What do we need to know about young people and eating disorders?

Recognising changes in a young person’s relationship with food can be distressing for parents and carers. However, engaging in a mental health conversation and talking through the changes can alleviate some of the stress for both the parent or carer and the young person.

Before approaching a young person about their changing relationship with food, it is crucial to gain an understanding what eating disorders are, the types of eating disorders young people experience, and how to talk about them with compassion and without judgement.

Young people can be particularly vulnerable to developing eating disorders. Approximately one in five boys and one in three girls experience disordered eating. The risk of developing an eating disorder is often higher for girls, older adolescents, and those living in larger bodies.

Eating disorders encompass a range of behaviours, including food refusal patterns, restrictive eating, binging and secretive eating. To an adult, these behaviours may present as being overly concerned about appearance or weight, strict adherence to principles or ethics that seem unnecessarily restrictive, or changes in mood, habit, or secrecy levels.

Knowing what to look out for, how to communicate, and how to support a young person can make all the difference.

Here is a summary of the five eating disorders commonly seen in young people and strategies for talking about eating disorders in a supportive way.

Anorexia nervosa

Characterised by restrictive eating, a fear of weight gain, and distorted body image perception. Anxiety can accompany anorexia nervosa and is closely linked to obsessive-compulsive behaviours.

Bulimia nervosa

Characterised by episodes of binge-eating, often including eating beyond capacity to an oppressive state of fullness. Between episodes of binge eating there are compensatory behaviours such as dieting, over-exercise or purging.

Binge eating disorder

Similar to bulimia nervosa, binge eating disorder involves consuming large quantities of food beyond the point of fullness, followed by feelings of shame, guilt and self-disgust. However, binge eating disorder typically does not involve purging or compensatory behaviours.

Other specified feeding or eating disorder (OSFED)

A general category that is used to classify individuals who present with significant disordered eating patterns and symptoms that do not meet the specific criteria for diagnosis of anorexia nervosa, bulimia nervosa or binge eating disorder.

Avoidant restrictive food intake disorder (ARFID)

Characterised by an avoidance or restriction of food intake that often results in inadequate nutrition and significant weight loss or nutritional deficiencies. ARFID differs from eating disorders like anorexia nervosa or bulimia nervosa in that it is not primarily driven by body image concerns. It may present as an aversion to certain textures, flavours or smells, or may involve personal justifications for excessive restrictive eating.

Signs to look out for with eating disorders

• Unusual weight changes, such as significant weight loss or weight gain. It is important to remember that all eating disorders occur across the weight spectrum, and changes may not be noticeable until the disorder has become severe
• Increased focus on dieting and fixation on food characteristics such as calories, sugar or fat content
• Extended periods of time spent in the bathroom that could be indicative of purging
• Engaging in obsessive exercise rituals
• Physical health changes, such as tooth discolouration from acid or bile, yellowing of knuckles and fingers from self-induced vomiting, or hair or nail deterioration
• Evidence of hidden food stashes or secretive consumption in the bedrooms or rubbish bins
• Developing rigid eating habits, meal avoidance, and social withdrawal from food-related events such as family BBQs
• Social avoidance or withdrawal, changes to mood, evidence of social exclusion or bullying
• Obsession with food, body size, weight, and appearance
• Changes in clothing habits such as opting to wear baggier, non-form-fitting clothes
• Experiencing fainting spells or dizziness, or difficulty regulating body temperature
• Lying or withholding information about food consumption, including solo consumption or skipping meals like breakfast or lunch
• Disruption to menstrual cycles.

How to talk to young people about eating disorders

If you suspect that a young person may have an eating disorder, using the ALGEE Action Plan can help guide supportive, informed conversations.

A – Approach, assess, and assist with any crisis

Approach the young person at a time when you are both relatively calm. Don’t start the conversation when food is present, such as at dinner time, as this can be distressing and trigger a defensive response.

Consider the evidence you have of disordered eating and what you know of the young person in front of you. Check for the risk of self-harm or suicide and the level of discomfort the young person may be showing. In a medical emergency, seek emergency help by calling an ambulance or taking the young person to hospital.

L – Listen and communicate non-judgementally

Set a warm, non-judgemental tone that allows the young person to disclose their thoughts and feelings. Be prepared to hear things that might challenge you as an adult and how you perceive the young person you are talking to without judgement. To help build their trust and reduce their distress, it’s important not to dismiss, attempt to fix, or challenge their self-perception.

G – Give support and information

Letting them know that change is possible with appropriate support and guidance can make a world of difference. Encourage the young person to talk about their feelings, and promote healthier coping strategies when difficulties arise.

Encourage them to visit reputable websites such as the Butterfly Foundation and Eating Disorders Victoria to learn more about eating disorders and body image.

• Eating Disorders Victoria (1300 550 236)
• Butterfly Foundation (1800 33 4673)

E – Encourage appropriate professional help

The best place to start is with a visit to the GP. GPs can make a referral to an eating disorder service, psychologist, dietitian and other professionals who can help. Recovering from an eating disorder often takes a multi-disciplinary team.

Eating disorders are serious illnesses that can lead to long-term physical problems.

E – Encourage other supports

Encourage the young person to engage in activities they enjoy and that give them a sense of accomplishment and do not focus on body shape or size. Encourage them to speak with their psychologist or seek resources from reputable websites that can help them to find strategies to cope with triggers.

• Suicide Call Back Service on 1300 659 467
• Beyond Blue on 1300 22 46 36
• Headspace on 1800 650 890