Eating difficulties – guidance for 11-16 year olds

Lots of people worry about what they look like and from time to time and might be unhappy with their weight or shape. At different times people might eat more or less and this might be okay. For someone with an eating disorder thoughts and feelings can have a serious impact on their life.

An eating disorder is a serious mental illness that involves a person developing thoughts, feelings and eating behaviours which take over and make them very unwell. It can impact on physical health and lead to things like feeling cold or dizzy. It might make concentrating at school or college harder. It can also get in the way of general daily living, such as spending time with friends or family and taking part in activities.

Eating disorders can involve not eating enough, eating and then making yourself sick, compulsive exercise, thinking about food and eating a lot of the time or a mix of these where someone might not eat and then eat too much.

There can be lots of reasons for young people developing difficulties in eating and it is worthwhile considering these before thinking that someone has an eating disorder like anorexia or bulimia. These can include physical illnesses which will need medical assessment first.

Sometimes people naturally have strong preferences about what they eat and how they eat it and this can lead to less variety in what these people eat. At other times someone may have another mental health problem like low mood which may be resulting in difficulties with eating and need treatment.

There is no one cause of an eating disorder. People can develop them as way to cope with feelings of sadness, worry and stress. Sometimes life stressors such as exams, bullying, friendship or family relationship difficulties and bereavement or loss may play a part in how someone copes or feels about themselves.

There are also some personal factors such as having low self-esteem, experiencing anxiety or depression, setting high standards and being perfectionistic. It can be that people identifying as LGBT (Lesbian, Gay, Bisexual or Transsexual) have more body image concerns. Boys get eating disorders as well as girls, but these are sometimes not noticed. However, experiencing any one of these things does not necessarily mean that someone will develop an eating disorder or difficulty.

All eating disorders are treatable and recovery is possible.

• Ask the young person how they are feeling and what they are thinking at first rather than making assumptions or offering advice.
• If there are signs that the young person is at a risk to their physical health, they may need help in accessing medical help which might start with a visit to the GP. See below for what to look for under getting help.
• Avoid discussing weight, shape, food, and diets in front of the young person and model a balanced relationship with your own food and exercise
• Recognise how distressing the illness is for the young person.
• Educate yourself about eating disorders where you can.
• Remind yourself that things can change and reassure the young person that recovery is possible.
• Ask the young person what you can do to help – for example, helping them to stick to regular eating, putting in boundaries following mealtimes, having a space to talk about how they are feeling. They may respond that you can just “leave them alone” or that you can’t do anything to help, so here it can be helpful to remind them you can hear their distress and how difficult things are, and you are there if they need you.

• BEAT (The UK eating disorder charity) has an excellent website with more information about what eating disorders are and a helpline that young people or parents can contact
  • BEAT Helpline 0808 801 0677
• Youthline 0808 801 0711
• FEAST is an international organisation that has excellent resources for people needing to know more about eating disorders or how to help

It is common for children and young people to experience eating difficulties during childhood and adolescence. These may be short term, have no impact on physical health or everyday life. These can be managed with understanding and support from parents / carers.

What you might see or a young person might report

• No longer eating foods they previously enjoyed
• Wanting to or trying to diet by ‘eating healthily’ or following food movements such as the ‘clean eating’, ‘raw food’,
• Taking a more active interest in food, meal preparation, e.g. checking food labels or packaging or not wanting parents to cook for them
• Taking a more active interest in fitness or health
• An increase in activity or exercise and distressed if they can’t do it.
• Talk about body dissatisfaction / worrying about appearance
• Comparing themselves to other people
• Feeling anxious about eating in public/in front of others
• Young people with Type 1 diabetes may become more inconsistent with insulin and diabetes less well managed (this should be checked with a medical team as a matter of priority)

Things to try, support and next steps

• It is important that all young people eat regularly so insisting upon breakfast, lunch and dinner plus snacks
• Encourage a balanced lifestyle and broad concept of what healthy is. Developing young people need all food groups (carbohydrates, protein, fats, vegetables and fruits, dairy/dairy alternatives) plus it’s ok to have snacks and treats.
• Ensure young people are well hydrated; aim for 6-8 glasses per day (water, milk)
• Talk to the young person about all areas of their life, don’t just focus on concerns about eating.
• If you are concerned about your child’s eating:
• Talk to them about your concerns, listen and hear what they are thinking.
• Monitor and restrict use of apps / gadgets that track exercise and food e.g., My Fitness Pal and Fitbit watches
• Encourage team sports and activities rather than solitary activities such as sport.
• Ensure food and fluids are had before and after exercise.
• Monitor use of social media and ensure only positive accounts are being followed/ accessed
• Notice if talking is only about body concerns, weight or food.

Support available

• See your GP (ask for physical health observations to be done: height, weight, blood pressure, pulse)
• Inform your child’s school to share concerns and ask if they have noticed any other concerns

Eating difficulties may at first have some mild impact on a young person’s ability to cope with everyday life such as coping with school, seeing friends, or taking part in leisure activities. When an eating disorder is developing there may be more signs.  Families may also find themselves arguing more around food, exercise levels or other behaviours like suspected vomiting. Other people may notice changes to weight or mood.

What you might see or a young person might report

• A committed effort to lose weight or control weight or shape through:
  • Deliberately eating less
  • Exercising or increased activity
  • Making themselves sick after eating
  • Taking laxatives
• Eating excessive amounts or constantly seeking food
• Experiencing feelings of guilt or shame after eating
• Dissatisfaction about body image
• More emotionally labile / more sensitive (upset, irritable, withdrawn) especially when boundaries are put in around food or exercise
• More argumentative (especially around food or mealtimes)
• More controlling or rigid around food / mealtimes and other areas of life
• Overly interested in food (like counting calories)

Some signs of physical compromise e.g., gradual weight loss, tiredness, difficulties concentrating, not seeming usual self, feeling cold

• Other areas of life might be a struggle e.g., academic work, friendships, engaging in family life

Things to try, support and next steps

• Share your concerns openly and ask them what they are thinking and feeling
• It will be important that all young people eat regularly so insisting upon breakfast, lunch and dinner plus snacks
• Encourage balanced lifestyle; need all food groups (carbohydrates, protein, vegetables and fruits, dairy/ dairy alternatives) plus it’s ok to have snacks
• Ensure young people are well hydrated; aim for 6-8 glasses per day (water, milk)
• You may need to support during mealtimes by sitting with them, sometimes by directly encouraging other times by talking about other things.
• Support your young person to access self-help resources
• Share concerns with your child’s school/college
• See your child’s GP; ask for physical observations to be taken (including; height, weight, temperature, blood pressure, pulse and request a blood test)
• Monitor and restrict use of apps or gadgets that track exercise and food e.g., My Fitness Pal and Fitbit watches
• Monitor use of social media and ensure only positive accounts are being followed/ accessed

Other resources:

• For fussy/ faddy eating : Food Refusal and Avoidant Eating in Children; A Practical Guide for Parents and Professionals
• What’s Eating you? A Workbook for Teens with Eating Disorders by Tammy Nelson
• The Self-Esteem Workbook by Lisa Schab
• Banish Your Self-Esteem Thief by Kate Collins-Donnelly
• Banish Your Body-Image Thief by Kate Collins-Donnelly
• Beat (eating disorder charity)

Support Available

If families or professionals are concerned that a young person is experiencing the types of eating difficulties described above than they should seek advice and consultation from the Specialist Eating Disorder Team as soon as possible.

The focus of the team is on anorexia, bulimia and binge eating disorders.

They offer face-to-face, web based, and telephone support on a needs-led basis.

Available Monday to Friday, 9am-5pm.

Please contact: 0300 123 6632.

The degree to which a young person experiences eating difficulties may cause the young person distress or might have an impact on their ability to cope with everyday life such as going to or coping at school, seeing friends or taking part in leisure activities. The family may also be experiencing a degree of stress characterised by; more arguments or disagreements around food/ mealtimes or exercise levels/known or suspected vomiting. Other people may be commenting or noticing there is a difficulty or noticing change in weight.

The difficulties may have had a sudden onset at a significant level of concern or may have been deteriorating gradually over a long period of time.

What you might see or a young person might report

Emergency symptoms – seek immediate medical advice

• Sudden or rapid weight loss
• Fainting, feeling dizzy or collapsing
• Drowsiness
• Refusing food or drink for more than 24 hours
• Chest pains
• Concerns about daily vomiting
• Significant restriction of food (and fluid) leading to rapid weight loss. This is a concern for both young people that lose weight and become underweight as well as young people who perhaps are overweight then lose weight and appear a healthy weight. It is the speed of weight loss not necessarily just their weight that is a concern.

Other signs that things are becoming more serious and needs added professional help are

• Avoiding eating; excuses such as ‘have already eaten’, ‘not hungry’, ‘don’t feel well’
• Distress before, during or after meals.
• You might notice your young person may want to prepare their own food or eat alone
• Preoccupation with food / eating / weight or shape or having rituals around eating/ preparing food such as weighing food, eating with certain crockery / cutlery
• Unusual eating behaviour such as unusual combinations of food or cutting up food into very small pieces / eating very slowly
• Hiding or throwing food away
• Weight control behaviour including exercise, laxative misuse, or self-induced vomiting
• Young people with Type 1 diabetes may become more inconsistent with insulin and diabetes less well managed
• Reluctance, avoidance or secrecy of the young person to talk about eating; lack of recognition of concern that others may have or minimising the extent of difficulties
• More withdrawn / lethargic or tired
• Feeling physical unwell; dizzy, light-headed, chest pains, fainting, stomach pains, constipation, coldness
• Symptoms of vomiting including bad breath and swollen or puffy face; poor dental health
• More emotionally labile / more sensitive (upset, irritable, withdrawn) especially when boundaries are put in around food or exercise
• More argumentative (especially around food or mealtimes), may become aggressive and violent
• May hide under baggy clothing
• Either becomes preoccupied by checking themselves in the mirror and weighing or avoids mirrors altogether
• Frequent trips to the bathroom especially after meals
• For females: periods stop (they make stop asking for feminine hygiene products)

Things to try, support and next steps

• Share your concerns with the child and listen to what might be going on for them.
• See your child’s GP if there are signs that their health is worsening; ask for physical observations to be taken (including; height, weight, temperature, blood pressure, pulse and request a blood test)
• Share concerns with your child’s school / college
• It is important that all young people eat regularly so insisting upon breakfast, lunch and dinner plus snacks. Support and supervise meals and snacks.
• If a young person has severely restricted their food and fluid, you must seek advice from a medical professional about restarting eating and drinking as this needs to be done with careful monitoring of physical health.
• Encourage balanced lifestyle; need all food groups (carbohydrates, protein, vegetables and fruits, dairy/ dairy alternatives ) plus it’s ok to have snacks
• Ensure young people are well hydrated; aim for 6-8 glasses per day (water, milk)
• Monitor and restrict use of apps / gadgets that track exercise and food e.g., My Fitness Pal or Fitbit watches
• Monitor use of social media and ensure only positive accounts are being followed/accessed

Support available

Requires urgent medical attention either through an urgent GP appointment or urgent visit to acute medical hospital

Seek urgent advice and consultation from Specialist Eating Disorder Team

Available Monday to Friday, 9am-5pm.

Please contact: 0300 123 6632.