When a young person’s eating pattern is disturbed, it is surprising how quickly this can lead to changes in weight and may have serious medical implications.

There are many reasons a young person may experience a disturbance in their eating, or sudden weight changes. These may include changes in mood, illness, a growth spurt or a period of intense training for sport.

Parents must remember that weight gain and height increase is normal and expected for children and adolescents. It is cause for concern if your child is not gaining weight or is not growing.

It may be surprising to know that malnutrition can happen to anyone, whether they are overweight, normal weight or underweight. Malnutrition happens when a person does not eat enough food to meet their bodies’ energy requirements. In young people, malnutrition is especially detrimental because it affects growth and development, as well as the ability to manage tasks and demands (such as learning).

Malnutrition can affect young people who have lost weight quickly (i.e. 500g or more per week), even if they are still a normal weight or overweight. Even a seemingly ‘small’ weight loss (e.g. 2.5kg for a 50kg person) is serious, as this is 5% of their overall body weight.

There are two ways malnutrition can occur:

1. When the body does not receive enough volume of food over a period of time.
2. When the body does not receive enough variety of food over a period of time, resulting in a deficit of vitamins, minerals and protein.

Dieting is a way people try to restrict the quantity and/or variety of food which can lead to malnutrition.

There are physical, cognitive and social effects of malnutrition.

Physical effects of malnutrition include a reduced core body temperature and sensitivity to the cold. Malnutrition has an impact on the cardiovascular system, resulting in dizziness or fainting episodes because of a low heart rate. The development of the reproductive system may be delayed or it may not function normally. Young people may complain of gastrointestinal problems, particularly if they restrict how much they eat.

A malnourished brain will have altered thinking patterns. It will be more difficult for young people to make decisions, sustain their level of concentration and understand new information.

Young people can experience changes in mood as a result of malnutrition. They may seem more depressed or anxious. They may have problems recognising and expressing emotions.

Social situations can become stressful and young people may become less interested in spending time with their friends and family.

Overnutrition is also a problem. This happens when someone consistently eats more food than required for their physical needs. It can result in weight gain over a long period of time, and may negatively affect a person’s health.

If a young person is overweight and it is affecting their health:

• Speak about your concerns with your General Practitioner.
• Seek a health professional who will provide support in a collaborative, family based framework.

The focus should be to move towards healthier behaviours rather than a focus on weight loss.

“I wish I didn’t wait so long to get her to the Doctor. It was very early on but I still kick myself for not recognising the signs earlier and doing something. I know now every day counts!”

-Parent of a young person with an eating disorder

Some young people with disordered eating may experience binge-eating episodes. These episodes are characterised by two features;

1. A subjective sense of loss of control.
2. Consuming an amount of food much larger than most other people could consume in the same period of time.

Binge eating is usually associated with high levels of distress and embarrassment. Because of this it is often done in secret. A person may appear to eat normally at other times.

There may be particular events or situations that increase the likelihood of binge eating. These are referred to as ‘triggers’. There can be one trigger, or a number of triggers for binge eating. Triggers can include negative emotions, negative thoughts about body shape or size, or thinking a lot about food. Young people who are not eating regularly or restricting the amount of food they eat are at higher risk of binge eating.

Young people with eating and body image problems may engage in behaviours aimed at compensating for the food they have eaten, or to reduce emotions such as anxiety and guilt that can be experienced after eating. These ‘compensatory behaviours’ can be dangerous and include dieting, excessive exercising, self-induced vomiting and taking laxatives, ‘diet pills’ or diuretics. It is important for parents to act swiftly if they notice any of these behaviours, as they can become habitual quickly.

“Speak to a professional at the earliest point you think things are becoming abnormal. Don’t wait to see if you can ‘fix-it’ by yourself.”

– Parent of a young person with an eating disorder

Diets are not effective. Dieting may help young people lose weight in the short term, but in the long term it leads to further weight gain.

Dieting can result in many problems with both physical and mental health. It is a major risk factor for eating disorders.

Dieting tends to occur in three ways:

• Changing regular eating patterns, such as as skipping meals
• Restricting the amount of food eaten
• Avoiding certain types of food, or food groups

All of these methods of dieting can lead to problems with binge-eating. This is because the person is hungry.

The best way to maintain a healthy body shape and size is to eat regularly and be physically active.

Self-induced vomiting is another compensatory behaviour young people sometimes use in an attempt to control their weight.

Vomiting can lead to serious medical complications and does not have any impact on body shape or size. Young people may use self-induced vomiting after eating; falsely believing it may reduce the calories from food absorbed by the body. Parents may want to monitor bathroom use during meals and for about an hour following meals. Young people may try to conceal their vomiting, for example by taking showers after meals (to obscure the noise), by frequently brushing their teeth or using breath mints.

Some young people may use laxatives, diet pills or diuretics after eating in an attempt to control their weight. This can lead to a number of serious medical complications.

Laxatives, diet pills and diuretics have no impact on body shape or size and do not change the way calories from food are absorbed by the body.

Young people with eating and body image problems often find themselves using physical activity in an unhealthy way. Sometimes this is obvious e.g. when a person is engaged in repetitive, energy burning and strenuous activities like pacing, sit ups or star jumps. However, sometimes it may be more difficult to recognise because it may look a lot like healthy exercise.

Below are some indicators that will help parents determine if the level of exercise may be a problem:

• The young person feels compelled to exercise and experiences feelings of guilt or distress if they do not exercise.
• The main goal of exercise is to change their body shape or size.
• When exercise is very time consuming, and displaces other normal activities e.g. sleep, socialising, school work.
• When the young person continues to exercise despite injury, exhaustion, when ill or against the recommendation of their coach or doctor.
• If exercise is done in secret.
• When exercise is almost always done alone.

The feelings of guilt experienced when a young person tries to resist the urge to exercise will make it very difficult for them to overcome this alone. Parents may need to set limits on the amount of exercise their child undertakes and support them with any distress they experience because of these limits.

“I feel pretty stupid for not spotting it earlier. I didn’t see it as a problem until too late. Initially I thought that my daughters sudden interest in good health, healthy eating and exercise was a great idea and that I could influence her making appropriate decisions. Pretty soon it became obsessional and I found it very difficult to influence her behaviour.”

-Parent of a young person with an eating disorder.

It is important to remember that if a young person is losing weight rapidly, experiencing significant fluctuation in weight over a short period of time (even if they are ‘normal’ weight), or engaging in compensatory behaviours, they are at risk of becoming seriously unwell.

Some behaviours that can quickly lead to medical instability include:

• If a young person stops eating or severely restricts their food intake for a few days
• Restricting fluid intake over a few days
• Too much fluid intake (more than 3 litres per day)
• Self-induced vomiting multiple times a week
• Regularly using laxatives or other medications in an attempt to control weight

Warning signs of medical instability that parents may notice are:

• Fainting episodes, or dizziness
• An irregular, very fast or very low heart beat (less than 50 beats per minute)
• Feeling clammy or constantly cold, with cold blue extremities
• Chest pain, or having trouble breathing
• Complains of ‘pins and needles’, or unable to feel their hands or feet
• Extreme fatigue or exhaustion
• If there is blood in their bowel movements, urine or vomit
• Confusion or disorientation (e.g. aren’t sure where they are)
• Rapid weight loss (500gm-1kg a week for a few weeks)

If any of these warning signs are observed, it is recommended parents immediately take their child to the Accident and Emergency Department of their local hospital for medical assessment.