«We have forgotten how to find normal body shapes beautiful»

Mrs Pauli, how many teenagers in this country suffer from an eating disorder?

This is difficult to say, as we have to assume a high number of unreported cases. It has been proven that around 5 per cent of people develop an eating disorder in the course of their lives. Around 1 per cent of young women suffer from anorexia and around 2 per cent from bulimia. Eating disorders most often begin between the ages of 14 and 16, bulimia usually between the ages of 17 and 20. However, eating disorders in younger children have increased in recent years.

How does an eating disorder develop?

In my view, the environment plays an important role. This includes society's exaggerated ideals of beauty and depictions of extremely slim models that are disseminated in the media by the advertising and fashion industry. Or fitness influencers who regularly report on how much sport they do, what they eat and post photos in which they are underweight.

And such images become ingrained in people's minds?

Exactly. As a result, we have forgotten how to find normal body shapes beautiful. For many young people, this triggers strong self-doubt because they are constantly comparing themselves with unattainable ideals. On the one hand, an eating disorder develops as a result of social conditions, but on the other hand it always has to do with the person affected themselves. For example, low self-esteem or very high expectations of oneself, but also a genetic predisposition, are factors that can contribute to the development of an eating disorder.

What is the significance of social media?

Young people are constantly on social media such as Instagram, where they compare themselves with others. They stage themselves in selfies and often manipulate them with image editing tools in order to look particularly slim or have the desired figure.

Studies have shown that young women who spend a lot of time on social media and compare themselves with images of extremely slim role models are less accepting of their own figure and feel less self-confident than young women who do not.

Why are young people susceptible to ideals that can lead to eating disorders?

Young people orientate themselves strongly towards others, especially their peers. Self-worth is often based on appearance. And self-esteem is often not yet so firmly established at this age. Considering the influence of the aforementioned aspects, it is not surprising that young people today have a more negative body image than the generation before them. Many find themselves «wrong» or «too fat». The result is often problems with self-esteem - and this makes them more susceptible to eating disorders.

When it comes to eating disorders, girls come to mind first.

Girls suffer from an eating disorder around ten times as often as boys, while the number of eating disorders with binge eating is around five times higher. This ratio remains roughly the same into adulthood. The symptoms are similar in boys and girls. However, an eating disorder is often not recognised in boys because it is more likely to be suspected in girls.

Boys often want to build muscle through training and have as little body fat as possible. If they are told that they are more likely to lose muscle than gain it if they train without a sufficient calorie intake, this is often an eye-opening experience for them. However, whether they can then change their behaviour depends on how deeply they have already slipped into the eating disorder.

It is worrying that eating disorders are occurring at an increasingly younger age.

In fact, children as young as 11 or 12 are coming to our clinic more often than before. Some are even as young as 8 or 9 years old. This is possibly due to the fact that social media is being used earlier and earlier. And the fact that children reach puberty earlier and are then more concerned with their own bodies.

What are the warning signs of an eating disorder?

It is alarming if a child or adolescent is underweight or loses weight rapidly - even if he or she was previously overweight. In this case, parents should react quickly and have the causes of the weight loss clarified by the paediatrician. In general, you should be alert if a child is losing weight or not gaining weight in line with their age and growth.

What else should parents look out for?

Conspicuous eating and exercise behaviour can also indicate an eating disorder: for example, if a child avoids meals, eats very slowly or only eats certain foods such as salad and vegetables. Or if they exercise compulsively, for example doing gymnastics alone and without much pleasure or going jogging every day. Another warning sign is when thoughts are constantly, almost obsessively, revolving around food, weight and appearance.

What advice do you give mums and dads in such cases?

That they act quickly and courageously. If the child is younger, they can first seek information from a counselling centre, the paediatrician or a helpline. For adolescents aged 12 and over, it makes sense to address their eating behaviour yourself.

For example, you can say: «I've noticed this or that about you and I have the impression that you're not feeling well. I'm worried about you.» It is always important to start a conversation with your child and use first-person messages: «I would like to go to a counselling centre with you and clarify whether my worries are justified or not.»

What if my child refuses?

Then you should use your authority as a mother or father and insist on going to at least one such meeting. This can often achieve a lot.

What can parents do to prevent an eating disorder from developing in the first place?

It is important to teach children a natural, relaxed approach to food and exercise. You shouldn't force your children to eat - but you shouldn't constantly talk about calories and their figure either. Regular meals together are important. And parents should be good role models when it comes to food and the body.

In the book «Size Zero» you write about a two-generation effect. What do you mean by that?

Today's mothers have already grown up with the ideal of being very slim. They unintentionally pass this ideal on to their children by paying close attention to their growing child's weight and figure. Today's children grow up with the topics of healthy eating, diet and fitness from an early age. The natural attitude towards food is often lost in the process. Health and figure are often a constant topic in such families, even at the family dinner table.

But most people would claim to have a relaxed attitude to food.

Most parents don't even realise that they are giving their children a negative body image by constantly «picking on» their own figure, for example.

What can I do as a mum or dad to change this?

The first step would be for us as parents to think about our own body image and our relationship with food. How do I feel about my body and my curves? Can I enjoy eating or am I constantly preoccupied with the fact that I should actually eat less and want to lose weight?

It is important to teach children a natural, relaxed approach to eating and exercise.

Do we model healthy and enjoyable eating behaviour for our children by preparing food well, eating a balanced and rich meal and sitting together at the table? Or does everyone quickly grab something from the fridge? Shared meals where we eat enough and exchange ideas not only prevent eating disorders and obesity, they also promote a healthy family atmosphere.

And what if your daughter's best friend is constantly talking about wanting to be slimmer? At some point, children tend to orientate themselves towards their friends rather than their own parents.

If your daughter tells you about this kind of behaviour or I, as a mother or father, hear about it, it's worth talking about it in the family and critically questioning the prevailing ideal of beauty and the diet craze.

What else can I do?

It is crucial to strengthen children's self-esteem. You can make them realise that it's not just their body and looks that are important, but also their many other qualities, and I don't just mean achievements and abilities.

The main thing is to show them that they are great, lovable and attractive just the way they are. Negative comments - even subtle hints - about their appearance should be avoided at all costs. This is because adolescents entering puberty in particular react very sensitively here.

Many parents want to teach their children a healthy lifestyle with a balanced diet and sufficient exercise. How can a «relaxed» approach to food and one's own body be achieved at the same time?

Mums and dads should simply offer their children a balanced, varied mix of different foods - and not too much sweet, fatty or salty food. For breakfast, this could be muesli, bread, yoghurt or fruit.

Everyone should just eat what they feel like eating. A sweet treat in between is also fine. This also prevents cravings for sweets. A varied diet is important for the main meals, preferably home-prepared. However, it is not a good idea to constantly talk about what is healthy or to «analyse» food in detail.

What can children and young people themselves do to protect themselves from an eating disorder?

Firstly, they can take a critical look at common ideals of beauty and consciously distance themselves from them. In general, they can ask themselves: What is good for me? What strengthens my well-being and my self-esteem? For example, perhaps I follow a very slim person and realise that this puts me under pressure and is not good for me. I can then make a conscious decision to stop following them.

Young people can take a critical look at common ideals of beauty and consciously distance themselves from them.

In the same way, I can consciously think about it: Which friends do I want to have? Who do I want to go out to eat with - those who are always counting calories or friends who are fun to eat with? Parents can also support their children by asking: How do you feel when your friend is always talking about losing weight? Does that make you think more often that you should be thinner? However, bans are useless here; young people have to realise for themselves what is good for them.

Where can parents and affected children and young people find help?

Even if some sufferers believe they can get out of an eating disorder on their own - in reality it is very difficult. If someone has already severely restricted their calorie intake or if binge eating occurs, it is important to seek professional support.

You can contact outpatient child and adolescent psychiatrists or registered child and adolescent psychiatrists, counselling centres for eating disorders or paediatricians. You can search for specialists on the website of the Swiss Society for Eating Disorders.

In your book, you also discuss the responsibility of politics. What needs to be done at a political level to prevent eating disorders?

The problem is that politics does not intervene in the issue of thinness. For example, there is no minimum body mass index for models that specifies how thin they can be. There are also no comprehensive prevention measures in schools that teach what constitutes a healthy body image and a healthy, balanced diet.

For example, it would be important not to focus solely on preventing obesity and a diet low in fat and sugar. It is also important that children and young people develop a healthy body image and self-confidence. At the same time, young people should learn at school to critically scrutinise media that convey an exaggeratedly slim body ideal and to «expose» photos in which body shapes have been manipulated.

How good are the chances of returning to normal eating behaviour after an eating disorder?

If the eating disorder has only existed for a few months, the chances are very good. However, if an eating disorder has existed for years, residual symptoms often remain. However, only around 10 per cent of affected adolescents have a pronounced eating disorder in the long term. Generally speaking, the longer the eating disorder lasts, the more entrenched it becomes. Conversely, this also means that the earlier you intervene, the better the chances of overcoming the eating disorder completely.