Eating disorders - guidance for professionals

Being very overweight or obese can cause a lot of problems, particularly with health. Quite often, someone who is overweight can lose weight simply by eating more healthily. It sounds easy, but they may need help to find a way of doing this.

A lot of young people, many of whom are not overweight in the first place, want to be thinner. They often try to lose weight by dieting or skipping meals. For some, worries about weight become an obsession. This can turn into a serious eating disorder. The information is this section focuses on the most common eating disorders, anorexia nervosa and bulimia nervosa.

• Someone with anorexia nervosa worries all the time about being fat (even if they are skinny) and eats very little. They lose a lot of weight and for girls, their periods stop.
• Someone with bulimia nervosa also worries a lot about weight. They alternate between eating next to nothing, and then having binges when they gorge themselves. They vomit or take laxatives to control their weight.

What are the signs of anorexia or bulimia?

Both of these eating disorders are more common in girls, but do occur in boys.

• Weight loss or unusual weight changes
• For girls, their periods become irregular or stop
• Missing meals, eating very little and avoiding `fattening' foods
• Avoiding eating in public, secret eating
• Large amounts of food disappearing from the cupboards
• Believing they are fat when underweight
• Exercising excessively
• Becoming preoccupied with food, cooking for other people
• Going to the bathroom or toilet immediately after meals
• Using laxatives and vomiting to control weight.

It may be difficult for parents or teachers to tell the difference between ordinary teenage dieting and a more serious problem. If you are concerned about a child or young person's weight and how they are eating, discuss it with them and/or their parents and advise then to consult their family doctor.

What causes eating disorders?

Eating disorders are caused by a number of different things:

• Worry or stress may lead to comfort eating. This may cause worries about getting fat.
• Dieting and missing meals lead to craving for food, loss of control and over-eating.
• Anorexia or bulimia can develop as a complication of more extreme dieting, perhaps triggered by an upsetting event, such as family breakdown, death or separation in the family, bullying at school or abuse.
• Sometimes, anorexia and bulimia may be a way of trying to feel in control if life feels stressful.
• More ordinary events, such as the loss of a friend, a teasing remark or school exams, may also be the trigger in a vulnerable person. 

What effects can eating disorders have?

• Tiredness and difficulty with normal activities
• Damage to health, including stunting of growth and damage to bones and internal organs
• Tiredness and difficulty with normal activities
• Damage to health, including stunting of growth and damage to bones and internal organs
• Loss of periods and risk of infertility
• Anxiety, depression, obsessive behaviour or perfectionism
• Poor concentration, missing school, college or work
• Lack of confidence, withdrawal from friends
• Dependency or over-involvement with parents, instead of developing independence.

It's important to remember that, if allowed to continue unchecked, both anorexia and bulimia can be life-threatening conditions. Over time, they are harder to treat, and the effects become more serious.

What can I do?

If you think a child or young person you are working with may be developing an eating disorder, don't be afraid to ask them if they are worried about themselves. Some young people will not want you to interfere. These simple suggestions are useful to help young people to maintain a healthy weight and avoid eating disorders:

• Eat regular meals - breakfast, lunch and dinner.
• Try to eat a `balanced' diet - one that contains all the types of food your body needs.
• Include carbohydrate foods such as bread, rice, pasta or cereals with every meal.
• Don't miss meals - long gaps encourage over-eating.
• Avoid sugary or high-fat snacks (try eating a banana instead of a bar of chocolate).
• Take regular exercise.
• Try not to be influenced by other people skipping meals or commenting on weight.

When eating problems make family meals stressful, it is important to seek professional advice. Their general practitioner will be able to advise them about what specialist help is available locally and will be able to arrange a referral. Working with the family is an important part of treatment.

If the eating disorder causes physical ill health, it is essential to get medical help quickly. If the child or young person you're working with receives help from a specialist early on, admission to hospital is unlikely. If untreated, there is a risk of infertility, thin bones (osteoporosis), stunted growth and even death.

Some people are more at risk than others. Risk factors include being female, being previously overweight and lacking self-esteem. Sensitive or anxious individuals, who are having difficulty becoming independent are also more at risk. The families of young people with eating disorders often find change or conflict particularly difficult, and may be unusually close or over-protective.

See our links page for further advice.