On their own, the patterns of interaction or the
characteristics of parent–child relations are not sufficient to produce
the disorder. All families have their dysfunctionality, and many parents
struggle with their children’s quest for autonomy and independence.
Many parents can’t find a way of communicating with a silently hostile,
intense, and secretive teenage daughter. And many couples with children
negotiating puberty and adolescence are struggling with their own
developmental processes as they reach middle age.
Blame and guilt
won’t help—little is solved through them. The development of an eating
disorder is a complex interplay of many factors. The response required
is equally complex and needs to include more open, positive family
interaction, supportive, non-judgmental relationships, sensible patterns
of eating and exercise and, often, a qualified therapist.
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Obesity
Obesity is on the rise. Dieting increases binge eating, which leads to unstable eating and obesity.
There may be complex causes of obesity, but in general they are fairly
straightforward. For the most part, it is not that we eat more, but that
we exercise less.
There are genetic
factors in the origins of obesity. However, theories about lower
metabolic rate leading to being overweight have not been borne out. In
fact, evidence shows that overweight people have a higher metabolic
rate. Also, the theory that there is a genetic predisposition for
overweight people having more fat cells is unsupported. It seems that
the more we eat, the larger are our fat cells, and the more we have of
them. The bottom line is that obese people, in general, have a higher
energy input than energy expenditure. Young people are experiencing
unprecedented car use and sedentary digital entertainment. Psychological
factors underpin overeating just as much as they do for undereating.
There is some support for the hypothesis that overweight young people
are less responsive to internal cues of hunger and satiety than
average-weight youngsters. There is also evidence that they eat as a
response to emotional triggers such as boredom, depression, and
emotional emptiness. Parents can help with overeating by involving their
teenagers in a frank discussion about their eating habits. Taking
responsibility for their eating behavior and understanding the
consequences of overeating can simply be a matter of education. However,
if there is an emotional trigger for overeating or bingeing, together
you may be able to pinpoint danger times such as getting in from school
before everyone else has arrived home. A simple plan for a healthy snack
may easily resolve this situation.
If the psychological
factors are more complex and involve dieting, bingeing, and purging,
professional help is more likely to be needed. Nonetheless, as parents
of an obese teenager, regular mealtimes, healthy menus and good role
models are all crucial building blocks to a healthy weight and size.
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