Around 1.25 million people in the UK have an eating disorder. They can start at any age but most often develop during adolescence. And despite greater awareness, the number of children and young people living with an eating disorder has increased by 55% in just two years, figures released by NHS England reveal.
Perhaps surprisingly, anorexia is the least common eating disorder (behind bulimia and binge eating disorder), accounting for just 10% of cases, yet it has the highest mortality rate of any psychiatric illness. Early intervention dramatically increases the chances of a full recovery, so it's crucial that parents know the warning signs, and how to tackle them.
Renee McGregor, eating disorders specialist dietician and lead nutrition adviser for Anorexia and Bulimia Care (ABC), says that while every child is different, there are a number of early signs to look out for. "You may start to notice agitation and irritation around mealtimes, and your child might start showing a lot more interest in food, and talking about food a lot," she comments.
Often, this starts with a specific event - such as giving up chocolate for Lent or going sugar-free for a month - and although it might be tempting to encourage this behaviour as healthy, it can sometimes indicate that a child is beginning to exert unhealthy control over their diet.
"Where it starts to go wrong is when the child does the month, then they carry on or say they might try something else," McGregor adds. "You start to notice some anxiety around breaking away from some of the rigid 'food rules' they've made."
Other signs include a preoccupation with exercise, becoming more reclusive, wearing more clothes, and inability to sleep. Your relationship with your child will usually begin to suffer as well as they withdraw into themself.
It's commonly only when a child's weight begins dropping rapidly that parents first recognise that something is wrong - by which time, it can be very difficult to stop an eating disorder in its tracks. McGregor recommends that, upon any slight change in your child's behaviour which you're uncomfortable with, you sit down with them and try to get them to open up. "The more you can communicate with them, the better," she says.
Identifying that your child is developing an eating disorder is only half the battle - recovery is a long, difficult journey for everyone. The most effective treatments combine weight restoration with specialist counselling, and addressing one without the other simply won't work. The first step is to see your GP, who can refer your child to appropriate mental health services.
However, long waiting times for assessment and treatment can leave parents feeling isolated and children at risk of becoming more ill.
"With anorexia you hide it very well, but even when I finally went to my GP, it took a long time to access specialist care," she recalls. Eventually, Virgo became so unwell that she was hospitalised in a mental health unit for a year.
Her story is far from unique: people wait on average three years before seeking help and meanwhile, hospital admissions for girls under 19 with anorexia have gone up by a massive 93% in the last six years.
As a result, it often falls to parents to step in and deal with a potentially life-threatening illness they often understand very little about.
"The first thing parents must know is that eating disorders are very complicated; it's not about food or body image," McGregor explains. "The underlying problem is a child's perception of themself, and a real dissatisfaction with who they are."
A hard-lined approach
That said, it's vital to combat restrictive food habits early on and, according to McGregor, treading carefully won't cut it.
"Eating disorders are manipulative, so children will use a softly-softly approach to their advantage," she says. "It's very important that parents are firm and put in place non-negotiable boundaries."
This means insisting - as firmly as possible - that your child sits down with you and eats healthy, balanced meals. Most importantly, there must be consequences if they refuse, such as not letting them take part in sport or go into town with their friends. McGregor points out that while this might seem very harsh, allowing your child to go about their life unchallenged simply normalises their eating habits and sends the message that it's OK if they choose not to eat.
There are steps you can take to minimise conflict around meals, like involving your child in decisions about what you'll eat as a family, planning ahead, sticking to set mealtimes and avoiding last-minute changes.
"There's always an understanding when I get together with my family that we don’t draw attention to what's on our plates or to what other people are eating," says Virgo. "It also really helps to make sure that when you sit down for a meal, it's not stressful and you're not in the middle of an argument."
If you feel you're not getting the help your child needs, or if you're waiting for assessment or treatment, it's important to seek support elsewhere. The charities Beat and ABC are a great place to start; both have helplines, a wealth of information for parents and young people, and a directory of other useful resources.
Now aged 27, Virgo is healthy - thanks largely to the support of her parents. Little things, like a text from her mum, help her get through bad days.
"When I was ill, my parents tried really hard to talk to me about how I was feeling," she recalls. "But I think they wish they'd tried a little bit harder. Often, anorexia makes you feel like you're completely alone, so making sure your child can talk to you is the most important thing to help them get better."