WORDS: Dr. Ertimiss Eshkevari, Clinical Psychologist, PhD

“Should we be naughty and eat another slice of cake?”

​​How often have you heard someone say something like this?

Our society’s obsession with appearances and dieting has become very ‘normal’, especially with the public health focus on reducing obesity and other preventable chronic health conditions. Unfortunately, however, this can be quite a dangerous obsession. It can result in a range of consequences in physical and mental health.

The rates of eating disorders in Australia are concerning and current estimates are around 1 in 20 Australians have an eating disorder.

Alarmingly, around 1 in 3 Australian adolescents are engaging in disordered eating, meaning behaviours and symptoms that are similar to an eating disorder that don’t quite meet the strict criteria to receive a diagnosis. Understandably, many parents have expressed they feel talking about food, eating, weight, body shape and appearance is an absolute minefield they just don’t know how to navigate in order to support their loved one to be healthy, confident and avoid the dangers of disordered eating and eating disorders. Indeed, you may have your own worries and past experiences around your appearance that make it difficult to know how to provide the right information or support to your child.

What is normal?

Every person has a body image, a mental picture of their body with thoughts and feelings about this. This might range from positive and satisfied, neutral, to dissatisfied and filled with hatred. The status quo in our society is for women especially, to feel unhappy with their appearance, such that body dissatisfaction has been considered to be a “normative discontent”. However, the issue of body image dissatisfaction is not just an issue for females, nor does it start only when puberty hits. Studies have shown that from around the age of 6, children may start to experience body dissatisfaction, with girls desiring slimness and boys muscularity. 

Why is t­his so important?

Young people in Australia have been letting us know that body image is important to them, ranking it among their top concerns according to Mission Australia’s Annual Youth Survey results over the past years. Research, including from Flinders University, has shown that social media use is linked with greater body dissatisfaction as well as disordered eating. The visual nature of social media means young people may be spending a lot of time viewing idealised images of bodies that promote an unrealistic image that often cannot be achieved in real life.

The problem with young people feeling unhappy with their body is that they may focus on attempting to change their body using unhealthy behaviours such as strict dieting, driven exercise to lose weight, or such things as diet pills/supplements or laxatives. Repeating these behaviours over time can lead to developing an eating disorder. The other danger in developing an eating disorder is in young people judging themselves and basing their self-worth on their appearance.

What is an eating disorder?

Eating disorders are not a lifestyle choice out of vanity, nor are they simply a diet that has gone “too far”. An eating disorder is a serious mental illness characterised by extreme concerns about weight, shape, eating and/or body image. These concerns lead to disordered and unhealthy patterns of behaviour, including restricting food intake, fasting, counting calories, bingeing, vomiting, misuse of laxative use, and excessive or driven exercise. These behaviours can lead to serious problems with physical, psychological and social functioning. A “watch, wait and see” approach can be very dangerous as eating disorders are not a phase that will just pass with time. Young people with an eating disorder need appropriate evidence-based treatment in order to recover.  It is always best to seek professional help so a comprehensive physical and psychological assessment can be carried out and an appropriate treatment plan developed.

 What should parents and teachers watch out for?

It is important to watch out for changes in mood or behaviours that might indicate there is a problem. For example, changes in food choices, avoiding eating socially, sneaking foods, referring to foods as good/bad, dieting, skipping meals, unusual eating behaviours, constantly going to the bathroom immediately after eating, exercise patterns, talking negatively about their weight or appearance, preoccupation with food or appearance, changes in weight in a short period of time, isolating, withdrawing, anxious or depressed mood. These changes are especially important when you notice that it stops them from doing things. Especially things they used to enjoy or avoiding eating foods they used to like.

What can parents and schools do to help support young people and make positive changes?

The family environment sets the foundations for the development of thoughts and beliefs around food, eating, evaluating one’s own and other’s bodies, along with all the behaviours related to these things. It is important not to misunderstand this as blaming families for causing problems, rather knowing how much of an important role you can have and to feel empowered. Challenge the unhelpful messages in society, the media and other places that promote toxic diet culture. Refer to the tips section in this article for how you can be a positive and healthy role-model. Help young people to develop social media “literacy”, gaining the knowledge and skills to critically analyse, evaluate, participate online and to avoid the toxic aspects of social media.

The people around a child also have influence on them and they play an important role. Support them to avoid “fat talk”, focusing on appearance (positive or negative), teasing and bullying. There should be a “no tolerance” policy when it comes to teasing or negative comments about appearance.

Tips to being a healthy role model and supporting a positive relationship with food and body image

• Talk about food for what it is, something that nourishes bodies and something you can enjoy.
• Avoid role-modelling strict dieting in order to lose weight and focusing on your weight in front of your children and teenagers. This might mean learning to manage your own relationship with food and your appearance.
• Don’t “forbid” any foods completely from your child’s intake because you think it will impact their weight.
• Don’t use food as a reward, punishment, or bribe.
• Encourage eating and exercise behaviours for health benefits and mental wellbeing, instead of weight or shape reasons.
• Focus on health and the functions of the body, namely what bodies allow you to do, rather than how they look.
• Avoid any encouragement, rewarding or praising of weight loss.
• Unless there is a medical reason, a child should never be on a diet or lose weight.
• Use non-judgemental language when talking about food or bodies so that you don’t encourage the development of unhealthy beliefs or behaviour. For example, don’t talk about “good” or “bad” when it comes to foods or bodies, as this gives them a moral value and can lead to shame and guilt if something is considered “bad”.
• For further tips, download the information sheet: Helpful language and behaviour to support body confident children and communities

Where can I go for further help and advice?

• Your GP, Paediatrician, Psychiatrist or Psychologist. Preferably a Credentialed Eating Disorder Clinician.
• The Statewide Eating Disorder Service (SEDS, ph: 08 7117 8800). This SA Health service is the only public eating disorder service in South Australia. SEDS provides comprehensive assessments and evidence-based treatment planning for people developing or living with an eating disorder. They also provide support and education to professionals, family and carers.
• The Butterfly Foundation butterfly.org.au is Australia’s national charity supporting those impacted by body image issues and eating disorders. The Butterfly National Helpline (1800 33 4673) provides free and confidential support. They offer a range of free resources and support.

Dr. Ertimiss Eshkevari is a Senior Clinical Psychologist at the Statewide Eating Disorder Service. She also consults privately at Thrive Family Practice, where she provides individual psychological treatment for eating disorders as well as other common mental health problems. She provides educational information sessions, workshops and is a Psychology Board-Approved Supervisor.

To contact Dr. Eshkevari: 

psychologist@thrivefamilypractice.com.au

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