Transcript for
How to talk to children and young people about disordered eating

Narrator (00:02):

Welcome to the Emerging Minds Families podcast.

Alicia Ranford (Host) (00:06):

Hi. I’m Alicia Ranford, and you’re listening to an Emerging Minds Families podcast. In today’s episode, we will be talking about disordered eating. So if you feel that this may cause you some distress, perhaps give this episode a miss and join us next fortnight or you can find some resources for support in our show notes.

(00:23):

We live in a society that often places importance on unrealistic body standards, and many children and young people struggle with the relationship between food and their bodies. If you or someone you know has experienced disordered eating, you’re not alone. Today, we’re talking to Ellen Murray. Ellen is a mental health nurse who supports children and young people who experience disordered eating. She works to repair their relationship with food and also helps them and their families navigate through what can be an incredibly difficult time. Welcome, Ellen. It’s great to have you back here today with us on the Emerging Minds Families Podcast.

Ellen Murray (Guest) (00:55):

Thank you so much for having me back. It’s wonderful to be here.

Alicia Ranford (Host) (00:57):

Ellen, I imagine many of our listeners today would be familiar with the term eating disorder but perhaps not so much with the term disordered eating. Could you start by explaining the difference for us?

Ellen Murray (Guest) (01:08):

Absolutely. I think a lot of young people or even adults can certainly display signs of disordered eating. And when I think about disordered eating, I think about active attempts to lose weight, which often show in restriction, cutting out certain food groups, fasting for long hours or intermittent fasting as it’s known as now, engaging in really excessive exercise, engaging in some really unhelpful behaviours like purging, which is inducing your own vomiting and laxative abuse. So there are a certain set of behaviours that are linked to disordered eating but perhaps don’t quite meet the criteria in terms of the severity of the symptoms, how long it’s been happening for and how consistent it’s been over a space of time.

(01:51):

The way I look at disordered eating when we meet with young people who are assessed in our clinics is if the diagnosis ends up being disordered eating, I look at that as the potential for evolving into an eating disorder if there isn’t interventions put in place. So certainly, it’s almost like a pre eating disorder for some people, and it’s really important at that point for the young people to get some help.

(02:13):

There are many eating disorders that exist, and currently, with the research that we have, there’s up to one million people in Australia living with an eating disorder. Of that one million, 47% of those live with binge-eating disorder, 12% have bulimia, 3% have anorexia, and 38% have something that’s called eating disorder not otherwise specified. So that falls into a category of an eating disorder but it doesn’t quite meet the criteria of, say, anorexia or bulimia. Typically, though, binge-eating disorder aside, eating disorder manifests as an overevaluation of weight and shape so really being quite hyper fixated on how our body looks, what our weight is and having a lot of concern about what people think of us as a result of that.

(02:57):

There’s also a preoccupation with oral intake, so eating and drinking can be affected to the point where there’s extensive amounts of restriction every day, calorie counting, gauging in other compensatory behaviours such as purging or laxative abuse, excessive exercise, cutting out all food groups. There’s a number of behaviours, but typically speaking, the criteria of an eating disorder usually is a preoccupation with oral intake with food, with water, and the need to restrict that or to limit it because you have an overevaluation of your weight and shape and the two are connected. So that leads to really driven behaviours that can really be quite consuming.

Alicia Ranford (Host) (03:35):

So today, we are going to focus on disordered eating. Can you tell us in your experience some of the underlying factors that contribute to why children and young people perhaps experience disordered eating?

Ellen Murray (Guest) (03:46):

I think a lot of it boils down to the world that we live in. We live in a world that really puts a lot of value on thinness and having our body look a certain way. So some children experience levels of disordered eating because they do have an overevaluation of their weight and shape and what that means to the rest of the world. So they view their body, their weight, the shape of their body as something that puts value on them and who they are that they’re concerned about how people will perceive them if their body isn’t a certain size. And so that can definitely lead to disordered eating because we know that if we diet or if we adjust the way we’re eating, that can potentially lead to weight loss, which could then lead to my body looking differently and me being happy with that. So that overevaluation or that emphasis on our body looking a certain way is certainly one of the leading factors that can lead to disordered eating.

(04:39):

I think we live in a world where there’s a lot of normalised conversations about weight loss, and people are often praised for weight loss regardless of why they’ve lost weight. And I think about people who potentially are really unwell and receiving something like chemotherapy and they lose a lot of weight and they might get comments and compliments about that. Children are like sponges. They absorb everything that they hear and they see. And so if they’re seeing the adults in their lives praising people for losing weight, they’re going to internalise that and try to make sure that they fit a view that their parents are going to be proud of, which can lead to disordered eating.

Alicia Ranford (Host) (05:17):

How should we talk within families about health and weight and from what age should we be doing this so that we create healthy habits for the whole family?

Ellen Murray (Guest) (05:25):

I think it’s really important for parents or caregivers to be representing themselves what they hope that their child or children will internalise. So I think it’s really important from a very young age, from a point where maybe a child can even talk and understand the world around them, to be talking about our own bodies in a positive way rather than a negative way because children will absolutely pick up on negative terms associated with specific body types, and certainly, from there you are increasing the risk of disordered eating behaviours coming into play.

(05:57):

So I think it’s really important as a family to think about what relationship we want our children to have with their own bodies. Do we want them to grow up hating themselves for how they look or do we want them to grow up being accepting of who they are, not just because of how they look, but who they are as a person? As families, we should be really thinking about how we can represent healthy relationships with food by showing regular eating, by eating together as a family at the end of the day and talking about our days together and really embracing that time and also enjoying the food that we’re eating, not putting any moral value on it being healthy or unhealthy, simply it being fuel for our bodies and nourishing our bodies for the days to come.

Alicia Ranford (Host) (06:39):

And I imagine for many parents and caregivers, it can be hard to know if their child or young person is just perhaps going through a phase or if there is something much more serious at play. What should they be watching out for?

Ellen Murray (Guest) (06:50):

So generally speaking, young people shouldn’t really be losing weight. As they’re getting older, their bodies are developing, particularly as we’re hitting times such as puberty, our bodies should be growing. If we have a young person who is losing weight, there’s something wrong. And whether or not that is directly related to active pursuit of weight loss through dieting or whether there’s something more sinister at play like an illness, it is something for parents to take seriously.

(07:16):

I think parents should be aware of the child’s attitude towards food and towards mealtimes. Are you visibly seeing that they are eating regularly? Are they trying to get out of eating a certain meal every day? Have they slowly over time cut out more and more of that main meal to the point that they’re now only eating two or three mouthfuls? Are you finding there’s a lot of pushback around food or are they no longer wanting to eat food that previously they would have eaten without a care in the world? These are signs to me that says there’s a disruption there between the relationship with food and how that young person sees food affecting their bodies.

Alicia Ranford (Host) (07:52):

And if parents do notice these behaviours, what can they do at home to support them?

Ellen Murray (Guest) (07:57):

I think it’s really important to have very honest conversations and raise that level of concern. It can be as simple as saying, “Hey, I’ve noticed that you haven’t really been eating your breakfast lately. Is there something going on? Do you want something different for breakfast or is there a reason why that I haven’t quite picked up on? Having a bit of a conversation is incredibly important. And kids may lie and they may not be as truthful as you’d want them to, but I think showing your child that you do have a level of concern about their physical state because of the behaviours you’re witnessing, whether that be restricting food or weight loss, I think letting them know that you’ve noticed is an incredibly important part to stop the behaviours from happening and to interfere.

(08:36):

I think it’s really important to then seek some professional advice and support through a GP because we do know that children in particular can deteriorate quite quickly physically with weight loss, so making sure that they can be medically monitored by a GP is really important. And then obviously, seeking specialist support where you think it has escalated to that point.

Alicia Ranford (Host) (08:57):

How can families access support from someone like yourself?

Ellen Murray (Guest) (09:00):

Starting with your GP is always going to be your first port of call, and your GP will always be able to direct you in the right space, and certainly if they don’t know, it would be their job to find out where to get you that help. The Butterfly Foundation is a wonderful organisation, and they have a great website that has lots of resources for parents, for families, for young people, for adults, for clinicians, and certainly would be able to give you some information about where to access help. And the Butterfly Foundation is a national organisation, Australian wide.

Alicia Ranford (Host) (09:29):

What do you think parents need to think about in terms of the wider family when a child or a young person is experiencing disordered eating?

Ellen Murray (Guest) (09:36):

Once again, communication is incredibly important, and I think making other people aware that you might have some concerns. Particularly in family gathering situations like Christmas or Easter or big events, they can typically be quite anxiety provoking for someone who has disordered eating or is potentially at the cusp of being diagnosed with an eating disorder. So having a conversation with wider family and alerting them to be sure that they’re not talking about their bodies in a negative way, that they’re not talking about trying to engage in weight loss, that they’re not putting moral value on food being healthy or unhealthy or good or bad, just so that that young person is in an environment that is supportive of regular eating and promoting neutral, if not positive, body image at all times.

(10:21):

Most of us have probably engaged in some form of disordered eating in our lifetimes, but there’s certainly a difference between disordered eating behaviours and the development of an actual eating disorder. When we think about the development of an eating disorder, there’s multiple risk factors that come into play. Most prominently, the genetic predisposition to develop one, we know that if a young person has a mother or a sister who has had anorexia, they’re 14 times more likely to develop it themselves.

(10:51):

Psychological risk factors can include perfectionistic personality type, high achieving, general worrier or anxious predisposition, people who are quite detail orientated and have low self-esteem, these kinds of traits we see a lot of in people who develop eating disorders, particularly anorexia. From an environmental and cultural perspective, thinking about the world that we live in, the thin ideal, the diet culture that we are surrounded by, but things like puberty and stressful life events can also bring on that desire to want to change our bodies through weight loss.

(11:25):

And ultimately, we know the perfect storm to reach a diagnosis of an eating disorder usually involves genetic environmental risk factors, psychological risk factors paired with weight loss. We know that weight loss is the biggest indicator of the development of an eating disorder, so if we can help prevent our young people from losing weight where there is no weight needed to be lost, that’s going to be incredibly important in ensuring that they don’t go on to develop an actual diagnosable eating disorder.

Alicia Ranford (Host) (11:52):

How can parents find out what is a healthy weight for their child or young person?

Ellen Murray (Guest) (11:57):

Having a really good relationship with a general practitioner or a paediatrician can be really important in knowing what your child’s trajectory was going to look like when we think about percentiles for growth. So generally speaking, a paediatrician can track along a chart where a child is likely to go and to be by a certain age. When we see weight loss, we can see a negative impact on the trajectory of that child’s growth.

Alicia Ranford (Host) (12:20):

Ellen, before we finish, I wanted to ask you, what would be the key messages you would want listeners to take away from our conversation today around disordered eating?

Ellen Murray (Guest) (12:28):

The biggest take home, I think, for anyone, and it’s not necessarily just in relation to children, but the way we talk about our bodies can be incredibly powerful. And I think if we are in a world or in spaces where we’re constantly talking negatively about our bodies, that can have a wider impact on the people that we are surrounded by. For example, if I say negative things about my weight and my body, anyone who’s the same size as me or bigger can internalise that in a way that they should feel shame or guilt for how they look because I feel that way about my body looking that way.

(13:00):

So I think the biggest take home there is just be very mindful about how you talk about yourself, how you talk about others and not to put such an emphasis on food being good or being bad or certain body shapes being healthy or unhealthy. I think it’s incredibly important to look at body diversity as a good thing and that health does not necessarily align with weight, and we need to remember that. Certainly, health can be achieved at any size, and equating health and weight is only going to lead to further engagement in disordered eating behaviour.

Alicia Ranford (Host) (13:33):

I think it’s so important for parents all around Australia to understand how important it is to talk about health, weight and food in a positive way. So thank you so much for joining us today.

Ellen Murray (Guest) (13:42):

No worries. You’re very welcome.

Narrator (13:45):

Visit our website at www.emergingminds.com.au/families for a wide range of free information and resources to help support child and family mental health. Emerging Minds leads the National Workforce Centre for Child Mental Health. The Centre is funded by the Australian Government Department of Health under the National Support for Child and Youth Mental Health Program.