The signs your child might have an eating disorder – and when to act

It's important to act quickly if eating disorder 'red flags' are spotted. Photo / 123RF

We know children and young people’s mental health was hit particularly hard by the pandemic, and now new research has confirmed a “staggering” rise in the rates of eating disorders amongst teenage girls since Covid arrived in the UK.

Data from more than 1,800 GP practices (between 2010 and 2022) found eating disorders such as anorexia and bulimia among girls aged 13-16 were 42 per cent higher than would be expected, based on trends before the pandemic. Levels among girls aged 17-19 were 32 per cent higher.

“During the height of the pandemic demand for our helpline services spiked by 300 per cent,” confirms Martha Williams, senior clinical advice coordinator for Beat, the eating disorder charity. “Demand has remained high and referrals to the NHS are going through the roof. If parents are worried they should contact their GP as soon as possible, visit the Beat website or ring our helpline,” she adds.

Victoria Chapman is a consultant child and adolescent psychiatrist and clinical lead for the Royal Free Eating Disorder Service. She says: “During the pandemic, there was more anxiety and distress generally, and fewer ways for young people to relieve those pressures. Without the structure of school and seeing friends there was no relief from those external pressures. They were in their homes for long periods, exposed to parents’ anxieties, say about grandma’s health or financial worries, and spending a lot of time online on social media. Social isolation makes you more vulnerable to an eating disorder.”

Yet the crisis is showing no signs of slowing down and when it comes to treatment, early intervention is vital.  “The sooner someone gets support and treatment the more likely they will make a full and sustained recovery,” explains Williams. “Don’t wait for the situation to get bad, speak up and intervene as soon as possible as the first three years are very important.”

Eating disorders can be hard to spot as young people are ashamed and will often hide weight loss or conceal disordered eating. Here are the red flags the experts say to look out for.

1. They’ve gained or lost a lot of weight

This is an obvious symptom of an eating disorder, but in the case of weight loss it can be hard to spot if a young person takes to wearing baggy clothes. Weight gain is also a potential cause for concern, but don’t resort to a diet. “What I am seeing is patients coming to us with an eating disorder having started a health-kick diet and it very quickly gets out of control. I would not recommend a diet to any young person. If your child asks to go on a diet, suggest that they exercise a bit more within reason and eat more healthily,” says Chapman. If your daughter stops having periods you should immediately make an appointment with your GP.

2. They’re spending a lot of time worrying about their weight or body shape

If they suddenly start saying “I’m fat” or expressing concerns about their body shape, this could be a cause for concern, says Williams. “Try to have a conversation with them, don’t make the conversation about weight or their bodies, as that might make them more defensive. Say something like: ‘You seem a bit more anxious, or not yourself recently, can I check how things are going?’”

Tread carefully as children and young people will often go to great lengths to hide their eating disorders. “They are ashamed and worried that parents will make them get treatment and they’ll have to give up. The eating disorder is often providing the solution to the underlying symptom, whether that is depression or anxiety, and so giving it up can feel very scary for them.”

3. They’re not seeing friends, turning down invitations and staying home

Sometimes young people with an eating disorder might avoid social situations that involve eating, whether that is hanging out with friends, going out to a restaurant or having a birthday dinner with family. “Portions are bigger and more calorific at restaurants, and the calories on menus have exacerbated the problem. They might feel overwhelmed by looking for the lowest calorie item on the menu, or worried about turning down food,” says Williams.

Given that an eating disorder is a sign of deeper emotional distress it could also be that they are suffering from low mood or feeling socially anxious and less motivated to do the things that they used to enjoy.

4. They are exercising excessively

Their exercise habits might have changed from going to a weekly class with friends to visiting the gym every day or exercising alone at home. They might also be overly preoccupied with burning calories as soon as they have eaten. “Exercise is obviously good for you, but anything excessive or very different from what they are used to can be a red flag,” says Williams. Try to talk to them or visit the Beat website where there is a helpline for parents, carers and young people.

5. They’ve cut out major food groups, are on a diet or skipping mealtimes

“Young people often become vegan or vegetarian, and this is OK as long as they are still eating enough food overall. I would be worried if they are drastically reducing certain food groups like carbohydrates or showing extreme faddiness,” says Chapman. Changes in food patterns can also be a worry, whether that is skipping breakfast or saying they had dinner with a friend, or showing a lot of distress around mealtimes and avoiding all treats. Sometimes young people might be bingeing in secret and you might find sweet wrappers or food packaging in their bedrooms.

Mealtimes with family are a common flashpoint, but Chapman says it’s important to continue to eat as a family, where possible, as that is where you notice how your children are eating. Try to stay compassionate and non-confrontational, advises Williams. “If they storm off or refuse to eat this can be very difficult for parents as it goes against quite fundamental instincts, they may feel a failure if they’re not able to effectively feed their child. It’s about communication and working out a plan.”

6. They are making themselves sick or taking laxatives

This can be difficult to spot as young people will try and hide the behaviour. You may notice abrasive marks on their knuckles, hear the shower go on in the bathroom after a meal, or smell sick around the house. You might find laxative packets in the bin. “Try to talk to them but be careful not to directly name the behaviour in the first conversation, and try to manage your own anxiety. Even if your young person doesn’t want to talk about it, do bring it up again, and be gently persistent,” says Williams.

Starting the conversation

If you notice any of these red flags try in the first instance to talk to your teenager. Eating disorders thrive in isolation so it’s important to keep lines of communication open.

“This is not easy to do. Don’t choose a high pressure time, like mealtimes, and focus on being compassionate and non-judgemental – don’t say ' why haven’t you eaten your dinner?’.  Listen more than you speak and try to focus on their emotional experience rather than the food as the eating disorder is just a symptom of a greater emotional problem. The first conversation may be hard, but even if they say they are fine, keep an eye on them and bring it up again. It’s about gentle persistence, you may need to return to the conversation many times,” says Martha Williams.

Concerned parents should contact their GP as soon as possible.