Are you a parent to girls? If you are, whatever their age, you might already have that niggle in the back of your mind about the social pressures they'll face regarding body image, either now or in years to come.
It's at least part of the reason why eating disorders exist in the UK. Although it's hard to know exactly how many people suffer from one, it's estimated that between 3 of people do – and nine out of 10 of those are female.
Professor Christopher Fairburn, from Oxford, is considered a leading international authority in his field. His book Overcoming Binge Eating provides a comprehensive and readable account of eating problems, as well as an extensively tested (15 trials worldwide) self-help programme for those who binge.
We talked to him about what concerned parents can do if they suspect their child needs some help.
Are eating disorders primarily a teenage issue?
It's common for eating disorders to develop in the teenage years – between the ages of 14 and 18. They're most prevalent among girls and young women between the ages of 14 and 30. Some children can develop a problem earlier than this, but that's not common.
And why, in your opinion, are girls so much more prone?
I'm glad you stressed 'in your opinion' because no-one definitely knows. That said, it is likely to be because the initial behaviour that leads to an eating disorder is, in most cases, dieting.
Go into any school, and you'll find it's the girls who are dieting – and therefore they are the ones engaging with the risk behaviour. Interestingly, eating disorders tend to be predominant in cultures where slimness is regarded as attractive.
For most of us, dieting is a temporary thing – it's not particularly significant other than the person wants to change their weight. If you're developing an eating disorder, dieting becomes highly significant and gets out of control.
There must be more to it than just body image though?
Characteristically, people developing an eating disorder often feel that aspects of their life are somewhat out of their control – it might be that they have insecurities in relationships, or problems at school or home.
Regimenting what and how they eat can give them a powerful sense of being in control of at least something – weight loss has the advantage of being measurable and socially condoned. And those who binge find it can distract them from negative emotions or events – it can be calming or even sedating to vulnerable people.
Many people might associate 'bingeing' with bulimia nervosa, but binge eating disorder is slightly different – can you explain?
Bulimia nervosa wasn't recognised until the late 1970s and even then wasn't taken that seriously, because sufferers tend to be a normal weight (unlike anorexia nervosa, where the sufferer tends to be extremely thin).
Now doctors recognise bulimia nervosa is a huge problem. These sufferers are into a constant cycle between binge eating (often followed by vomiting) and sustained attempts to limit what they are eating.
Their weight is often normal but they experience severe shame and guilt, and the condition is very self-perpetuating. If it's not nipped in the bud it can become severe and plague a sufferer for decades.
Binge eating disorder is less recognised by doctors. It's different in that the sufferer does not induce vomiting or diet strictly between the binges. Rather, the problem is simply repeated binge eating.
It can be viewed as trivial because there are fewer symptoms to worry about from a medical perspective. Often it occurs in people who are overweight, in which case the binge eating is superimposed upon a general tendency to overeat.
Binge eating disorder is not so persistent as bulimia nervosa. Sufferers often report periods – perhaps six months to a year – when they are not binge eating. But then it returns once again, often triggered by emotional difficulties.
If the bingeing is occasional, it is not problematic – but persistent bingeing is very impairing and might be accompanied by other psychological problems.
What signs might a parent look for if they are worried their child is binge eating?
The most obvious will be food inexplicably disappearing, and also money inexplicably being spent. Parents might find food wrappers, in the bedroom or hidden in other places.
A teenager with binge eating disorder is likely to be very secretive about their binges, and ashamed of them. They won't want to discuss it. They might be overweight, or have an oscillating weight pattern.
With bulimia, there might be signs of vomiting (the toilet smelling bad). A sufferer might disappear to the toilet straight after eating. They might not want to eat in front of anyone, and be extremely sensitive about discussing what they eat (even if they seem to be highly interested in food in general).
Your book contains a chapter for relatives which suggests the best approach is to take a supportive, yet not overly demonstrative role – yet it would seem to me many a parent's instinct would be to take control of the situation immediately. What's your advice?
I have seen cases where parents padlock the fridge, or lock their child in their room at night. It doesn't work. It creates a terrible atmopshere, it creates battles and tension.
Forcibly taking control away will not solve the problem – it will be a short term fix with absolutely no long term effect.
So what should parents do?
Reading the book is a good way to understand what is going on, both for the sufferer and the parent. The parent needs to ask, without judgement: "Are you having problems controlling your eating?"
The next stop should be the GP. Your doctor might refer your child for help or they might even be able to help you work through the problem at your local surgery. In fact, the whole reason this book came about in the first place was that GPs in Oxford wanted to treat eating disorders. Many surgeries around the country have copies – and practice nurses may use it to help patients.
Parents can also encourage their child to contact b-eat, which offers helplines and online support. There is lots of support for parents there too.
The key is to help your child regain true and healthy control over his or her eating, rather than trying to take control yourself.
Overcoming Binge Eating is available now, priced at £12.99
b-eat is a national charity which aims to combat eating disorders of all types. Helpline: 0845 634 1414. Youthline: 0845 634 7650.
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