Families For Life | Eating Disorders: Pre-teens and Teenagers

What are eating disorders and disordered eating?

Eating disorders are serious mental health conditions that also affect physical health.

These are the most common eating disorders:

Anorexia nervosa – this is when someone has a fear of gaining weight, restricts the amount of food they eat, and has a distorted body image.
Bulimia nervosa – this is when someone eats very large amounts of food and then gets rid of it – for example, by vomiting or using laxatives, diuretics or enemas.
Avoidant restrictive food intake disorder (ARFID) – this is when someone eats only a small range or amount of food and does not get all the nutrients they need.
Binge eating disorder – this is when someone eats very large amounts of food and feels distressed about their eating but does not try to get rid of the food.

Disordered eating is behaviour that is not as severe as the behaviour seen in anorexia nervosa, bulimia nervosa, ARFID or binge eating disorder. Disordered eating is still serious and can need treatment too. Someone with disordered eating might be at risk of developing an eating disorder.

Signs of eating disorders

Changes in your child’s eating habits, mood, behaviour, physical health and appearance can be signs of eating disorders.

Note that you do not have to be ‘thin’ to have an eating disorder. In fact, rapid weight loss in pre-teens and teenagers of any size can be a sign of an eating disorder.

Food and eating habits
You might notice that your child:

Prepares food for others but does not eat it
Cuts down on portion sizes or shows other signs of highly limited eating and dieting
Cuts out ‘junk food’ or major food groups like meat or dairy
Eats large amounts of food in a relatively short period of time
Complains about the colour, smell, texture or taste of food.

Moods
You might notice that your child:

Seems anxious, angry or irritable, particularly around mealtimes
Feels ’out of control’ around food
Experiences shame, guilt and self-loathing in relation to food.

Behaviour
You might notice that your child:

Avoids social activities, particularly ones that involve food
Talks a lot about food but does not seem interested in eating
Has rituals for preparing and/or eating food
Goes to the bathroom or toilet straight after meals
Wants to try different diets
Vomits or uses laxatives or diuretics
Exercises too much, goes for long walks or runs, or exercises alone in the bedroom.

Friends, teachers or coaches might tell you that something does not seem right with your child.

Physical health and appearance
You should also be concerned if you notice physical changes in your child, including:

Irregular periods or loss of periods
Constant tiredness or lack of energy
Rapid weight loss or gain
Complaint about being cold all the time, even in warm weather
Fainting spells or dizziness
Very dry skin
Constipation
Soft downy hair growing on your child’s face, arms or torso
Hot flushes or sweating episodes
Reflux, bloating, nausea or feelings of fullness
Hair loss from their head.

Swollen or puffy cheeks, damaged teeth or gums and sores on the knuckles or hands might be signs that your child is making themselves vomit.

Pre-teens and teenagers of both genders can develop eating disorders.

Talking with pre-teens and teenagers about disordered eating and eating disorders

If you notice any of the signs above, you need to talk with your child and your General Practitioner as soon as you can. If you just think that something is not right about the way your child is eating or behaving around food, trust your judgment and talk with your child.

It is important to be sensitive, caring and non-judgmental when you talk with your child about food, weight and body image, but it could be a difficult conversation.

You might feel worried, and your child might get angry and say that there is no problem. Even if this happens, try to stay calm and send the message that you are concerned about your child’s health and wellbeing, not your child’s weight and appearance. You might need to say that you think your child needs to see a health professional.

If you are not sure how to talk with your child about these issues, you could ask your General Practitioner or a mental health professional for help. Contacting a support organisation for eating disorders is another option.

If your child has an eating disorder, your love and support will be very important in helping your child get better.

Getting help for eating disorders

If you’re worried about your child’s eating habits, it is best to take your child to see the doctor in a polyclinic who may refer you to a team of doctors at Singapore General Hospital or KK Hospital who specialise in dealing with patients who have eating disorders.

Early intervention for disordered eating can stop problem eating turning into a more severe eating disorder. It might save your child from intensive treatment and a very long recovery. Also, it might be easier to get your child to see a health professional now rather than later.

Support services for eating disorders

For adolescent eating disorders support services in Singapore, contact your nearest hospital or speak to your General Practitioner.

For information about support and treatment services for eating disorders, you can also contact:

KK Hospital - their multidisciplinary service provides treatment for young people aged 16 and below with eating disorders.
SGH Eating Disorders Programme - they have a dedicated treatment programme for the management of eating disorders, such as Anorexia Nervosa, Bulimia Nervosa and Binge-Eating Disorder.

Why pre-teens and teenagers can be at risk of disordered eating and eating disorders

We do not know why some children develop eating disorders. However, adolescence is a risky time for pre-teens and teenagers treating their bodies in unhealthy ways.

During adolescence, your child’s body and brain grow and develop very quickly. There are many changes going on in the way your child thinks, feels and relates to people. Your child is more influenced by messages from media, school and other places. Many pre-teens and teenagers also become more aware of body image.

At the same time, your child needs more of the right kinds of food. However, it can be harder to keep up with teenage nutritional needs because they are growing so fast.

Also, lifestyle and food habits might change as your child begins to eat more meals and snacks away from home.

So you might notice some changes in your child’s eating habits and attitudes towards food, including:

Eating at random times and/or skipping meals
Eating more convenience foods and high-energy sugary snacks and drinks
Being more aware of information about ‘healthy’ eating, body image and weight control
Experimenting with dieting, or deciding not to eat certain foods or food groups.

The combination of all these things can lead some pre-teens and teenagers to develop eating habits that are not good for their growing bodies.

Other risk factors for eating disorders

We cannot link eating disorders to a particular gene, environment or personality type. However, there are some factors that can put pre-teens and teenagers at higher risk of developing an eating disorder.

These risk factors include:

Family history of eating disorders
Dieting
Perfectionism
Obsessive compulsiveness
Family history of overweight or obesity
Early puberty
Anxiety and depression
Low self-esteem.