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Hello and welcome to teenagers untangled the audio hug for parents going through the teenage years. I'm Rachel Richards, mother of two teenagers and two bonus daughters. For some time now, I've been conscious of eating disorders as a phenomenon that's particularly prevalent in the teen years. Although it can strike at any time of life. I wanted to cover the topic. But even though I've supported another parent through their teen having an eating disorder, I've experienced one myself and had a teen struggle with it, too. I didn't feel remotely comfortable covering it. The issue is incredibly complicated.
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And even professionals struggle to give definitive treatments.
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Meanwhile, parents report that they've been turned away by specialists because their teen isn't ill enough for treatment or, ironically that they're too ill. So to help navigate this topic, I decided to bring in my room Malik, who's the clinical advice coordinator at BT, which is the UK is main eating disorder charity. Whenever people ask for support on Twitter, it's the first name that comes up, listen to the end, because she's actually worked on the phones with desperate people, and comes up with some really great tips for us parents, she began by explaining what an eating disorder actually is. Thanks, Rachel.
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It's great to be here.
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And so anytime disorder is complex mental illness, we estimate that it affects around 1.2 5 million people in the UK, but the actual figure might actually be higher just because of the stigma and the difficulty in measuring how many people are affected. But it's essentially when people use food to manage difficult situations in life, it might be that, you know, there's something going on, and they're using food to navigate difficult situations coping with difficult feelings, big changes in life, the the
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general feeling is that it's mostly young teenage girls who are impacted, too. So that's not the case.
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It's
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not not. So there are people, typically, people at adolescence or young adult age are at highest risk of onset, but anyone at any age can be affected. So earlier this year, for example, we focused on men with eating disorders, and we estimate around one in four people or males who are affected. And people have, you know, different ages, older people, people of any ethnicity.
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Any kind of personal characteristic that someone can have anyone can be affected.
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And I think one of the difficulties is that parents don't really know what the triggers are, which is what's scary for us, because you our kids move from us controlling their eating and saying this is how you're going to lead to them, then having a bit more agency over it. And we just don't know what to look out for. Are there any key triggers or things that we could be watching out for?
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Yeah, and I think you're right, it is difficult as a parent, there are so many things to look out for so many different changes that are going on in one person's life. And that, in particularly, as you've said, there's this movement away from food people might be, you know, eating out with friends, you know, they're eating in school, or they're preparing their meals by themselves. And I think sometimes it can be helpful to move away from the focus of why it might be happening, although identifying big changes, like, you know, transitioning or like, maybe there's a particular difficult event going on in a young person's life that are really important to be mindful of. But signs that someone might want to look out for are things like, you know, someone's saying that they've eaten earlier, or that they've, you know, that they'll eat later, maybe they're saying that they've eaten more than they actually have. But on the other side of that, there's also, it's not just about eating less or restricting intake, there might also be children who are eating more than they usually do. There might be unexplained instances of food going missing, in which case, you know, they might be binging things like are is, you know, your child going to the bathroom immediately after eating, because then that might indicate that they're purging. And those signs can be really helpful to look out for. But equally at the same time, there might not be any visible signs. And I think sometimes that's what can make it difficult, but trusting you know, your child, and trusting your instincts about that, and then moving on to having a conversation with them can be a really useful way to navigate that because of the fact that there can be so many physical and emotional signs.
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So I wanted to pick up on that because you say Okay, so moving on to having a conversation with him about it.
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I think, again, we parents are scared. How do we broach this with our kids in a way that's not going to make them just conceal everything that's happening and back off?
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Yeah, I think so. One of the main concerns we often hear from parents is what if I say the wrong thing? What if I make it worse? And I think leaning into that concern is important, because educating yourself and making sure you're as informed as possible in the conversation that you want to have. And on eating disorders before you approach your loved one can be really helpful, but also empowers you to have that conversation in a way that is works and that you're prepared for the different things that might come up. And also being prepared for the fact that it might be that your loved one comes back and denies that there's an issue. Sometimes that can be part of the eating disorder. And so then it's a case of coming back to it and revisiting it. And there are different ways that that conversation can be easier to have, for example, you might not want to have it around a mealtime, mealtimes can be distressing for anyone with an eating disorder. And so you want to start to stay away from that, you know, maybe it's you and a couple of other family members that have noticed that something's going on. But you want to do it in a way where it's not confrontational, where it's not, you know, lots of people having that conversation just to make it easier. And sometimes people might feel like they don't want to have a conversation face to face and abuse it next to someone or maybe have that conversation in a car, because then it takes that pressure off. And you're both not completely focusing on each other. I love awesome.
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Yeah. And you also want to make sure that, for example, you're not being confrontational, it's not a case of I've seen you do this, you've done this while you're doing this, making it quite open. So for example, I've noticed that you've not been sitting and having family meals with us, I've noticed that you've been going to the bathroom after straight after we've eaten together. Is there anything you want to tell me about that? What are your feelings around food at the moment, that kind of thing, as opposed to, I've noticed that you've lost this much weight, you eat this much food in a day.
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Because sometimes that can then you know, trigger someone's barriers to come up.
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So more of a non judgmental approach towards it and even talk about it. I suppose. I mean, it's what was very interesting when I was reading your literature was that there's an average of three and a half years for someone to get treatment after the symptoms begin. And I've spoken to one mother who dealt with this, and she said, it's a really sneaky illness. And it's very hard to spot because there are so many ways in which it can be, you know, they'll just wear baggy clothes, or they won't, they'll say, Well, I ate earlier or, and so for a parent, it's so difficult to hone in on what's going on and support our kids properly. Are there? I mean, obviously, they can call your helpline, but are there other, you said sort of try and find out as much as possible? What kind of resources are there for people to, to get information as soon as possible? Because you're saying you're saying, Look, you know, it's better that you know stuff before you approach them.
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But quite often we don't know things? Don't you know, we it's there are so many things we should be looking out for his parents i What, what do I need to know? And this, this suddenly becomes an issue where we think, Ah, this doesn't look right.
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What would you say we should be doing? You're
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right, it's incredibly isolating eating disorders, by their nature can be very secretive. And so when you come to you realize that there's something going on, it can be overwhelming. Even if you Google eating disorders or disordered eating, there's so much information that comes up. And so sometimes carers it was like you've just said it, and where do I go first. And so there is a lot of information on our website on how to approach someone and have that conversation with them. We've also got something called pod, which stands for peer support and online development. It's our online platform for carers, so anyone supporting someone with an eating disorder, and we've got lots of different videos on their bite sized, you know, information that people can watch in their own time. And I think that's something that's really important to emphasize that, you know, take your time.
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You want to blame for your child developing an eating disorder, parents aren't to blame. And we know that. And so that can be really helpful the platform that we've got, also speaking to other people in similar situations, which you can also do through our online platform.
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Eating disorders are isolating for the person who's going through them, but they can also be incredibly isolating for anyone who's supporting someone, and to taking the time to, you know, get the information you need calling a helpline, if it's a particular issue that you're struggling with, and then going on to have that conversation.
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I think it's wonderful advice. What concerns me is that from what I understand, the quicker you can get treatment for your your loved one, the better. But it seems that first of all, we need to understand what's going on before we can really talk to them about it. And then everybody I've spoken to says it's nigh on impossible to get really skilled support, you know, in terms of mental health services, particularly here in the UK. I'm not sure what it's like in all the other countries, but I've had some very desperate pleas of people saying I just hearten, you know, almost that they're not ill enough to get proper support. What is how can we get? How can we expedite this process to get more done for our loved ones?
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Yeah, it's hard. You know, where all of our particularly in the UK is that the difficult landscape of the NHS at the moment? We know that services are working incredibly hard. They're seeing more people than they ever have before. But they're struggling to meet the demand. And it's something we often hear a lot as well that, you know, I've done all the things, but I'm still struggling to get help. What do I do? What do I do during this waiting period? And so if you are in that process, where you've, you've spoken to your GP, you know, you've been referred, but you're waiting, or you've been told that you aren't unwell enough, something that we've have found helpful is looking at the treatment guidelines. And you know, there's different guidelines and different areas of the UK, for example, the NICE guidelines, which would apply in England, Wales and Northern Ireland, is, they're very clear that they're just
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for people who are not in the country. Nice is our kind of over overarching body that will give out guidelines to all the all the health services,
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yeah, on different conditions. And then you have sign guidelines in Scotland.
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They're very clear on the fact that things like weight thresholds shouldn't be used to deny someone treatment. And now that's often a really common one that people are told it, you know, their weight is too high.
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And we know that anyone anywhere can be affected by an eating disorder, you know, very few people will actually be on the web with an eating disorder. And so I think it comes back to being informed but also using information like those guidelines to then advocate for yourself, to go back to your GP, or to contact the eating disorder service directly to say, you know, this is what I have a reasonable entitlement to include, can you provide me the right treatment that's in line with those guidelines. But also, as a parent, as a carer, as someone supporting someone with an eating disorder, you've also got a certain reasonable entitlement to a certain level of inflammation. And so if you are really struggling with this, that's something that eating disorder services should be providing to parents and carers, you know, what can you do in a particular situation? Is there any advice that they can give you. So, for example, if like Mealtimes are becoming really confrontational or really emotional, then that's something that you're entitled to. But I think, and sometimes that can require quite a bit of persistence with a service or with a with a health care professional, particularly if you know, they're not trained in eating disorders, or if you're in an area where services are quite sparse because of a direct result of a commissioning decision. But continuing to push and remembering that it's okay to advocate for your child for yourself. And that's difficult.
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I think, you know, we've already learned it's incredibly difficult to do. And in an ideal world, it wouldn't have to happen. But continue to push and know that you do have a reasonable entitlement to getting the right support. Yes, from
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someone who has spoken with parents who were it's a daily, a proper fight, over trying to get their children to eat, and it feels so it's such a viscerally painful thing for a parent, because you know, and the message that's not your fault to parents is actually, I think, quite important. Definitely, have we seen a rise in in eating disorders? Because it seems like there's been a rise in them.
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Yeah, I think it's a combination of things. So we saw retries, on our helpline services have seen a similar rise in people, children or young people coming forward. And there's more people that are accessing those services, but also more people than ever trying to get into those services. And so I think it's a combination of probably an increase in awareness of eating disorders, but also the more children and people are affected when you think about the impact that the pandemic had on on everyone, but children or young people in particular, the, you know, the changes to their routine, not being able to see their friends, that the impact that it's had on their education, alongside the existing difficulties and challenges that come with being a young person. All of those amounted together, are all going to contribute, but alongside the people who might not for some people, there might not be an evident reason as to why they've developed an eating disorder.
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But all of those things brought together are contributing and mean that more people than ever need help. What
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are your thoughts on social media? If a parent comes to you and says, you know, my child's on social media, should I be blocking it?
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What how? Because, you know, we've all heard the stories of how there can be accounts that you know, from everywhere you go, this is diet culture. You know, which can feed disordered eating? You know, what would you be saying to a parent who asked you a question like that?
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I think social media is a difficult one. And it's always going to be very individual to the situation of the parent and their child. Now, there isn't enough evidence to say that social media causes eating disorders, but it might impact negatively impact someone who's already vulnerable to developing one or if someone is in, someone already has an eating disorder, it might make their eating disorder behaviors or thoughts worse. And yeah, it's competitive. Yeah.
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The other people talking about their own eating disorder, then they can think, Oh, well, I'm not doing it hard. You know, I'm not being
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Yeah, yeah, that content is, like you said dangerous, particularly where it's like you're saying promoting the eating disorder behaviors, obviously, for that person, it's coming from their eating disorder, but it's difficult, then kind of triggering for the people to see. And so having those open conversations about how damaging that content can be, I think, is really important to say that, you know, there is so much on social media that isn't representative of real life, it isn't realistic, but having conversations as well about diet culture, and how damaging that can be, is can be really useful.
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And you know, at the same time, maybe maybe you have, if you're not in a position where you want to completely take social media out of the equation, are there accounts that you can find that are about, you know, promoting healthy relationships with food and healthy relationships with our bodies to sort of counteract some of that negative information. But definitely, I think if it's something that a parent is concerned about, you know, have that conversation with them, discuss what kind of content they're looking at. And also being mindful of how algorithms work. So you know, the more you watch a certain type of content, the more it's going to come up on your feed, just because that's how social media is set up to make us stay on it as long as possible. And I think modeling healthy relationships with social media in your own life can also then help you have that conversation with about it with your child.
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That
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makes so much sense. This almost sitting side by side with your teenager and talking through, we had a similar conversation when I was talking to Taylor and Malia about the trans movement and this kind of be aware of where your children are going on social media, what are they looking at, with a judgment free approach and just trying to normalize a different way of looking at it that's much healthier, so that they can start moving towards a more positive viewpoint of the way the world works? Yeah. Yeah. One of my, the people who listened to the podcast said that one of the massive game changers to her that the best thing she did in helping her daughter recover was to talk to a nutritionist. And the nutritionist explained what her body actually needed to live, you know, for the organs to function. And that then took the control out of her hands, that she actually had to have that just to exist, rather than it being a choice. I don't know what what do you that?
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Obviously, that works for her.
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It's not going to work for everybody. Are there other, you know, think tips, things you've heard that can really support and help parents when they they're on their own? They're at home? They're trying to help their child?
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Yeah, I think there are different books that can be really helpful that have some of this information. We've got a list of helpful books on our website for parents carers of supporting someone with different eating disorders. But I think it's like you said, it's gonna be different for everyone.
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But having that information from a healthcare professional is really valuable, particularly as the amount of food that we're eating is going to be so individual to everyone in the amount that we need to function and to thrive. And so if it is, if you are in a position where something like that would be helpful, you know, can you have a conversation with your GP about maybe speaking to a dietitian? Is it something that the eating disorder can provide the eating disorder service? Is it something that they can offer? Have they got resources or information, but using trusted sites of information? So you've got for example, like if it's a dietician, you've got the British Dietetic Association, who have, you know, information that's evidence based, and founded on clinical expertise and lived experience? So that's really important before we start, you know, offering advice, making sure it's trusted, and coming from healthcare professionals, because there can be so many different things that are spread so quickly on things like social media that aren't necessarily factual. I
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love that. Yes.
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And I think it's as a parent, you get desperate and I know when I've been with friends who've been going through this, you sort of look for anything, anything you can find Find that might support them. And the more I research, the more I found that there isn't really an agreement over how you fix this, this mental condition, this mental illness.
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Yeah, I mean, there's so much more research needed.
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And indeed him as orders, there are different treatments that are recommended in different areas of the UK and different ones will work for different people. And so sometimes it is a case of figuring out what works and if it's not working, trying something different. And so that's going to be the case as well, for a parent, you know, you might try something with your child or your team. And it might not work. But then you might try something else, it's about having that open dialogue as much as possible, because the nature of anything sort of means that sometimes he it might be quite confrontational, or people are in that stage where they're not yet able to recognize that they have an eating disorder.
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For example, something that we find that works for some people and doesn't is externalizing, the eating disorder. So for some people, it can be really helpful to say to them, so for example, you know, your teen says, I don't want to have this meal, you might say to them, it sounds like that's an eating disorder thought it sounds like I'm having a conversation with eating disorder at the moment.
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How can we challenge that? You know, can we combat that a little bit by saying, Okay, no, this is I need to eat, you know, I need to eat to survive. So I'm going to have this meal. And for some people, that really helps because it separates the eating disorder from them. Whereas for some people that might not work, it might be that they feel that the eating disorder is quite part of them, and they're not quite able to disentangle it as easily. And then that means that that kind of approach doesn't work. So I really think it is quite individual and figuring out these different things that you read about from trusted sources of information, and then having that conversation and taking it from there.
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I love that I have actually spoken to people who've tried that and almost given their other identity, a name, so their eating disorder, they call them ed or, and, and that because because when I've spoken to some parents who've had to deal with children going through this, they say, it's almost like I'm not talking to my child, they turn to someone different around mealtimes, because it's so triggering for them. And I have to do other things like switch the TV on so that they can eat, because they don't, we can't focus on the food. And just, and just anything, anything that gets in their mouth is better than nothing. So you know, setting aside all the ideas about you've got to have these many vegetables, and there's just anything that they'll eat will help. You know, are there other tips, any other things that you think if you were if you were to meet somebody in a schoolyard?
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And they potentially have a problem like this? What would you be saying to them?
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Yeah, I think, first of all, recognizing how difficult it is. And I think we've sort of discussed this a fair bit that is difficult, and it's about taking it slow, and in a way that everyone's looking after themselves. You mentioned one there things like watching TV.
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And so distractions can be something that are really valuable at mealtimes things. So for example, something that sometimes people do is make a placemat where it's all their motivations to recover. And it's can be something quite creative to do together. You know, you might have photos of people that you care about things that you're looking forward to doing, you know, if you're, if it's a teenager, you know, loving going to university, you know, images of the, you know, the career that they're working towards all these things that they need food to sustain themselves with, it might be positive quotes. It might be that you, as a parent want to do that with them, just so that, you know, it's something that you're doing together. And then having that meal times, that can be helpful.
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It might be that sometimes for people with eating disorders, the uncertainty of a meal can be can be really challenging, if they're not quite sure what's coming. So maybe you sit down and create a meal plan together for the week ahead, and maybe you do the food shop together as well, you know, depending on what kind of circumstances there are, and if that sometimes something that can help with categorizing food. So, you know, what are the foods that are really difficult at the moment?
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What are the foods that are quite easy to eat at the moment, and creating a combination of those within the meal plan that you're creating? And if it is something that you need more advice on obviously, having that conversation with a healthcare professional, and then distractions before and after meals just because that time can be quite difficult. And something that's going to quite distract people from the how loud the eating disorder can be after a meal. You know, if you think about if your teen is being quite difficult or your struggling to get through them after, after a meal, it's it might be because you know, there's this incessant voice that's telling them horrible things about themselves, it might be telling them to compensate for what they've eaten or engage in an eating disorder behavior. And so what distractions are there that you can do together to help sort of bring that down a little bit, and you know, it's not going to be cured, it's not going to be curative, it's not going to make everything go away. But it's about in that moment, what's going to help make that a little bit easier. Things like playing board games, having a conversation, you know, whether it's watching TV, watching a film, any kind of activity that someone finds useful. People can find that useful sometimes to do something with their hands, men who take up any hobby together, you know, knitting, crocheting, all of these things that are huge at the minute. Any kind of distraction that you can do before, during and after a meal as well can be really helpful.
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Now,
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I saw that it obviously it takes a long time, often for things to be diagnosed, I have seen this happen very, very quickly. But the majority of the cases it takes a while before everybody's really sure what's going on. But it also is quite a long haul get becoming better? And what sort of do you think the I don't have information on what the average times are for? Because Because I all the people I know, myself have they have come through the other end, it'd be extremely hard. But there is there is light at the end of the tunnel, but it's a marathon. So what can they be expecting in terms of how long it will take?
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Obviously, it just depends on getting treatment. And but how long do you think that this sort of there could be expecting to be dug in for that for? Yeah, so
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I think something that we that's an alternative way of looking at it is, instead of sort of quantifying the time is maybe quantifying the stages. So sometimes we refer to the different stages of change. So for example, the first one is pre contemplation where someone is, in the early stages, they might not be ready to acknowledge that they've got an eating disorder. And you know, then they sort of move into the contemplation stage where they're kind of thinking of opening about, maybe they're acknowledging that they have a problem, sometimes it might be that they're not. And then it goes through the cycle of sort of, you know, making those changes, maybe that's during treatment being open to it. And then, you know, the recovery sort of stage where things are sort of getting better making positive changes. And although it's although it's a cycle, it's not linear, people might move through the different stages, you know, they might get better, and then they might have a setback. But no one is ever back at the beginning. Because there's always going to be so much that's that's learned through that process. And I think, like you said, it's a marathon, isn't it? And having, thinking, When am I gonna get right till the end can feel so overwhelming, because it might feel like there's so much more to go. But recognizing, I think the different positives that are happening, we call them Abby, we call them branches. And as a parent, it can be really difficult to identify them. And so we often encourage parents maybe once a week, think about things that have gone well. And I think although that can be really difficult in what is such a challenging situation, it can help to keep a record of them, particularly when you're looking back over a longer period of time to think about the things that have gone well. And like you said, it's it can be a long and hard slog, but it's holding on to the belief that that recovery is possible. You know, we see it every day we see it happen, and it can happen for anyone regardless of how long they've been struggling with this for.
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Yes. And I think just that the one that I love that they love that positive, the small positive reinforcements that make everybody feel like okay, we can do this, this is this is we're going somewhere, something's happening, because I think it can feel so debilitating when you're right in the thick of this. And I'm thinking of all the parents at home who are really in the trenches at the moment, I read a fantastic book by Hadley Freeman about eating disorders, which I'll put in the, because she's suffered.
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She's, she's a writer in the UK, and she suffered. And it's very, very helpful because, you know, she's come out the other end, she's a healthy woman. And she talks about some of the stages and, you know, the fact that it's not really anybody's fault and how this can start without anybody really understanding why. So I'll put that in the podcast notes. Omar, thank you so much for joining us. I really appreciate it. I think this is a really difficult topic. So it's very good to have an expert to cover it for us rather than me floundering around trying to find the information. And we'll put all your we've got all the contact details in the link. So anybody who's struggling with this, please go and look at the website. And also there are other resources that you can go to, which will give you and reach out to support. And if you're trying to support someone who's struggling with this at the moment, just keep calling them check in with them because a lot of the support just falls away because people feel awkward. They don't know what to say. Just being there and listening is is sometimes what people need.
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Definitely it thank you so much for having us on. And yeah, echoing what you've said, for anyone who's struggling, please do get in touch and hold on to the hope that recovery is possible.
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That was HUMIRA Malik, who's the clinical advice coordinator for the charity beat. Eating disorders are incredibly isolating, and they have a tendency to creep up on us. If you have any concerns about someone you love. Don't hesitate to reach out for help.
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There are lots of books and websites where you can get support and guidance. If you have a friend in this situation, reach out, just be there to listen at the very least. If you found this helpful, please share it with a friend on social media. Wherever you know people who have teenagers, you never know whom it might help. You can find all the links in the podcast notes and you can reach me with feedback at www.teenagersuntangled.com.
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That's it for now. Thanks for listening
