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Schools urged to show caution over anti-obesity messages

Schools which over-emphasise the risks of being overweight could unwittingly be encouraging eating disorders, a leading psychiatrist from Priory Group said today.

Dr Janet Walsh, who led a specialist child and adolescent eating disorders unit at Priory Hospital Altrincham, in Cheshire, said a significant proportion of young people had identified school lessons focusing on weight and healthy eating as one of the triggers to their eating disorder.

“Rather than food being labelled as ‘good’ or ‘bad’, it is important to focus on eating a balanced diet, eating three meals a day and participating in regular exercise,” she said.

The UK’s leading eating disorders charity Beat also expressed concern that public campaigns to tackle childhood obesity were sending conflicting and pressure-laden messages to young people.

Lorna Garner, its Chief Operating Officer, said: “Low self-esteem and self-worth can be an influencing factor in the development of an eating disorder.

“Eating disorders are complex and multi-causal, and the onslaught of information about diets, calorie intake and ‘good’ or ‘bad’ foods, along with exercise, can add to the insecurities a child might have about their weight and body shape.

“Healthy attitudes towards food and lifestyle should be positive, not solely negative messages. This includes healthy attitudes to variety in shape and size of bodies, particularly at a time when young people’s bodies are developing and changing rapidly. It is concerning if schools focus on the words ‘diet’ and ‘exercise’ alone in relation to obesity. Care must be taken to ensure the messages we convey to young people are consistent and responsible.”

Striking the balance

One 16 year old girl being treated at Priory Hospital Altrincham, who had developed anorexia, said: “Schools are all ‘don’t eat too much carbs, don’t eat too much fat’ and in biology it is the same. No-one ever teaches you that it is fine to have a chocolate bar every now and again, no one ever teaches you ‘go and eat that meal’ – it is almost the opposite.”

Another female patient, aged 15, said: “My school did not appear very helpful to me– focusing on who was larger and who wasn’t, instead of just promoting healthiness.”

Dr Walsh said: “It is important not to stigmatise, and moralise, about size. The debate is not about being fat or thin and certainly not about encouraging girls to be thin.

“In some cases, there may also be missed opportunities at school for identifying eating disordered behaviours earlier.”

Another teenage female Priory patient who developed an eating disorder pointed out that she did not eat her packed lunch for a year and a half before anyone noticed.

The 14 year old said: “One day I forgot my school lunch…and I liked the feeling of hunger, feeling powerful and in control, and it spiralled. I didn’t eat lunch for a year and a half until people started noticing. I used to make a packed lunch (for school) and throw it in the bin.”

Spotting the signs

However, Dr Walsh said she was seeing evidence that schools were getting better at spotting the signs of eating disorders, like bulimia, and communicating their concerns to parents.

“It is quite often a concerned phone call from school to a parent that has triggered the young person and their parents to seek professional help” she said. Her comments come after recent Government figures revealed that one in five primary school-age girls said they had been on a diet.

Eating disorders: the facts

Soaring numbers of children and young people are being taken to hospital, for sometimes months at a time, because of eating disorders, NHS figures show. The number of young girls admitted to hospital with an eating disorder has doubled in the last three years, according to figures compiled by the Health and Social Care Information Centre.

  • In 2013-14, hospitals in England had 1,656 admissions for 0 to 19 year old females who were diagnosed with an eating disorder. Yet in 2010-11 there were 840 admissions for the same age group
  • And further back, while 658 under-19s in England needed a spell in hospital in 2003-04 to treat an eating disorder, by 2013-14 that number had increased to 1,791, up 172%
  • More than 90% of them were girls and young women, with teenage girls among the likeliest to become an inpatient, usually because they were suffering from anorexia
  • The number of 14 year old girls ending up in hospital because of an eating disorder rose from 74 in 2003-04 to 336 a decade later, with a similarly steep rise – from 87 to 336 – among 15 year olds

The figures are said to be the tip of an iceberg because many eating disorder sufferers are on waiting lists or never hospitalised.

Priory Group, the UK’s leading provider of behavioural care, and its largest independent provider of treatment for eating disorders - has seen its own increase. Since 2010 there has been a rise of 85% in eating disorder patients aged 12-17, from 75 to 139. Its experts say that exam stress, social media, bullying and the pressure to look slim are all combining to make children’s lives unmanageable.

Taking the first step: discussing eating disorders

Dr Walsh said: “Young people in particular can feel under enormous pressure to be very popular, look thin, and excel in exams. Many sufferers from eating disorders are highly competitive in everything they do – and sadly, this can include their attitude to losing weight. And when other parts of their life seem to be in chaos, limiting eating can make a young person feel more in control.”

Teenagers were strongly influenced by images – whether in magazines, on TV or social media, or billboards, she said.

“I would advise parents to look out for signs of their children under-eating and act swiftly if they notice their child consistently going without food, making repeated claims they have already eaten, constantly checking the calories in food, or becoming highly selective in the foods that they will eat.

“Don’t be afraid to be open with your son or daughter about your concerns, and even if, initially, they deny that there is anything wrong, keep a close watch on the situation and talk again if you still feel that things aren’t right.

“Reassure your child that you will support them to eat a normal healthy diet and maintain a healthy weight, but explain the dangers of being underweight. Early intervention is vital and can stop a habit developing into an eating disorder. If things don’t improve, speak to your child’s GP and request help."

Anorexia, one of a number of eating disorders, has the highest mortality rate of any psychiatric disorder, from medical complications associated with the illness as well as suicide.

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