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This eating disorder is on the rise among young girls – and boys – in South Africa. The good news is that anorexia can be prevented.

The parent’s guide to dealing with anorexia …

Rina de Beer, mother to two young girls, says, “at first people will tell you how good you look. That causes you to eat less even though you are constantly hungry, cold and lethargic. Then people start commenting on the fact that you never eat. This causes distress because you’re not sure which is better: not eating and being thin or eating and being fat.”Parents need a guide to constructively dealing with anorexia.

Let’s start at the beginning

Rina first developed anorexia aged 16 and her constant obsession with being thin has ruled her life ever since. She’s woken up at 2am to exercise (compulsively doing everything from weight training and running on the treadmill to kickboxing). She’s also stayed home rather than go out with friends for dinner in case someone should suggest she eat something fried, battered, doughy or, even worse, have dessert. “Food has been my biggest enemy all my life. Not only have I robbed myself of 20 years. I also robbed my children of having a fully functional, energetic mother.”

Who is most likely to develop anorexia?

While there are currently no statistics on the prevalence of anorexia in teens and pre-teens in South Africa, according to psychiatrist Dr Rita Thom, “eating disorders are being seen more in all racial and socio-economic groups,” with probably between three and five percent of the population affected by eating disorders as a whole,” she says.

Cape-based clinical psychologist Kate Rogers says: “Anorexia most frequently occurs during adolescence. A period of identity confusion and adjustment.” UK researchers and authors of Childhood-onset eating problems Claudine Fox and Carol Joughin agree. “There are fewer patients with eating disorders aged between 8and 13 years than there are aged between 14 and 19 years.” And Thom has, in the six years she was practising in a psychiatric hospital, seen just one pre-teen girl of 11 years of age. “Pre-teens with anorexia are rare.”

Is it a phase?

While eating disorders are more common in teenage girls, younger children are prone to what Fox and Joughin term, “eating problems”. This refers to the likes of “faddy eating” in which children are unwilling to try new foods. They have a “poor appetite” and a “refusal to eat solid foods”. While these problems are “relatively rare”, according to experts, and do not necessarily lead to eating disorders, it is important to note that some, such as childhood-onset anorexia nervosa, are more serious. They can have an effect on your child’s physical and psychological development.

Why do children become anorexic?

Influence of media and advertising

“I would say that the media is partly to blame for eating disorders in young children,” says Rina. “I see it in my own two daughters. My eldest  is bigger than her younger sister and she is constantly comparing her body. Also, it is extremely difficult to find hip clothes for bigger teenagers.”

Emotional issues

When children feel stressed and out of control for a variety of reasons, they may develop anorexia as a way to exert control over their emotions.

For Rina, whose father was abusive towards her mother and was verbally abusive to her about any weight she gained, control was critical. “When I controlled what I ate, I could lose weight, and by losing weight I pleased the people around me,” she says. “Obsessing about weight, where the obsession becomes all-consuming, becomes the perfect distraction from underlying problems,” confirms Rogers.

Parental expectations

A desire to be “perfect” is a common thread running through many anorexia sufferers. Perfectionism can be seen in a tendency to set extremely high goals and frustration or tearfulness if these goals aren’t met. As a result, children with anorexia often appear to be “model” children. They are well-behaved high-achievers in sports, culture and/or studies.

And some parents can also play a role.  Sometimes they might be trying to get their children to remedy something they didn’t manage in their own development.” This was certainly true in Rina’s case.

“My father was extremely ambitious, overcompensating for what he missed during his school years. My siblings and I had to excel in both the sport and academic fields.” But when her teenage hormones kicked in and she started to gain puppy fat, he would make hurtful comments. “He made me feel like a broken toy. Not good enough to be his daughter.”

While Rina’s father’s attitude is thankfully the exception, there does appear to be one rule among anorexia sufferers. “One of the core features underlying all eating disorders is a disordered sense of self – self-esteem and self-worth,” says Thom. “If a young girl does not have a healthy self-esteem,  she is much more likely in a particular social context to develop an eating disorder.”

How parents can help

Seek professional help as soon as possible.

A UK study found that it took an average 7,4 months between parents initially requesting professional help and referral to specialist services.  Fox and Joughin say: “Some empirical research investigating older patients with eating disorders has found that a shorter history of illness is a predictor of good outcome.”

Be a role model

Check in with yourself. How much do you obsess about your own weight? “If putting on weight becomes a life-or-death drama for a parent, this will impact a child. This is of particular importance for adolescents whose hormone changes may lead to weight gain. This might seem unacceptable to a child if her mother is extremely weight-conscious.

Educate yourself

Learn about the disease and don’t underestimate it. In the early stages, an anorexic is comfortable with their illness – it is their means of coping and they are unlikely to want to change. Trying to take this ‘safety raft’ away causes extreme anxiety and is likely to lead to deceit to protect the symptom. Rina says: “Unfortunately this disease makes you a very cunning liar. Do not believe your child when she says she has already eaten.”

Warning signs

The warning signs that your child could be developing an eating disorder include:

  • eating alone
  • saying they have already eaten
  • playing with their food
  • exercising excessively, possibly in secret
  • constantly talking about their weight and that of others
  • comparison to others
  • wearing oversized clothing to hide weight loss.

How to help

  • Develop a healthy self-esteem in your child, through providing “good-enough” parenting (loving your child and showing them that you love them, but also setting limits on what they can and cannot do).
  • Establish good communication with your child.
  • Be realistic about your expectations.
  • Model good eating behaviour – eat meals together as a family, enjoy a variety of foods and eat a balanced diet yourself and as a family.
  • Don’t make food a battleground, but see it as part of human life. Food is necessary and to be enjoyed.
  • Be aware of areas and times of high risk – the onset of puberty in girls is often accompanied by an increase in “puppy fat”.
    and changing body shape – educate your child on this and how this will change as she grows and develops.
  • Encourage team sports and discourage over-achievement in individual sports.
  • Be aware of your child’s friends and their attitudes to eating. Discuss these with your child and your concerns if you have any.

Karen Robertson