‘I’m worried my daughter is developing an eating disorder’

Question: My daughter is 17 and I’m worried she might be developing an eating disorder. She often skips meals, can head off to school without breakfast, and sometimes her lunch comes back uneaten. I am always on her case about not eating and we often row about it. I try to explain how important it is to have a healthy breakfast etc but I feel like I am talking to the wall – she says she is just not hungry. She won’t really have a sensible conversation about it.

While she is not underweight, I notice she is cranky and irritable without food. For example, she can come in from school like a demon and then when she has dinner she is calmer. Though she tries to miss meals, sometimes she binges on treats in the evening and I find wrappers in her room. I'm not sure what the best approach is. As her mum, I want her to have good eating habits and in the back of my mind I worry about her going on to develop anorexia. I know she worries about her appearance and body image like most teens and I am sure this is a factor. She is good at school and studies hard and can be a bit perfectionistic and over-anxious at times.

What can I do to help her?

Answer: Body image and pressures around appearance peak during the teenage years and many engage in restrictive eating and unhealthy diets as a means of controlling their weight. During the Covid crisis eating disorders, such as anorexia, have dramatically risen for young people and many services are reporting up to 50 per cent increase in referrals. While anorexia is often thought to only affect people who are underweight, in fact up to 30 per cent of people with anorexia are normal weight or above. Many people with anorexia can appear to be healthy yet adopt over-restrictive eating habits leading to serious malnourishment and negative physical and mental health impacts. Psychologically, eating disorders are associated with young people who are high-achieving, perfectionistic and prone to anxiety and poor self-esteem.

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You are right to take time to consider how best to respond to your daughter’s eating habits. While she may not yet have developed anorexia, it sounds like she has developed some unhealthy eating habits which could worsen over time. Though common, the pattern of skipping meals and then later binging on “treat” foods is an unhealthy one which will only lead to more problems. However, it is hard to know how to influence a headstrong teenager who won’t talk about what is going on for her. Below are some ideas.

Opening up a sensible conversation

Where possible try to avoid getting into a “battle” about food with your daughter. As a worried parent, it is understandable that you might find yourself “giving out” and cajoling your daughter to eat – however, this is likely to be counterproductive.

While it is important to raise the issues, it is better to do this in a planned way and to rehearse what you might say. Make sure to pick a good time to raise the subject. This may not be in the morning when she is rushing out the door. It might be later in the day when you are both relaxed together. When you raise the subject avoid being critical or angry and instead make sure to come across as caring, calm and interested. Rather than angrily exclaiming “ what is the matter with you?” it is better to gently ask “how come you missed breakfast today?”.

Encourage her to talk about her feelings

Give her space to say what is on her mind. She may feel under pressure about body image and fear weight gain but it is likely that she will find it hard to discuss these issues immediately with you. She might feel annoyed at herself when she binges and has a harsh “inner critic” putting herself down, but once again she might find this hard to talk about. Make sure you are patient and non-judgmental and try to listen to what she says. If she fobs you off, just gently persist – “I notice you are missing meals…I want to know what’s going on for you so I can help...I only ask because I care for you”. Once she starts to reveal some of her thoughts and feelings then you are in a good position to help her.

Focus on establishing healthy eating routines

Whatever is going on for your daughter, establishing regular family mealtimes will help with her eating habits. The main reason she is irritable and binges on treats in the evening is because she has not eaten enough healthy food in the day. Take time to explore how to set up this routine with your daughter. You might ask her “ how can we ensure you start the day with healthy breakfast?” or “how can we make sure you have a lunch in school?”.

While each family is individual, the sorts of solutions that might work are:

– Change the morning routine so there is less rush and more time for a sit-down healthy family breakfast. This might mean trying to have an earlier night-time routine in the family so there is more time in the morning.

– Try to have a sit-down family dinner at the same time for as many days during the week as possible. Allow plenty of time for meals to ensure time for family chats and connection, (with phones and TV turned off).

– Involve your daughter in the planning and preparation of meals and assign her responsibility for one or two or even more meals a week.

– Make sure at least one parent is available to sit down with your daughter for meals. Busy two-parent families can alternate the role, but both being present for as many meals as possible is the ideal.

Seek further help

Helping teenagers establish good eating habits can take a long time especially if unhealthy eating habits are well established. Do seek further help as needed. bodywhys.ie is the national eating disorders helpline and they have lots of great information and supports for parents and carers as well as supports for young people.

John Sharry is a social worker, founder of the Parents Plus Charity and an adjunct professor at the UCD School of Psychology. See solutiontalk.ie