While eating disorders are common, they have serious health consequences and can be dangerous. Dr. Victor Kwok, Senior Consultant Psychiatrist, shares insights about a few conditions and how to spot if your child has an eating disorder.
Food is the primary nutrient source that provides all the energy for a youth's bodily functions and activity, growth and development, and keeping their immune system healthy. So, why do food relationships turn unhealthy?
“People with eating disorders have a distorted opinion of their body shape and weight, either worrying that they are too fat or that their weight is too high. As a result, it leads to abnormal eating behaviors such as eating a lot less, starving oneself or choosing low-calorie foods, engaging in excessive exercise and other ways to lose weight," Dr. Kwok explains.
On the other hand, an eating disorder may not always be linked to the perception of body shape or image, but can be just uncontrollable eating long after the person is full. It could be a coping mechanism for stress and anxiety. With the copious amount of food intake, weight can become an issue which means at some point, body shape and size dissatisfaction could set in. It works against their self-esteem, heightens stress, and causes more eating disorders.
He further explains that eating disorders are severe psychiatric conditions that often start when young. The conditions are often triggered during the transition years in school; an example would be the first year of starting in a new school.
“Some children may recall feeling embarrassed by remarks or teasing about their weight or body by family, relatives, or friends,” he adds.
“In the developing young person, eating disorders can lead to stunted growth and affect many different parts of the body. In young children, this can stunt their growth permanently. It can also go on to result in fertility problems and osteoporosis in later years. However, family members may not notice that someone has developed an eating disorder until after a few months," he says
There are genetic or biological risk factors where individuals with a close family member who suffered from an eating disorder are at a higher risk of developing an eating disorder.
Another risk stems from a family culture that focuses on external beauty and puts teens at greater risk of developing eating disorders. Children from these families try to achieve the appearance of success by being thin and attractive, even if they do not feel successful.
Images posted on social media further propagate our concept of beauty. Constant exposure to these online images increase their dissatisfaction and develops unrealistic expectations of how their body should look, leading to unhealthy eating behaviors and disordered eating.
A history of physical and emotional abuse at home or school, such as bullying and other stressful events and traumas, may also be linked to the development of eating disorders
There are several different eating disorders, but the top three most common eating disorders affecting youth in Singapore are anorexia nervosa, bulimia nervosa, and binge eating.
Anorexia nervosa is characterized by an extreme fear of gaining weight, and people with this condition often see themselves as overweight even when they are underweight. As a result, they may show behaviors linked to eating disorders like refusing to eat for long periods or excessively exercising. Bulimia nervosa, however, involves bingeing and compensatory behaviors including purging. Lastly, binge eating disorder is where people binge eat but do not purge or restrict themselves. In all of these conditions, there are body image issues.
According to Dr. Kwok, the stress and uncertainty during the pandemic may have triggered more cases of eating disorders in children and teenagers.
“They are also made to adapt to numerous changes in school such as using virtual classrooms and stopping of school activities,” Dr. Kwok says.
“Furthermore, there is greater awareness in parents, teachers, school counsellors, and family doctors of signs, symptoms, and the seriousness of eating disorders. There is also more help-seeking behavior by parents due to less stigma associated with mental health conditions,” he adds.
Studies have found that people with pre-existing disordered eating can develop worse symptoms. They may have more binge eating episodes, especially since the kitchen is better stocked.
“Eating disorders are dangerous because they carry the highest risk of mortality amongst all psychiatric conditions, even higher than depression. The risk of death is 10%. Therefore, it is important to seek help early from a professional who has experience in treating eating disorders,” he says.
“Eating disorders often happen insidiously and the teenager often hides the symptoms. When one’s child makes an effort to lose weight, especially when their weight is normal in the first place, talk to them to see if they have strong body image issues," Dr. Kwok advises.
He also suggests looking for signs like excessive exercise, fear of sitting down after meals, and excessive walking.
“They may also skip meals, or keep making excuses that they have eaten. When eating with family, they may get angry with normal portion sizes and insist on small portions. They will also refuse food that they deem unhealthy or high in calories,” he adds.
Other signs are episodes of uncontrollable eating and running to the toilet after meals. They may also spend more time looking at recipes and food programs on social media and cook more.
Healthy eating is good, but obsessively going for a diet could mask a dangerous eating disorder.
“I have seen patients with extreme diets and excessive exercise that lead to unhealthy weight, vitamin deficiencies, and medical problems. They may have much dissatisfaction with their body, or they may lack insight into their body image issues,” Dr. Kwok says.
Eating disorders are usually treated by a team involving a psychiatrist, a pediatrician, psychologist, occupation therapist, and dietitian. The doctors concerned will conduct physical examinations and blood tests to ensure the patient is not in danger. However, patients may require urgent admission for medically unstable cases such as blood abnormalities, low heart rate or extremely low body weight, or feeling suicidal.
“Once they are medically stable, the parents will have to work closely with the medical team to help the child restore normal body weight and restore normal eating behaviors. For those who are also anxious or depressed, they may also consider antidepressants," Dr. Kwok advises.
Cognitive Behavioral Therapy (CBT) also effectively treats binge eating disorders. It helps patients learn to cope with issues that trigger binge eating.
Family-Based Therapy has been scientifically proven to help and is the gold standard intervention to help teenagers beat their eating disorders.1 First, parents must closely work together to supervise all meals. Then, when the eating patterns and body weight improve, parents can gradually return control to the teenager.