Eating disorders in children and young people

Eating disorders are serious mental illnesses, characterized by disturbances in a person’s relationship with food and eating. For some people this extends to a preoccupation with movement and with body size, weight or shape.

Eating disorders can be understood as a maladaptive coping mechanism. This means they serve a function for the person; an eating disorder may help someone feel safe or in control during challenging times. Until recently, eating disorders were rare in younger children, but this is no longer the case, and they have increased in children under the age of 12.

It is important to recognize that eating disorders develop through an interaction of factors. There is no single cause.

Early warning signs#

Some signs that a young person might have an eating disorder, and that should be looked into further, include:

• rapid weight loss or weight gain, or changes in body shape
• an intense fear of gaining weight
• body dissatisfaction, or unhappiness with body shape or particular body parts
• fear, avoidance or lack of interest in food and certain types of food
• denial of being hungry
• developing food rituals, such as always using the same bowl, cutting food into tiny pieces or eating very slowly
• deceptive behavior around food, such as throwing out or hiding meals
• avoiding food and eating in social situations
• excessive or compulsive physical activity, and a need to be active all the time, even when unwell or injured
• eating alone or in secret
• cutting out particular food groups, such as meat or dairy
• low self-esteem, low mood or irritability
• sleep difficulties
• behavioral changes, such as social withdrawal or no longer engaging in activities once enjoyed

Young people can become wary of particular foods or lose weight for many reasons, including other medical or physical health conditions. It is important to get any concerns checked by a health professional.

Types of eating disorders#

The main types of eating disorder include:

• Anorexia nervosa – characterized by restricted eating, significant weight loss and a fear of putting on weight.
• Bulimia nervosa – periods of binge eating, often in secret, followed by attempts to compensate through excessive exercise, vomiting or strict dieting. Binge eating is often accompanied by feelings of shame and a sense of being out of control.
• Binge eating disorder – recurrent periods of binge eating, including eating much more than normal, feeling uncomfortably full and eating large amounts when not physically hungry. Feelings of guilt, disgust and depression can follow. Binge eating disorder does not involve compensatory behaviors.
• Other specified feeding or eating disorder (OSFED) – feeding or eating behaviors that cause distress and impairment but do not meet the criteria for the disorders above.
• Avoidant restrictive food intake disorder (ARFID) – characterized by avoidance of and aversion to food and eating. The restriction is not due to body dissatisfaction or body image disturbance. It results from anxiety or a phobia of food or eating, a heightened sensitivity to sensory aspects of food such as texture, taste or smell, or a lack of interest in food and eating beyond a low appetite.

Eating disorders more commonly experienced by children and young people include ARFID and anorexia nervosa.

Risk factors#

We do not know why some older children (aged eight and over) develop an eating disorder and others do not. Many factors can influence a young person to develop an unhealthy eating pattern or to become afraid of gaining weight. These may be psychological, social, environmental or biological, and often a combination of things triggers an eating disorder in a vulnerable person.

Psychological risk factors may include:

• low self-esteem
• body dissatisfaction
• preoccupation with dieting and rigid rules around food and eating
• perfectionism
• difficulty expressing feelings, such as anger or anxiety
• sensitivity to acceptance and judgement from others, or being a ‘people pleaser’
• difficulty being assertive with others

Social or environmental risk factors may include:

• major life changes, such as moving to a new school
• changes in friendships or family breakdown
• the build-up of many life stressors
• being teased or bullied, including appearance or weight-related bullying
• a belief that high expectations from family and others must be met
• peer pressure to behave in particular ways
• societal messages that promote a particular body or appearance ideal, from media, advertising, family or peers
• a cultural tendency to judge people by their appearance

Biological factors may include:

• adolescence and its associated physical changes, which can be a stressful and anxious time
• genetic or familial factors, such as a family history of an eating disorder or another mental health condition

Dieting and the risk of eating disorders#

Dieting is the most significant risk factor for developing an eating disorder. It can be seen as a way of controlling the changes occurring in the body, in an attempt to attain an idealized body type that meets societal expectations. Dieting is common among young people and is often normalized, but it is not a normal or healthy behavior and should not be considered a normal part of adolescence. Young people should not be encouraged to go on a diet or take part in other weight-loss behaviors.

Eating disorders and gender#

Eating disorders are experienced by people of all gender identities. They are more likely to affect females than males, but about 25 per cent of adolescents who experience an eating disorder identify as male. Gender diverse and queer young people are also at risk. Young people of different genders may experience different social pressures about how they should look. Primary school-aged children are not immune to these pressures, and their attitudes and behaviors can reflect adult concerns.

How parents and teachers can help#

Parents, teachers and other adults play an important role in preventing eating disorders and promoting positive body image in children and young people.

Foster a healthy relationship with food#

• Avoid assigning a moral value to food. Try not to label foods as ‘good’ or ‘bad’, as this can lead to preoccupation with food and feelings of guilt.
• Avoid using food as a reward, bribe or punishment.
• Accept that children often have different eating habits from adults. For instance, adolescents may need more food more frequently, or go through periods of liking or disliking particular foods.
• Avoid dieting, and avoid talking about your own diet, exercise and body dissatisfaction in front of young people.
• Do not put your child on a diet or encourage them to restrict their food intake.
• Allow your child to eat when hungry and stop when full. Do not force them to eat everything on their plate.
• Celebrate food and eating, including both the pleasure and the nourishment it brings.

Encourage young people to feel good about their bodies#

• Accept and celebrate the diversity of people’s bodies, including different shapes and sizes, and your own.
• Role-model appreciation and acceptance of your own body. Focus on how your body functions and all the things it allows you to do.
• Demonstrate healthy eating and a positive relationship with food, and take part in physical activity for health and enjoyment.
• Do not criticize or comment on your child’s body or appearance.
• Encourage children to tune in to their bodies and become familiar with different physical feelings and experiences.
• Encourage physical activity that is fun and joyful, to help maintain your child’s health and fitness and build their body confidence.

Encourage self-esteem#

A strong sense of identity and self-worth helps children and young people cope with life’s pressures. You can:

• help them develop effective coping strategies
• encourage them to express their needs and wants, make decisions and cope with the consequences, and pursue things they are good at
• teach them that it is okay to say ’no’, and encourage them to be assertive if they feel they have been mistreated
• help them develop a critical awareness of the images and messages they receive from television and social media

Getting professional help#

If your child or young person is preoccupied and unhappy with their body, seems to be restricting their eating or binge eating, or is preoccupied with exercise, seeking professional advice is important. See your doctor for information and support options.

Key points#

• Eating disorders develop through an interaction of factors; there is no single cause.
• It is important to get any concerns checked by a health professional.
• Eating disorders more commonly experienced by children and young people include ARFID and anorexia nervosa.
• Dieting is the most significant risk factor for developing an eating disorder.
• Encouraging activity that is fun and joyful helps maintain a child’s health and fitness and fosters body confidence.

Where to get help#