What’s eating them

Jane* first noticed her son looked thin when she met him for dinner in Manchester. Joseph*, then 14, was a full-time boarder after winning a scholarship at a ballet school, and as he stepped off the train at Manchester Piccadilly, Jane handed her son a doughnut she had bought him at the station. Joseph had never had issues with food, but that day he devoured the doughnut so quickly it was “as though he’d never seen food before”.

“If you think about anorexia specifically, often the girls who display it are hyper-smart.”

That night, the family went for dinner at a pizza restaurant, but Joseph didn’t seem himself. “He didn’t eat much at all,” says Jane. “I kept saying, are you eating? You’re getting very thin, darling.”

What followed was a confession. Joseph broke down to his mother, telling her he had been restricting food in the belief that the less he ate, the better he would perform.

“I have a very close relationship with Joseph, and I had no idea,” says Jane. “It was unbelievable really.

“I hadn’t noticed because he was eating at home and he was growing, so it was really difficult to spot.”

Jane went to the school with her son that night to speak to the housemaster, but she says there wasn’t much support.

“The housemaster just said: ‘Right, OK – it’s just a case of you eating, Joseph.’ He was very young and not capable of looking after Joseph really. The problem with ballet schools is that they see eating disorders as a weakness in a dancer.

“There wasn’t a nutritionist on site, and there was no-one looking at what they were eating. I think his ballet teacher did have his suspicions, because Joseph told me he’d questioned him about what he was eating. [The teacher] would never admit that, but he did.”

As Jane started to realise what her son had been going through, there were more confessions from Joseph. He’d started getting ill. On one occasion he’d turned blue in a ballet class and had to be taken to the school’s medical centre, yet the school hadn’t notified his parents. Joseph also told his mother he’d started coming down with colds regularly and his hair had started falling out, yet the school had failed to pick up on the symptoms.

Jane sought help from private counsellors and a nutritionist, and Joseph was diagnosed with relative energy deficiency in sport – also known as RED-S. Most common in athletes, the British Medical Journal describes RED-S as “the result of insufficient caloric intake and/or excessive energy expenditure”, with consequences affecting metabolism, menstrual function, bone health, immunity, protein synthesis, and cardiovascular and psychological health.

Thanks to a four-pronged approach including hypnotherapy and support from a private nutritionist, Joseph is now in recovery, but Jane says if it hadn’t been for him acknowledging something was wrong and speaking to his mother when he did, he would most likely have been hospitalised.

Joseph is one of the lucky ones. Recent figures from NHS England show hospital admissions for eating disorders have risen by 37 per cent over the last two years. The most common age last year for patients with anorexia was 13 to 15, while a quarter of admissions in 2018-19 were for children aged 18 and under – at 4,471. There were also 10 cases of anorexia among boys, and six among girls aged nine and under.

If there’s one thing experts and those who are in recovery from eating disorders agree on, it’s that early intervention is key. Research by eating disorder charity Beat shows it takes nearly three and half years for someone to get treatment after first falling ill with an eating disorder, and the largest part of this delay – almost two years – is due to them not realising they have the eating disorder. There is often then a further wait of more than a year before they visit a GP. Then there’s what happens when people do finally attempt to get help.

Rose Anne Evans first started showing symptoms of anorexia when she was 15. After starting to cut out food during school lunchtimes, Evans managed to hide her disordered eating for a while, but friends eventually noticed she had started to isolate herself and urged her to get help.

By the time Evans went to her GP, anorexia had her firmly in its grip. Her eating disorder was affecting her energy levels, mood and mental health. But when her GP told her to step on the scales, Evans was told her BMI was too high for her to be referred to other services.

“My weight wasn’t low enough in the GP’s eyes and I was sent away,” says Evans, who has now been in recovery for more than four years.

Evans says the GP’s decision that day “fuelled” her eating disorder. Eventually she was hospitalised in an in-patient unit for eight months before being transferred to a day unit. When Evans went to university in York she became an outpatient, but she says spending so much time in hospital meant she had to learn to adapt to the outside world again once she was discharged. She now campaigns for early intervention.

“The more we can support young people at home rather than having to go into an in-patient unit like me, and also the earlier we can get these young people treatment, the better chance they have of making a recovery and flourishing and being able to live their life without an eating disorder,” she says. “The problem with hospital is it can help to a certain extent but then when you come out you’ve got to learn to live in the outside world again.”

Psychologist Natasha Tiwari agrees. Tiwari, who runs private education and wellness company the Veda Group, specialises in supporting children and adults with anxiety-related disorders including stress, phobias and past traumas. Most of the clients Tiwari sees with eating disorders are teenage girls, but she is noticing more younger children being referred for help, and says early intervention is “everything”.

“As time goes on we are seeing it with younger and younger children,” says Tiwari. “We don’t label it in the same way. We wouldn’t describe a seven year old who is restricting her eating as having anorexia, but what we might notice is that we have a seven year old who has serious anxiety and it is manifesting in the fact that she is restricting her eating.”

Social media might seem like an obvious place to point the finger, but Tiwari says eating disorders were an issue long before Instagram came on the scene in 2010. Instead, she says eating disorders, particularly in children and teenagers, are often triggered by factors that exist outside body image.

“There are so many reasons why it is happening more now compared to 20 years ago,” says Tiwari. “I definitely think schooling [is linked]. Kids are so aware of the fact they are being assessed and that they are constantly competing against their peers for higher grades.

“There’s also just a lot more toxicity in the environment. We are hit with information about food from all angles and it’s really hard to discern that which is good from that which is unhelpful.

“The language around food has also changed. We say things like food is clean, food is dirty, or we will say things like: ‘I’m on a detox.’ A detox only means you are restricting your body from having most of the things that you need in the assumption that you are going to be starting from scratch. These messages are so confusing for adults, let alone kids, and these conversations are framed around wellness, which is also very manipulative.”

But despite the external factors that can trigger eating disorders, Tiwari says the changing standards of beauty and the nature of the media can’t be ignored.

“It’s age-old but they give all people a sense that the unachievable is possible. But the difference is that usually for an adult who is reasoned and know images are manipulated, they are able to regulate their emotions. We are able to say to ourselves: ‘Yeah, I don’t look like her, but she probably doesn’t even look like her.’ But I would say even kids as old as 17
to 18 aren’t able to process that.

“Kids these days have only ever known the world with access to this kind of information. You’d have to be around
25 or above at the moment to imagine or remember a time when celebrities looked like ‘normal people’ – when they didn’t have plastic surgery, or had all the things you do to have a Jessica Rabbit-style body.”

Eating disorder charity Beat offers training to school staff so they can help spot the signs of eating disorders in pupils and refer children and parents to local support. Recently rolled out in the North East and Yorkshire and Humber, the charity is aiming to eventually have one staff member in every high school across the country trained in this way.

Tom Quinn, Beat’s director of external affairs, says: “My understanding is that levels of prevalence are pretty equivalent across the country. There is this stereotype that [eating disorders] only affect young, white girls who are middle class, but that’s absolutely wrong. It can affect anyone from any background.”

But Tiwari says successfully spotting the signs can be complex.

“The challenge with eating disorders is that they are so deeply intertwined with anxiety. A lot of children with eating disorders don’t always lose weight really fast, so it’s hard to know what you are looking at. People find it hard to distinguish between what is teen angst and what is somebody acting up because they are actually going through something psychologically and from a neuro perspective things are going a bit wrong.

“What’s also key is that often the person who is suffering from eating disorders doesn’t want to be found out. If you think about anorexia specifically, often the girls who display it are hyper-smart. They are really bright girls. If they don’t want to be found out they are bright enough and able to manipulate the adults around them for as long as possible into believing that they are eating.”

Evans admits her eating disorder was a “secretive” illness, but thanks to teachers tentatively asking about her welfare when they noticed things weren’t quite right, she felt she had somewhere to turn when she was ready.

“Teachers did ask me if I was OK and they did say they were noticing certain things, but there are stages, and at the time I was in the denial stage.

“What does help is those teachers coming to you and asking if you’re OK. I know Beat use the term ‘opening the door’.

“One message I always try to get out is that eating disorders are more of a state of mind than a state of body. You can still be what’s classed as a healthy weight, but it is a mental illness so you can be mentally unwell with it.

“Obviously if you’re not able to open up the first time, just knowing that there’s someone to go to when you are ready is really helpful. It often just takes a bit of time to be able to accept help.”

* Not their real names

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Nod of recognition

A new support group based in south Manchester aims to bring women in recovery from eating disorders together in a bid to share advice and reassurance.

Founded in January, Seeds of Hope invites women to meet once a week at Withington Fire Station.

Co-founder Helen Bourne was inspired to start the group with friend Eleanor Shiers after the pair lost a close friend to an eating disorder last September.

Bourne says: “Obviously no two eating disorders are the same but there are common experiences. We meet once a week and it’s a chance to give and receive advice, share ideas, inspire and motivate each other, and offer reassurance and hope.

“The main aim is to bring people together and provide a safe space where others understand. There’s something really affirming and reassuring when you say something and somebody nods as if to say ‘yeah, I get that’, and I can see that happening in the group.

“Mental illnesses can be isolating and you can feel like you’re the only person [going through it], so I can see it in the group when somebody says something and someone nods. It reduces that isolation a bit.”

See facebook.com/pg/seedsofhopemanchester