Parents beware: how eating disorders surge over summer
For most families the summer holidays are about ice cream, the beach, campsites and swimming pools; a chance to take a deep breath after another frenetic year. But for some they represent the beginning — or worsening — of their child’s eating problems.
Summer holidays are a ‘very difficult time’ for children who are susceptible to eating disorders, explains Dr Caz Nahman, a spokesperson for the royal College of Psychiatrists.
‘Children who are anxious, perfectionist, or high-achieving — the kind of children who are susceptible to anorexia — are going full-tilt through school exams and then the summer holidays are suddenly upon them and they’re faced with a lot of unstructured time.
‘They might be going away with their parents, maybe to a hot country and so they’re also faced with having to expose more of their bodies. Everyone is breathing a sigh of relief the summer has arrived, but the holidays can actually make things worse.’
It is a very common problem, she says. It was the start of the summer holidays in 2014, when she was 14, that Hannah Crossland, a beautiful, tall girl from retford, Nottinghamshire, first developed anorexia.
‘We were going on holiday to Spain in July — the same day I broke up from school for the summer holidays and I thought I wouldn’t look good in a bikini,’ she says. ‘on the beach I felt really self-conscious, I thought my legs looked really big and I wanted to cover up all the time.’
This is typical in children with eating disorders, say experts.
Furthermore, it’s only when they see their child in swimwear on a summer holiday that some parents realise there is a problem, says Dr Adrienne Key, a specialist at the private Chelsea and Harley Street Eating Disorder Service.
‘Seeing how thin they are on a beach or in a pool is when parents often first realise something is really wrong,’ she says.
Their behaviour can also signal problems, she adds. ‘At the start of the illness, they might feel great about losing weight and there’s more chance of them wanting to get into a swimsuit so people can see it.
‘If they’ve been ill longer, they’ll probably want to sit in the shade and won’t be seen dead in a swimming costume because they feel so ugly. They might get bad-tempered if they’re made to sit by the pool.
‘Losing weight is no longer reaping any benefits for them, and everyone has become conscious of the illness and has probably tried to stop them losing weight, so they want to hide it more. When they get more ill, children might refuse to be on a beach or near a pool at all.’
HANNAH says that it was only when she returned home in August 2014 after the family holiday that she ‘started really losing weight’. ‘I started really watching what I was eating — I had smaller portions and cut out snacks,’ she explains. ‘I became obsessed with the gym. I went every day for up to two hours and started secretly doing YouTube fitness videos in my bedroom.
‘At first I just wanted to look fit and healthy, but the first week I started the gym routine I lost three pounds and that felt so good I wanted to keep going.’ This was when the signs of her eating problem became unmistakable.
As her father, Tim, 47, a manager for agricultural accounts at NatWest, explains: ‘When children are at home all the time, you see things more. I noticed how obsessed Hannah had become about going to the gym. I went with her and saw how thin she was in her gym kit.’
Hannah became increasingly reclusive. ‘I couldn’t go out with friends or family because it would always involve food and I couldn’t physically sit in a restaurant,’ she says.
‘I’d become scared of calories. I thought anything I ate would make me put on loads of weight. I can see, now, that I looked like a ghost. My bones were showing too much.’
In September, when Hannah went back to school, her mother, Vicky, 43, a teaching assistant, took her to the doctor, worried about her extreme weight loss and the fact that her periods had stopped (a side-effect of anorexia). referrals to eating disorder clinics often ‘double’ in September as families who have noticed their child trying to lose weight during term time might hope the summer holidays will sort things out, says Dr Key. ‘We usually see referrals drop in August because families try to put things on hold.’
Despite the changes caused by Hannah’s extreme dieting, the GP told her simply to ‘do less exercise and eat healthily and regularly’. ‘For ages, it felt like doctors weren’t taking us seriously,’ says Tim. ‘They seemed to have this attitude that all children were fussy eaters and maybe it was a phase — but she’s never been fussy. It didn’t make sense.’
The situation deteriorated when Hannah stormed out of a restaurant the family had gone to one evening for a treat, and it was clear something was really wrong.
‘She had a complete breakdown because she couldn’t stand being near the food,’ says Tim. ‘I was shocked. By this stage she looked awful — pale, drawn-out, her wrists looked so tiny.’
By the Christmas holidays in 2014, she had ‘given up food completely’. one week before Christmas, after her mother insisted they see their GP for a second time, Hannah was eventually diagnosed with anorexia. It was five months after she first started restricting her food and she’d lost over two stone.
Her BMI was around 18 — which classed Hannah, who is nearly 6ft tall — as unhealthily ‘underweight’.
In the UK, more than 725,000 people are affected by eating disorders, says the charity Beat, with young women — particularly those aged between 12 and 20 — most at risk.
At the suggestion of her GP, Hannah started attending Freed Beeches, a free therapy service in Worksop, Nottinghamshire, for eating disorder patients over 14.
However, she continued to deteriorate and lost another stone, with her weight plummeting to just over 7st.
‘It sometimes took me two and a half hours to get Hannah to eat something for dinner,’ recalls Tim. ‘She became a real recluse, she didn’t want to go out or see anyone. She didn’t even want to go to her prom in June [last year]. It drove a stake through the family.’ Hannah reveals it made her mother cry. ‘She wanted to know what she’d done wrong to make me like this,’ she says. In less than a year, she’d lost about three stone. Photographs from the time show a painfully thin girl, her waist so small and her shoulders so thin that her parents are struggling to have something to put their arms around. In May 2015, when her body mass index dropped below 17 (a healthy BMI is between 18.5 and 24.9), she was referred to Nottinghamshire’s Child and Adolescent Mental Health Service (CAMHS) and put on 12-hour bed rest — a desperate attempt by doctors to stop her losing any more weight — for a month. She was on the verge being hospitalised. ‘I wasn’t allowed to get out of bed unless it was for the bathroom,’ says Hannah. ‘I just lay there. Being told I couldn’t exercise killed me. I’d get angry and scream and argue if anyone tried to make me eat anything. Not eating was a control thing.’
Dof r KEY says children regulate what they eat to feel like they are in control of their lives. But for parents it’s difficult knowing ‘how alarmed’ to be, adds Dr Nahman.
‘If your child’s personality begins to change — are they anxious, suddenly very indecisive, or refusing to see friends? — it can suggest an eating disorder is involved,’ she says.
‘More obvious warning signs include skipping meals, saying they’ve already eaten, or that they don’t like anything on the menu. If any of those things happen, I’d advise parents to take their child to their GP — early prevention is key.’ With the help of the CAMHS, which provided a psychologist to help her get used to eating again, Hannah was able to put on weight. She was discharged last month and is now studying for her A-levels. She hopes one day to be a primary school teacher and is, generally, much happier.
‘Now I can go for a walk with the dog again or go to dinner at a friend’s house,’ she says.
But she hasn’t been on a beach holiday since the trip to Spain in 2014. This year she will stay at home when her parents take her two younger brothers to Portugal.
‘I still want to cover up sometimes,’ she says. ‘Anorexia will always be with me, but I feel much better about the way I look.’
Her parents are naturally over the moon the ghostly girl who wandered around their house has been replaced by their daughter.
Tim — who did, in the end, persuade his daughter to go to the prom — says her transformation has been incredible.
‘There’s a picture of her taken at a family friend’s wedding recently. She looked amazing. really amazing. She still does. It feels like she’s back.’