How to talk to teenagers about eating disorders – and why boys may need help too

Before lockdown, Kitty had never been on a diet. But when she stopped going to school last March, the 15-year-old spent so much time in her room that she got sucked into a vortex of social media challenges suggesting she should use the time to get washboard abs.

At first, when her mother Jane, 53, heard her working out upstairs, she was just pleased that her teenager seemed to be staying healthy.

What she didn't realise was that when Kitty felt she wasn't getting a flat tummy like the other girls she saw online, she was visiting the loo after every meal to throw up.

For six months, Kitty told no one. But then finally her older brother, heard her vomiting, noticed the smell and alerted Jane.

“I felt wracked by guilt that I hadn’t realised," says the retail manager from St Albans, Herts. "I’d even been pleased she was keeping fit. When I confronted Kitty, she was furious with her brother for telling me.

"But then of course the last thing she wanted was for me to take away the one thing she used to keep herself feeling in control of her life. I virtually had to frogmarch her to see our GP to get help, but it's been a long slow battle, which isn't over yet."

Noticing when our children’s eating patterns stop being healthy, and knowing what to say if we suspect they are becoming destructive, has become one the greatest challenges of modern parenting.

If we do realise something is wrong, we may be so panicked by the knowledge that eating disorders are among the most difficult mental health illnesses to treat – as seen with the death this week of Big Brother star Nikki Grahame at the age of 38 after a life-long battle with anorexia – that we simply don't know where to start.

But with a huge increase in eating disorders cases over lockdown – the charity Beat saw a 73 per cent rise in people seeking help in the months after – and with access to services taking longer, knowing what to say as a parent has never been more urgent.

And increasingly it’s a conversation that we may have to have with our sons, as well as our daughters.

Eating disorders rates are going up for boys, too – they now account for up to 25 per cent of cases – showing up as obsession with gym-going and clean-eating, as well as disorders which were once more traditionally associated with girls, such as anorexia and bulimia.

So how should parents broach the subject, especially if they fear there is a genuine cause for concern?

Be alert to the signs

Secrecy is an important element of eating disorders and it can be difficult to help a teen to recognise they may need help. Look out for signs they want to eat alone, they are skipping meals, hoarding food, disappearing into bathrooms after meals or are adopting extreme exercise habits at the expense of other activities, or even wearing baggy clothes to hide their shape.

Psychotherapist Kerrie Jones, founder of Orri-UK.com - a day care eating disorder treatment centre, says teens may also become hyper-vigilant about what they are eating. "They may start taking an interest in what it says on the back of the packaging, like the calorie content, or ask you whether you are using ingredients like olive oil in your recipes."

See it through their eyes

Teens often feel frightened of their eating disorder being discovered because it may have become a coping mechanism which makes them feel safe and in control. Eating disorder psychotherapist Kerrie Jones says: "I often say to families, 'Try to imagine how that sounds to a young person. It can be a bumpy ride so patience is so important.'"

Plan what to say

If you have been given reasons to suspect disordered eating, don’t rush to confront them. Instead choose a time when you are both calm and relaxed to bring it up. Ask your teen: “What’s worrying you?” Then question how these concerns may be impacting on other areas of their lives, like eating, as well as sleep, friendships, and schoolwork. Remember that disordered eating may often disguise other problems, like anxiety, low self-worth or isolation, so kindness and compassion are always the way forward.

Say what you see

If you still have reasons to be concerned, Kerrie Jones advises parents to stick to the fact that they have noticed. "You might say: 'I’ve noticed that you often go to the bathroom after meals, or the bathroom smells of sick when you've been in there’ or ‘I'm noticing that your weight is fluctuating’. Be prepared for anger. But keep talking and let your child know you are there when they are ready to talk.

Offer them different ways to seek treatment

Getting a young person to seek help can be difficult. So offer suggestions, whether it’s texting the support service of their choice or choosing from a range of counsellors that they might like to work with, says Jones. “Give them some links, sit down with them and look at them together. Let them feel you are getting their permission to seek help."

Take off the academic pressure

Put your child’s health first. A string of A-stars will be no use to your child if they fall ill. The stress of trying to get top exam results can get in the way – and many young people can step off the academic conveyor belt for a while and get back on at a later date, with no permanent ill effects.

Don't let an eating disorder define your relationship

Young people with eating disorders are often also struggling with feelings of shame, fear of disappointing parents and low-self worth. Spending time with your son and daughter and showing you love them and enjoy spending time with them, without bringing up the subject, will help to counteract these feelings.

Take the stress out of meal times

A child with an eating disorder will often feel watched. Find ways to take the stress out of meal times, whether it’s by cooking and eating together or playing games around the table while you eat. Jones says: “Put on the TV if it helps."

Watch out for boys too

In recent years, the rate of eating disorders has increased among boys, partly in response to the rise in expectations about how males should look. In boys, it may also take the form of obsession with exercise and bulking up at the gym. They may also be susceptible because they will have observed that such physiques are more likely to earn them social status in their peer group, as well as attract sexual interest at a time when both are critically important to them.

Gauge the level: If your son uses apps or that measure exercise and calorie intake, ask him to talk though his regime. In a non-judgemental, and curious way, try to find out if he’s working out to be healthy or mainly to look good. Ask him what his goals are.

Talk to your son about idealised bodies: What many adolescents do not realise is that most of the male bodies they idealise are often only achieved only with the use of anabolic steroids or airbrushing. Talk to your son about how he may be chasing a body type that is impossible to obtain without putting his health at risk.

De-stigmatise eating disorders: As a boy, your son may feel embarrassed to talk about his body image issues believing that’s just for girls and adhere to "the boy code of silence", because he thinks talking about his fears is a sign of weakness. Your teen may also feel on his own, believing that he is "the only one" who feels this way. Look out for services for men that will help him feel he is not alone.

* Names have been changed

Tanith Carey is the author of 'What’s My Teenager Thinking?' Practical Child Psychology for Modern Parents', with Dr Angharad Rudkin, published by DK and available from the Telegraph Bookshop