Story by Elizabeth Chorney-Booth | Illustrations by Mateusz Napieralski
The Calgary Eating Disorder Program takes a family-centered approach to recovery.
Photo by Jason Dziver
It’s a parent’s nightmare: watching your teenager’s body waste away, getting thinner and thinner even when there’s plenty of food on the table, all because they refuse to eat or throw up what they do eat. When a child or teen won’t or, more accurately, can’t will themselves to gain weight because of an eating disorder, families can find themselves in a state of sheer helplessness. But as dire as an eating disorder can seem, there is help. Calgary has an excellent resource in the Calgary Eating Disorder Program (CEDP), which helps families understand and address the causes and behaviours surrounding these complicated mental illnesses.
So much scrutiny is placed on the way our bodies look, what we eat, and how much we exercise. It’s no surprise that kids can be extremely vulnerable to developing negative thoughts about their bodies, which can sow the seeds of a full-blown eating disorder. The idea of children and teens intentionally putting their bodies into a state of malnutrition is not just terrifying to parents, but can often be deeply confusing since the disorders tend to affect kids who otherwise seem healthy.
Eating disorders are mental illnesses
It’s important to understand exactly what constitutes an eating disorder. These conditions are about much more than emulating a supermodel or favourite pop star. The two most well-known eating disorders are anorexia nervosa, where the person restricts food intake to the point of malnutrition and low body weight, and bulimia nervosa, which involves binging and purging. There are other types of binge eating disorders that could even cause weight gain, but programs such as Calgary Eating Disorder Program primarily focus on those that cause malnutrition and weight loss. While anorexia and bulimia may often be seen as physical ailments because the visible effects can be shocking and dramatic, the threat they pose is as dangerous to the mind as the body.
Dr. Monique Jericho, a child and adolescent psychiatrist and the medical director of CEDP, says it’s important for families to know that a true eating disorder is defined by a quest to lose or maintain a certain weight that becomes so intense it overwhelms all other aspects of a person’s life. What might start as a seemingly harmless — or even healthy — diet or exercise regime will turn into an all-encompassing fixation. Individuals living with an eating disorder can barely think about anything beyond what and how much they eat or exercise.
“We may get distracted by the physical pieces of the disorder, but it is a mental illness,” Jericho says. “An eating disorder is diagnosed when dieting crosses a line and becomes a problem. It is no longer about having a choice — the eating disorder is guiding your thoughts, feelings, and behaviours, to such a degree, it is leading to impairment and problems psychologically, socially, and physically.”
Youth at risk
There’s a perception that anorexia and bulimia are primarily problems for teenage girls. While young women are certainly the most well-represented demographic, Jericho says these disorders can also affect young men and boys as well as non-binary and gender nonconforming individuals. (In fact, she’s seen an increase in 2SLGBTQIA+-identifying patients.) The disorders almost always begin to appear in youth, particularly during puberty. Many people do suffer from eating disorders well into adulthood, but the illness can typically be traced back to adolescence, which is why it’s important to diagnose disorders early on. If a person has been struggling with anorexia for years, it can be incredibly difficult to cure.
According to Jericho, somewhere around two to five per cent of youths in a city like Calgary will require treatment for an eating disorder, but she estimates that closer to 10 per cent of adolescents will struggle with a mild or moderate eating disorder. Many eating disorders thrive in secrecy and go undiagnosed. The COVID-19 pandemic, which caused an unprecedented spike in youth mental health issues, brought a 136 per cent increase in patients to Calgary Eating Disorder Program, a phenomenon that’s been mirrored around the world.
Jericho says that while anyone can develop an eating disorder, her most typical patients are kids with tendencies towards perfectionism and people-pleasing. As their physicality begins to change throughout puberty, these kids, who have always been praised for their model behaviour, strive to keep their bodies smaller or eat foods that are deemed “healthy” in order to please. They might see on social media or hear their parents talking about cutting out certain foods or taking up an intense exercise regime and decide to adopt those measures to win praise. Couple this need for positive reinforcement with the natural changes in a child’s body and the general uncertainty and mental stress that comes with puberty, and an eating disorder can sneak in and take hold.
“These are generally successful children who tend to be more from the perfectionistic side,” Jericho says. “They like rules, they like order, they like structure, they like pleasing people. They like doing things well for their teachers, their parents, and so forth. Oftentimes, there’s a propensity for some anxiety and a little bit of social reticence as well.”
Part of what makes eating disorders so tenacious is that, according to Jericho, there is no achievable end goal for the person with the disorder. As they begin to lose body mass, the compulsion to continue getting skinnier grows, and the condition will be exacerbated as malnutrition begins to inhibit normal cognitive function. The child might become isolated and alienate friends as food intake becomes their primary interest and, if left untreated, the disorder will likely continue until the physical effects lead to hospitalization or, in the most severe cases, death.
What parents can do
Identifying an eating disorder in a child or teen can be difficult, particularly when eating fruits and vegetables, avoiding junk food, and getting plenty of exercise are things most parents actively — and justifiably — encourage. Jericho says parents can do their best to discourage their children from developing eating disorders by avoiding vilifying larger body types, labelling certain foods as “bad,” or bad-mouthing their own weight or eating habits. Giving children the space to express their feelings about their changing bodies, fears, and uncertainties as they enter puberty can also help.
“Kids often fall into these disorders because they have beliefs about what people expect from them,” Jericho says. “Giving kids lots of opportunity to understand that no one’s perfect, that we all make mistakes, that we all have strong feelings, and that we’re comprised of much more than our appearance, is important.”
Still, with so many external influences, including social media, on which kids can find entire channels dedicated to “thinspiration” or even offering tips on purging, parents’ best efforts to model positive attitudes concerning body image may not prevent their child from developing an eating disorder. Jericho says parents should proactively take notice of a lack of interest in food and excessive time spent exercising. Behavioural symptoms like suddenly becoming withdrawn or socially isolating, not caring about anything other than weight loss, or declining performance at school should also raise red flags. Jericho encourages parents who suspect an eating disorder to intervene immediately.
“If an eating disorder has been ongoing for quite some time, you’re running up against an entrenched way of being and also malnutrition in the brain,” she says. “As soon as you notice, you have to say something and start the conversation, even if it’s going to be unpleasant. You can’t put your head in the sand and hope it will go away.”
Get help ASAP
If you suspect a possible eating disorder, Jericho says the first course of action is a visit to a family doctor or primary care provider. A physical assessment will set a baseline for an adolescent’s weight, and the doctor will also evaluate the patient for signs of malnutrition as well as overall function and wellbeing. If the physician does suspect a moderate to severe eating disorder, they’ll likely refer the family to a resource like the Calgary Eating Disorder Program, specifically designed to treat the disorder and accessible only through referral.
Once a patient is referred to CEDP, Jericho and her team take a multidisciplinary approach to treatment. Patients will see a pediatrician to assess the physical damage caused by the eating disorder, a psychiatrist to look for other mental health issues such as depression, anxiety, or additional forms of self-harm, a dietitian to perform an inventory of food intake and eating habits, a family therapist or social worker who works with the patient’s entire family for ongoing support, and other professionals such as occupational therapists, depending on the patient’s needs.
The program provides outpatient, daypatient, and inpatient treatment depending on the severity of each case. Calgary Health Foundation and the Alberta Children’s Hospital Foundation are funding the capital costs for the expansion of CEDP facilities and programming while Alberta Health Services and the Government of Alberta will provide operational funds over three years.
Specifically, Calgary Health Foundation is fundraising in part for the creation of a new dedicated inpatient treatment centre at Foothills Medical Centre — currently, such a centre only exists in Edmonton — and the expansion of the outpatient program, based out of Richmond Road Diagnostic and Treatment Centre.
At CEDP’s heart is a family-centred approach to make sure parents, siblings, and patients are all on the same road to recovery. While the process can be difficult and emotionally fraught, Jericho says there’s plenty of reason to be optimistic — the majority of the program’s patients experience significant success.
“A full 85 per cent of young people who present with anorexia will recover fully if they’re provided with the appropriate treatment,” Jericho affirms. These patients will no longer have their eating disorder and will return to leading full lives. Others may still struggle, but can manage their condition so it’s not life-threatening.
The key is to take immediate action and get help. Jericho emphasizes, “the most important piece is making sure the diagnosis is made as soon as possible.”
How to have a conversation with your child if you suspect an eating disorder.
- First, learn all you can about eating disorders.
- Prepare yourself to listen with compassion and without judgment. Remember that only a professional trained in diagnosing eating disorders can make a diagnosis.
- Plan a private, uninterrupted time and place to start a discussion. A car ride can work well. The goal is to express your concerns about what you’ve observed and persuade, but not force, your child to accept help.
- Be calm, caring, and nonjudgmental. Directly express your observations and concerns about your child’s behaviour. Try statements like: “I am concerned about you and what’s going on for you when I see you [fill in the blank].” Cite specific days/times, situations, and behaviours that have raised your concern.
- Share your wonder about whether the behaviour might indicate an eating disorder that requires treatment.
- Avoid expressing frustration with your child. Be gently persistent as you express your concerns. Ask, “Are you willing to consider the possibility that something is wrong?”
- Be prepared with resources to offer to your child. Or leave a list of resources for them to look at on their own. Even if they do not acknowledge a problem during your discussion, you have raised awareness that you are paying attention, have concerns, and want to be a support.
- Ask if your child is willing to explore these concerns with a healthcare professional who understands eating disorders.
- Remind your child that many people have successfully recovered from an eating disorder.
- Take a break if your child continues to deny the problem and revisit again soon.
Source: National Eating Disorders Association (NEDA) Parent TOOLKIT
