«Parents should pay attention to social aspects and enjoyment when eating»

Mrs Pauli, one eating disorder that occurs almost exclusively in male adolescents is muscle dysmorphia. What do you mean by this?

Many boys want to build muscle through training and often also have low body fat. A high-protein diet should support them in this endeavour. Muscle dysmorphia is characterised by a distorted body image: those affected believe they are too thin, even though they are already well trained.

Many teenage boys strive for a toned body. When should parents take notice?

A disorder is when a young person is excessively and almost obsessively preoccupied with building muscle. In other words, they spend a lot of time training and neglect their friendships, school or hobbies. Those affected often suffer from the compulsion to train themselves. Other warning signs are overly pronounced muscles or the use of anabolic steroids, which can be harmful. It becomes particularly problematic when young people train a lot and eat too little. They think they can build muscle and lose fat this way. This can develop into an eating disorder. The frequent consequences are malnutrition and exhaustion - at the same time, muscles are lost and not built up.

What factors can favour muscle dysmorphia?

These are similar factors to other eating disorders: low self-esteem, dissatisfaction with their own body, a strong focus on performance or even bullying. Boys in particular, who are slender, often feel inferior and are at risk of developing muscle dysmorphia. Here, too, role models have a major influence: friends and peers, but also fathers - for example, if they do a lot of sport and value a muscular body.

Until the age of 15, boys should not go to the gym to build up muscles.

How can parents prevent this eating disorder?

You should make sure that your child does not start doing sports that focus on optimising their body image too early. Up to the age of around 15, boys should preferably not go to the gym to build up muscles. Sport is important, but it should be sports that focus on fun and socialising, such as ball sports or athletics. From around 15 or 16 years of age, it's okay for young people to train their muscles - but it shouldn't get out of hand.

Healthy eating is a constant topic these days. However, even eating a balanced diet at all times can at some point lead to unhealthy behaviour - this is often referred to as orthorexia. What characterises this?

Orthorexia is not a medical diagnosis in its own right, but an eating behaviour disorder. Studies suggest that around 20 to 30 per cent of the population say they are overly concerned with «proper» eating. Orthorexia means that someone wants to eat healthily and is excessively and almost obsessively concerned with healthy eating.

Those affected have a less flexible diet and find it difficult to deviate from their chosen diet. The main sign of a disorder is when someone loses a lot of weight due to overly selective eating behaviour. The disorder is also characterised by the fact that those affected suffer from a constant preoccupation with healthy eating, which severely impairs social relationships, school or hobbies.

How is orthorexia related to other eating disorders?

Orthorexia is a risk factor for other eating disorders, particularly anorexia and to a lesser extent bulimia and binge eating. The latter can develop when a young person restricts their diet to supposedly healthy foods and then develops a craving for unhealthy sweet and fatty foods. This can lead to binge eating and possibly vomiting. To prevent orthorexia, parents should not focus on the topic of «healthy eating» in the family, but instead pay attention to social aspects and enjoyment when eating.

On the other hand, obesity among children and adolescents is a growing problem. According to a study by ETH Zurich, 16 per cent of Swiss children are overweight and 5 per cent are obese. What can parents do if they are worried that their child is too fat?

It is best to talk to your paediatrician after checking your child's weight - without your child - and clarify whether they are actually overweight and how you can react. A weight slightly above average is often not a problem. However, if your child is very overweight, you should definitely do something about it.

Namely?

The best thing to do is to seek nutritional counselling, review your food choices and make sure you eat regular, balanced meals together. This is often very helpful in avoiding snacking and stabilising body weight. The aim for children is to make a permanent change to their diet and get enough exercise so that they «grow out» of being overweight over time. For adolescents, the aim should be to lose weight slowly and sustainably. Banning food or saying «enough is enough» is rarely helpful. This is more likely to increase the craving for the forbidden food. Parents should avoid negative comments at all costs. This triggers shame in the child and increases the risk of an eating disorder.

Diets and rapid weight loss are not advisable if you are overweight.

So parents shouldn't tell their teenager to diet?

If young people who are overweight or obese try to lose weight, they run the risk of developing an eating disorder. Diets and rapid weight loss are therefore not recommended for overweight people. Instead, a permanent change in behaviour should be sought. A warning sign of an eating disorder would be if a child or adolescent who is overweight loses a lot of weight in a short period of time. Some are unable to stop this process and end up with anorexia. The low calorie intake can also cause ravenous appetite, which can then lead to bulimia or binge eating. In these cases, parents should intervene.

What else is important?

All aspects of a healthy, balanced diet are also important in the prevention of muscle dysmorphia and orthorexia. They can also help to prevent overweight and obesity and the tendency to develop an eating disorder.