The Invisible Epidemic
Eating disorders are serious mental illnesses with severe consequences to a person’s physical and psychological wellbeing. Anorexia has the highest mortality rate of any illness, with around 450 people expected to die each year in Australia from the illness. This is partly due to the physical complications that arise from the illness, and partly from the increased risk of suicide that accompanies it. Similarly, Bulimia Nervosa comes with the risk of sudden death from cardiac complications, and a risk of suicide that is also far greater than in the general population. Binge Eating Disorder, and OSFED (Other Specified Feeding and Eating Disorder) are no less of a threat to a person’s psychological and physical wellbeing either. Any disordered eating behaviours can place massive strain on a person’s physical health and symptoms such as anxiety, depression, social withdrawal, impaired concentration, overwhelming guilt, shame, and fear are well-recognised symptoms of eating disorders that can accompany them all.
What is particularly dangerous in today’s society is our weight bias in the way we view our own and other people’s bodies. In Australian culture, thinness is highly praised and valued, whereas being in a larger body is often discriminated against, either overtly, or in more subtle ways. Maybe people don’t always say it out loud, but due to the relentless social conditioning most of us have been subjected to, when people see someone in a larger body there is often an unconscious perception that they are inferior to slimmer peers, that it is their fault, or that they are “unhealthy” or “lack willpower”. Weight bias transcends many aspects of our culture, and what is particularly frightening is how it impacts children and teens who have internalised these messages that their own body is not good enough if it doesn’t match unrealistic ideals.
All of this is particularly relevant in how we view young people with disordered eating. The dangers of weight biases are that many parents, young people themselves, and even professionals can underestimate how unwell a child or adolescent is if their body doesn’t look completely emaciated. It is not uncommon for parents to notice their child has started skipping meals, cutting out entire food groups, engaging in intense diet or exercise routines, refusing to eat family meals, or focusing intensely on food or health-related behaviours at the expense of engaging in other areas of life. It is also not uncommon that if the child is noticeably underweight it gets labelled as an eating disorder and treated as such, but if the child is of average or even above average weight it gets dismissed as a phase, no big deal, or perhaps even a good thing that “they’re taking better care of themselves”. This disturbing trend means many vulnerable children and teens do not getting the help they need, simply because of biases that exist in our culture, or how the genetic shape or size they were born with fits into that.
Research shows us that the physical damage that amounts from disordered eating behaviours is not lessened simply because someone starts off at a higher weight. Similarly, the psychological consequences of starvation still result when any body is undernourished regardless of its size. Teenagers with eating disorders and average or larger bodies are often secretly trapped in a cycle of feeling so ashamed of their body that they restrict what they eat, which triggers physiological and psychological mechanisms that result in binge eating. This in turn either keeps their weight the same, or sometimes leads to metabolic changes that push their weight even higher. Yet if these behaviours come to light it is often the bingeing that is judged as being the issue (and often believed to be something they can just stop) rather than anyone seeing that it is the restriction and self-starvation that is the real problem. And yet if their weight were lower, would this still be the case or would the restriction itself be noticed and seen as the most alarming part?
If we imagine a teenager’s natural body shape were to fall into the 90th percentile (which some naturally will because that’s how percentile’s work!) and they lost a large amount of weight, they may become significantly underweight for their natural shape and size and yet viewed as being “healthier”. Whereas someone who is naturally smaller could lose far less weight yet instantly be recognised as unwell simply because their body was smaller to begin with. And part of the cycle of what triggers the body image dissatisfaction or keeps eating disorders going may be that teenagers in larger bodies report feeling judged whenever they eat certain foods, whereas in smaller peers nobody pays attention to what they eat. Furthermore, when a larger child begins to diet and restrict their food intake, they may be praised for the same behaviours that would trigger concern or intervention in a smaller peer or sibling.
So, what can we do about this harmful pattern?
1. Educate ourselves on all of the mechanisms that go into determining our shape and size. Understand how much of this is due to genetics, and also the physical changes that result if we restrict or undereat. Our bodies work hard to maintain the weight, shape, or size that it feels is right for us. Being in a larger body should not be seen as a flaw, it is part of human diversity. It is also not possible for most people to significantly change their natural size or shape in the long-term without significant consequences to their psychological or physical wellbeing.
2. If you have a child or teenager and you notice any dieting behaviours, ask yourself honestly whether your own weight-bias may be clouding your opinions of what’s going on. If they were a different shape or size would you respond differently? It’s important to see the behaviours for what they are, without letting ingrained fears your child “should” be a certain shape or size get in the way.
3. Reflect on how food is spoken about within the home – how does labelling foods as “good” or “bad” or “healthy” or “junk” impact your child or teen’s perceptions of these foods and of themselves if they enjoy or eat them?
4. Actively encourage behaviours which increase psychological and physical wellbeing such as sleep, seeing friends, eating a balanced diet from all food groups and moving their bodies for enjoyment or because it helps them feel strong or energised, rather than to change their weight or shape.
5. Take a firm stance against behaviours which are damaging. Unless there is a clear medical reason explained by a doctor who is aware of their own weight-bias, no teenager needs to diet no matter what their natural shape or size. See a weight-neutral dietitian if you have concerns about how to help your child or teen nourish their body in a way that fosters true wellbeing.
6. Be aware of what your teen is viewing on social media. Are they continuously exposed to material which reinforces weight biases and social stigma? Heavily filtered pictures or videos? “Fitspo” sites? Material which perpetuates a narrow and unrealistic view of what a healthy, natural body really looks like? If so, navigate boundaries around social media usage, or talk openly with them about how they feel about themselves when they view these things. Discuss how they can block certain things from their feed and fill it up with more body positive (or non-body-related!) material instead.
7. Be aware of your own anxiety and how this impacts your behaviours. If you have struggled with body acceptance or felt stigmatised because of your own weight or shape, is it possible your desire to protect your child from similar pain is causing you to buy into cultural messages that they “should” be a different size to what they naturally are? If so, how does this change your behaviour around food or around them?
8. Be mindful of over-focusing on being “healthy”. In a vulnerable teen who is not comfortable in their own skin there can be a fine line between encouraging behaviours that genuinely increase their wellbeing, and inadvertently sending messages that fuel patterns of guilt, shame, or disordered eating thoughts and behaviours!
9. If you’re concerned they may have an eating disorder get help early. Eating disorders are complex and often difficult to treat. And they are potentially fatal. The best defence is early intervention before the behaviours become more ingrained or their physical health deteriorates further.
10. Let go of your own guilt. There is no evidence to suggest parents are to blame for a young person’s eating disorder. Many teens will not develop eating disorders regardless of what messages they are exposed to, and many more will for reasons we may never fully understand. Eating disorders have many complex factors that intertwine to determine whether someone develops one. There is no one proven “cause”. Let go of guilt and instead focus on helping your child learn to love and accept themselves whatever body they are in!
