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The Skinny on Eating Disorders
Children are becoming body conscious at a very young age
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Carla*, from Johannesburg, is 1,8 metres tall and weighs just 45kg. “That doesn’t sound very thin, but for a girl that tall, it means she’s just bone,” says her mother Kim*. “That’s the kind of thin that means you can’t sit down because you get sores.” The average weight for a woman of that height is 65kg.
Carla is in her 20s, and has been suffering from anorexia since her early teens. “She’s been at death’s door. Her kidneys have been damaged and she has lost all her teeth. This is my daughter – a stunningly beautiful girl who is smart, but who has emotional problems,” says Kim.
As a mother, Kim has experienced various emotions over the years as she has tried to heal her daughter, and guilt has topped the list.
“I’ve had to realise she won’t recover unless she wants to and how can she do that when this disease is a comfort for her? Why cope with reality when everyone else will do it for you? It’s put a huge strain on my family. There’s a lot of blame out there, especially against mothers.”
Kim says the first inkling that something was wrong was when Carla was 14 years old, but she only realized just how serious the problem was when she turned 16. “I noticed she was always unhappy and upset about school. I put it down to her age. Then there were little behavioural things; she had problems with other girls and she felt hard done by all the time. She became a perfectionist and could not stand the idea of anyone doing something better than her.” Then some of the girls at school held a competition to see who could lose weight the fastest. While the other girls soon gave up, Carla continued. She first cut out “bad food”, or anything containing fat, but eventually she wasn’t eating at all.
Through years of counselling, Kim has learnt that eating disorders, like anorexia and bulimia, begin at an early age and the sooner they’re treated the better the prognosis for the child. When Carla was diagnosed at 16, her behaviour had already become entrenched.
Warning signs
When Kim first took 14-year-old Carla to the doctor, suspecting she had an eating disorder, he brushed it off. “Our GP interviewed her and she came across as so reasonable, that he said there was nothing wrong with her.” Kim then called a psychologist, but he said he only dealt with adults. Two years passed, and the situation worsened, but even then Kim struggled to find help as there are not many psychologists who deal with children’s eating disorders in South Africa.
Often anorexics are obsessive and aspire to reach and maintain extraordinarily high standards, says Cape Town-based clinical psychologist, Graham Alexander, of the Crescent Clinic Eating Disorder Unit. Bulimics, however, are ambivalent about themselves and others. But Alexander says it’s difficult to generalise as one disorder can turn into another. There is often a recognisable pattern in the families of sufferers, he says. “The parents are often either over-involved or negligent and unavailable. Such families may reveal a history of depression and addiction and tend to mask their problems from the outside world.”
Sharing responsibility
While media and peer pressure do have an impact, parents have a large part to play. “Blaming seldom works, but a parent’s relationship with themselves has a huge influence on a child’s (self-image),” says Alexander. Jasmine Kooverjee, a psychologist at Tara Psychiatric Hospital in Johannesburg says the parents’ influence is so important, that treatment at Tara begins with a family session. “Parents tend to step back when they cannot handle a situation, but you must be firm and monitor your children. Make them sit down to dinner. It will be much harder for a child to hide their eating habits that way.” She says children will pick up on small things, such as a mom who goes to gym every day. Also, if a child is overweight it can be dangerous for parents and siblings to tease them about it. “Parents need to watch what they say,” says Kooverjee. “They need to make sure they are role models.” Encourage healthy eating, but don’t be excessive.
Johannesburg dietician Deborah Jacobson says parents may be at fault when children are inappropriately concerned with their body image. “Children do get fussy about food, but most of the messages they get are from their parents,” Jacobson says. If you say “starch is bad”, your child will believe it. “Children emulate what their parents are doing. It happens so often that a mom is scared of food and of her weight, and this is passed on to the child. Often I advise parents to deal with their own fears about food before trying to deal with the
child’s problems.”
child’s problems.”
It’s not just anorexia parents have to watch out for; bad habits can also come from eating too much. Jacobson says being overweight leads to poor self-esteem, depression, heart disease and diabetes, which is being detected in children as young as four or five.
Jacobson advises parents to get help if they suspect a problem. “I often find that parents don’t really know what normal is.” Kim agrees. “Get help as soon as you start to wonder if something is wrong. And don’t just go to any therapist. You need someone who knows what to expect because children know how to tell you what they think you want to hear.”
Starting young
International studies show an increase in eating disorders in children under the age of 13. While it’s still more common in teenagers, younger children are showing signs of fussy eating that could become more serious later on. They are also becoming more body conscious and it is not uncommon for a five year old to jog around the house because they want to lose weight. One US study found that by the time girls are nine years old, 30 to 40 percent of them have been on diets. Dublin psychotherapist Marie Campion says children as young as three are vomiting meals, showing signs of food refusal and a desire to avoid nourishment. Children are being taught about good food and bad food too early, which can
be destructive.
be destructive.
Irish psychiatrist John Griffin says he has seen children as young as nine suffering from anorexia. He believes that by the time teenagers are diagnosed, the disease is already well established.
While anorexia or bulimia in children under the age of 14 is not as common in South Africa, it does occur. Kooverjee says she has worked with only three or four cases of serious eating disorders where the children were under the age of 13. “But this is probably because at that age group it’s often overlooked. Parents simply think it’s a stage their children are going through. They don’t realise there is a problem until it has become more advanced.”
Alexander says the incidence of younger sufferers is increasing, with some rare cases of children under the age of 10 needing treatment. “One must distinguish between the traditional eating disorders (anorexia and bulimia) and disordered eating, like food refusal, that is found in childhood,” says Alexander. While food refusal was often a demonstration of defiance, persistently worrying behaviour with food should not be ignored. The younger the child when the problem is diagnosed, the easier it will be to address the negative behaviour, says Kooverjee.
Types of eating disorders
- Anorexia and bulimia are the most common, with one in 10 girls likely to develop one or both. But recent research shows a rapid rise in boys with these disorders, says Alexander. “In my experience, male anorexics tend to account for much of their weight loss through excessive exercise.”
- Binge eating is when the sufferer eats large amounts of food in a short space of time, and feels out of control, says Alexander. There is not usually any compensatory behaviour, such as vomiting, to prevent weight gain.
- Orthorexia describes people who are excessively preoccupied with “health foods” and organic alternatives, and they will avoid anything that is fatty or processed. Alexander says there does seem to be an increase in children adopting eating preferences, such as vegetarianism. “Sometimes the increase in vegetarianism is simply because it is in vogue, but our media reflects the trend towards exceptional eating habits. The majority of anorexics become vegetarian to limit their caloric intake.”
- Childhood obesity is also prevalent as children opt for junk food and a sedentary lifestyle in front of the TV or computer.
*Names have been changed
The signs
In her book Life Talk for Parents (Zebra Press), Izabella Little says many parents don’t realise how common eating disorders have become. She advises parents to look out for any obsession with weight or rapid weight loss.
- Children may start hiding food or giving their school lunches away to friends.
- They may develop low self-esteem and poor body image, dressing in baggy clothes.
- Look out for the use of laxatives or diet pills, moving food around the plate to look as if it has been eaten, excessive snacking, a refusal to eat in public and excessive exercise.
- There could also be signs of depression and sufferers may become withdrawn, socially avoidant, tearful, lethargic, agitated and irritable.
Get help
- Tara Psychiatric Hospital 011 535 3043
- Crescent Clinic in Cape Town 021 762 7666
- Annex at Entabeni Hospital 031 204 1300
Somehow I doubt any parent could be at fault for his child's eating disorder; the child's so-called friends and mass media are more to blame for that. You have no idea how a few criticisms could harm your daughter's self-esteem and most times her friends are the ones to hurt her. Your job as a parent is to figure out in time when something is wrong; there are anorexia and bulimia treatments available to make things better once you know there's a problem - you just have to monitor your child's eating habits really well.