women
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.

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.

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.

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.

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.
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.

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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