When food dominates life
At 16, Nora stops liking her body. She often stands in front of the mirror, staring at her thighs, stomach and arms. «I was unhappy with my figure and my weight,» says the now 21-year-old, who goes by a different name and doesn't want to be recognised. «I compared myself to others in my family and at school - like a colleague who was thin and could eat whatever she wanted. I wanted to be as slim and sporty as her. That often put me under pressure.»
Nora is not alone in feeling inadequate. It is very common for adolescents to attach importance to their appearance and this is normal, says Felicitas Forrer, psychologist and co-director of the Psychotherapeutic Practice Centre at the University of Fribourg. «Their self-esteem depends heavily on how their peers judge them. Appearance plays an important role in their sense of belonging. That's why they often compare themselves with others and orientate themselves primarily towards people they find attractive,» she says.
Young people like their bodies less and less and often think they are too fat - partly because of social media.
This behaviour coincides with a developmental phase in which the body undergoes major changes. «In girls, female hormones increase the curves of the body during puberty,» says Dagmar Pauli. She is a child and adolescent psychiatrist and head physician at the Psychiatric University Hospital Zurich. «This runs counter to the ideal of beauty of the very slim female body in our society. It can therefore be difficult for adolescents to accept their bodies.»
More negative body image than before
Studies show that young people's body image has become more negative in recent decades: they like their bodies less and less and often think they are too fat. The media plays a major role in this - especially social media such as Instagram. But topics such as figure, fitness and healthy eating are also omnipresent in many families and in the social environment of young people.
«The mothers of today's young people grew up with the ideal of a slim body and paid close attention to their weight and figure,» says Pauli. «They pass this on to their children - often unconsciously.»
However, the child and adolescent psychiatrist also has some good news: «Despite all the problematic influences of society, most teenagers do not develop an eating disorder,» she says. «It is also normal for teenagers to eat a lot or less at times and not always be satisfied with their bodies - a lot of things are changing during this developmental phase.» It becomes problematic when they are constantly preoccupied with their appearance and their self-esteem suffers greatly as a result.
«Dissatisfaction with one's own body is one of the most important risk factors for developing an eating disorder,» emphasises psychologist Felicitas Forrer. «Girls often strive to be very slim. If other risk factors are added, this can lead to disordered eating behaviour,» says Forrer. «But boys are also increasingly concerned about their appearance. Their goal tends to be to build muscle. Sometimes this develops into muscle dysmorphia, a muscle addiction.»
But why does one teenager - despite temporary dissatisfaction - develop a healthy attitude towards their appearance over the years, while another slips into an eating disorder? What risk factors lead to unhealthy eating behaviour? And what role do parents play in this?
Increasing frequency of eating disorders
Eating disorders are a growing problem in Western society. «Studies show that they have increased over the last 20 years - and this has intensified during the coronavirus pandemic,» says Felicitas Forrer. «The same applies to eating disorders in boys.» On the one hand, eating disorders are now better recognised and younger sufferers in particular are more willing to seek help. But there is also an actual increase. «We are also seeing eating disorders in younger and younger children, even in ten to twelve-year-olds,» says the psychologist.
Because eating disorders are considered a «women's disease», the topic is very shameful for boys, so they often seek help late.
Dagmar Pauli, child and adolescent psychiatrist
Around three to five per cent of people develop an eating disorder in the course of their lives. «They most often begin between the ages of 14 and 20, so they are a typical disorder of adolescence and young adulthood,» says Forrer. «In addition, far more adolescents develop disordered eating behaviour that does not reach the full-blown stage of an eating disorder.»
The most important eating disorders include anorexia, bulimia and binge eating disorder. According to studies, around one to two per cent of girls, boys and young adults are affected by anorexia. One to three per cent suffer from bulimia and two to four per cent develop a binge eating disorder. «Anorexia most often begins at around 14 to 16 years of age, bulimia a little later, at around 17 to 20 years of age,» says the psychologist. A full-blown binge eating disorder often only develops in young adulthood.
Although eating disorders are less common in boys, they can suffer from the same forms as girls. «Because eating disorders are considered a «women's disease», the topic is very shameful for boys, so they often don't seek help until later,» says Dagmar Pauli. «The eating disorder is also often not recognised by parents or teachers and is therefore often treated late.»
Anorexia, bulimia, binge eating
Anorexic adolescents feel they are too fat and constantly monitor their eating behaviour. Some exercise excessively or vomit to get rid of calories. Even when their weight is very low, they still feel too fat. This often leads to physical consequences such as hair loss or missed periods. A very low weight can become life-threatening - in which case it is important to act quickly. Anorexia is much more common in girls, only around ten per cent of those affected are boys.
Because Nora was unhappy with her body, she began to exercise intensively. The 16-year-old set herself the goal of eating healthily, but also wanted to be slim and began to pay close attention to her diet. Over time, she developed more and more rules, such as what and when she was allowed to eat and how much she had to exercise. At the same time, she was terrified of eating too many calories. As a result, she lost a lot of weight in just a few months and developed anorexia.
Up to 80 per cent of adolescents with an eating disorder are affected by another mental illness.
Felicitas Forrer, psychologist
Binge eating is typical of bulimia: Those affected lose control and eat extremely large quantities at once. Because they don't want to gain weight, they take countermeasures: They vomit, take laxatives or exercise to the point of exhaustion. «This often creates a vicious circle,» says Dagmar Pauli. «Young people deliberately eat very little for a while and then develop a ravenous appetite. And that increases the risk of binge eating.» Boys can also suffer from bulimia: around 10 to 20 per cent of those affected are male.
Binge eating disorder is the most common eating disorder among adolescents. Binge eating also occurs here, but without any countermeasures. As a result, those affected often put on a lot of weight - and therefore have an increased risk of cardiovascular disease and diabetes. Binge eating affects female adolescents three times as often as males.
In many cases, the symptoms are also mixed. Or one eating disorder merges into another: For example, anorexia can develop into bulimia. What many parents clearly notice: The teenagers' mood deteriorates and they withdraw more and more. «Up to 80 per cent of young people with an eating disorder are affected by another mental illness,» says Felicitas Forrer. «The most common of these are anxiety and depression. »
Many of those affected find it difficult to cope with negative feelings and regulate them appropriately.
Felicitas Forrer, psychologist
Complex triggers for eating disorders
Several factors have to come together for an eating disorder to develop. «Social aspects, individual factors and aspects of the social environment work together,» says psychotherapist Forrer. In addition to the ideal of being very slim, the topic of «healthy eating» is playing an increasingly important role in society. At the same time, high-calorie, unhealthy foods are readily available everywhere - a dilemma that creates stress.
«Individual characteristics that can promote an eating disorder include low self-esteem, a strong focus on performance, compulsive behaviour and perfectionism,» says Dagmar Pauli. «Severe psychological stress, bullying or sexual abuse increase the risk of developing an eating disorder.»
Many sufferers find it difficult to cope with negative feelings and regulate them appropriately. «Restrictive eating behaviour and binge eating can then become a strategy for dealing with unpleasant feelings and stress,» says Felicitas Forrer. But genetic factors also have an influence. «Young people who start puberty early or have a biological predisposition to lose weight quickly are more at risk,» says Dagmar Pauli.
Pay attention to warning signals
What specific signs indicate an eating disorder? «If a child or adolescent is underweight or loses weight quickly without already being underweight, this is an important warning sign,» says child and adolescent psychiatrist Dagmar Pauli. «Parents should also listen up if their child has eating binges in which they eat very large quantities at once, or if they deliberately vomit. In these cases, they should act immediately.»
If an adolescent pays close attention to calories, skips meals together, only eats certain foods or eats very slowly, this may also indicate an eating disorder. «It is characterised by thoughts constantly revolving around food, weight and appearance,» says Dagmar Pauli. «Those affected fear non-stop that they are eating too much or are too fat.» Another warning sign is when a young person is constantly and unenthusiastically doing sport or is overactive in order to lose weight.
«Parents should therefore take a conscious look and listen to their gut feeling. Because they can often sense that something is wrong with their child,» says Christine Jordi Bärtschi. She is a nutritionist at the Swiss Association of Nutritionists (SVDE) and works at the Oberaargau Nutritional Counselling Centre in Langenthal.
What is happening?
«The main aim of nutritional counselling is to broaden the range of foods available, establish a regular eating rhythm and break down rigid rules,» says Jordi Bärtschi. A «policy of small steps» is important here - because young people are often unable to sustain changes that are too big.
It is also important to provide information, such as how to get enough of all nutrients. Education is also important for boys with muscle dysmorphia. «It must be clear that excessive training is not good for the body and that too much protein is useless,» says the expert.
Get professional support
If the child is still younger, experts advise parents to contact a specialist centre, such as a paediatrician. «Up to the age of around 13 to 14, mums and dads can set rules and stick to them, such as eating meals together,» says Dagmar Pauli.
With older children, parents should first seek dialogue and openly address the problems they perceive, says Christine Jordi Bärtschi, «Because some parents think it's just a phase that will pass. Others are afraid to broach the subject. Instead, they should say what they have observed and express their concern. At the same time, they can ask their child: "How do you feel about this? What are the reasons for your behaviour?», says the nutritionist.
The earlier professional help is sought, the better the chances of overcoming the eating disorder.
Dagmar Pauli, child and adolescent psychiatrist
It is important to have the reasons for the weight loss clarified quickly by a specialist. Parents can suggest specific points of contact to their son or daughter and offer to go to a doctor or counselling centre together. «If a young person refuses, parents should insist that they visit a specialist centre at least once,» emphasises Dagmar Pauli. «This can often achieve a lot.»
Because even if some young people or their parents believe that they can get to grips with the eating disorder on their own - in reality it is very difficult. «The earlier they seek professional support, the better their chances of overcoming the eating disorder,» says the expert.
Addresses and links
- Schweizerische Gesellschaft für Essstörungen (SGES), Infos und Suche nach Fachpersonen
- Schweizerischer Verband der Ernährungsberaterinnen und -berater (SVDE ASDD)
- Fachstelle Prävention Essstörungen Praxisnah (PEP) am Inselspital in Bern
- Studie i-Beat am Departement Psychologie der Universität Freiburg, Online-Behandlungsprogramm für junge Menschen mit Binge Eating
- Elternunterstützung bei Magersucht
A long road to treatment
For many adolescents, it takes a long time before they find their way into treatment. What this looks like depends on the eating disorder and how severe it is. «Outpatient treatment makes sense if the eating disorder is rather mild. It often consists of a combination of psychotherapy, nutrition and weight management and medical check-ups,» says Forrer. In the case of severe eating disorders that can no longer be treated in an outpatient setting, inpatient treatment in a specialised clinic should take place. This applies, for example, in the case of severe underweight, says the expert.
The aim of therapy for anorexia is for adolescents to regain a normal weight and return to independent eating behaviour in which they eat a variety of foods according to their needs. Adolescents with bulimia or binge eating disorder learn how to overcome cravings and binge eating, as well as countermeasures such as vomiting. This includes eating a regular and balanced diet and learning specific strategies to deal with the triggers of binge eating.
Parents should always be involved in the treatment.
Felicitas Forrer, psychologist
Felicitas Forrer advises working on the psychological and social factors that have contributed to the eating disorder and boosting the young person's self-esteem. «For example, in our psychotherapeutic practice, we work with young people to see how they can reduce the influence of stressful feelings on their eating behaviour.» The prerequisite for this is that they admit that they have an eating disorder and are prepared to change something.
The role of parents in eating disorders
«Parents should always be included in the treatment. They are often heavily involved in an eating disorder,» says Forrer. «We invite them to discussions and support them in dealing with the eating disorder in an appropriate way - and with the conflicts that can arise from it.» There are often many discussions about food in families.
«We work with the family to work out how they can get out of such conflicts and unfavourable behaviour and rebuild positive aspects of the relationship,» says the psychologist. Last but not least, it must also be carefully clarified whether other factors within the family are contributing to the child's eating disorder.
What needs to change in order to recognise eating disorders earlier?
There are already many measures in schools on the topic of «healthy living». «However, the focus should not just be on healthy eating,» emphasises the expert. "Rather, a relaxed, enjoyable approach to food, a positive body image and fun with exercise should be taught."
It would also make sense for everyone who has a lot to do with children and young people, such as teachers or sports coaches, to be better informed about eating disorders. «They should know how to recognise an eating disorder early on and how to react in good time,» explains Pauli. «It would be important for them to talk to young people about it and point them towards suitable contact points.»
In the case of anorexia, parents are also involved in nutritional management at the psychotherapeutic practice centre. At the beginning, it is important to clarify who in the family takes on which tasks. «In the first phase of therapy, young people give their parents the task of helping them to gain weight. In consultation with the treatment team, the parents take responsibility for meal planning,» emphasises Forrer. «Over time, the adolescents then learn to prepare and eat meals more independently again.»
For Nora, anorexia was a long journey through various treatments. She is now back to a normal weight and does things she enjoys. «Others say that I've become happier and livelier,» she says. «It will certainly take some time. But I have hope that I'll be completely healthy again.»
