It took me a long time to admit to anyone that I had anorexia. Even as I lost two stone, then three stone, then half my bodyweight, even as my clothes got looser and I stopped eating in public at all, I still maintained to worried friends and family that I was “fine, just not hungry”. Partly this was due to shame — I’ve always been independent and intelligent, and getting an eating disorder seemed like a weak, foolish, un-feminist thing to do. But even worse than the shame was a huge sense of fear. If I admitted I was sick, I would have to accept help, and that would mean gaining weight. My greatest fear — any anorexic’s greatest fear — is of getting fat.
For a parent, there can be few experiences as painful as watching your child starve. From birth, hunger is the most instinctive of a baby’s demands; feeding is the most fundamental expression of love and nurture. What if your child or teenager refuses to eat? Short of hospitalisation and nasogastric feeding, it may seem there is very little you can do.
The revelation this week that nearly 3,000 children were treated in hospital for eating disorders last year — a rise of 12 per cent on 2013 — took me back to those miserable, frightening days as my body wasted away and my brain began to fall apart. I was “lucky” enough not to get anorexia until I was 19. The physical risks to younger teenagers include long-term damage to major organs, low blood pressure and extreme sensitivity to cold, to say nothing of the isolation, depression and other psychological consequences. A girl who does not start to menstruate is at serious risk of osteoporosis in later life. Being underweight is also dangerous for boys and young men, and can damage their fertility.
For too long anorexia has been dismissed as a teenage condition, overwhelmingly female, and linked to pursuit of the body beautiful. But it’s time we treated it as the mental illness it is — and one that can kill. The Times campaign to raise awareness and improve treatment of child mental health problems could save many lives otherwise cut short by eating disorders. Of all the mental illnesses, anorexia has the highest mortality rate: 20 per cent of sufferers will go on to die from suicide or other physical complications. In 2014, the US National Institute of Health allocated eight times as much research funding to schizophrenia as it did to all eating disorders combined, even though anorexia is twice as deadly as schizophrenia.
And there is no magic cure: anorexia and bulimia are vicious, addictive illnesses, not a lifestyle choice. Conventional medical and psychiatric approaches have limited success. One thing’s for sure: the earlier you intervene to treat disordered eating, the greater the chance of making a full recovery.
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Eating disorders need more funding, more research and better treatment. I regularly hear from young people and their parents who are told that their body mass index is not low enough for them to be treated in hospital: to an anorexic, this is effectively telling them to go away and lose more weight.
The government also needs to treat the growing number of pro-anorexia and pro-bulimia websites as seriously as any other form of child abuse. Young sufferers pick up dangerous weight-loss tips from these so-called “thinspiration” sites, learning how to deal with hunger pangs and comparing their daily food intake with other sick youngsters. One 15-year-old recently told me that she learnt how to “purge silently” from a US-based website.
For three years I wrote a column for this newspaper charting my recovery from anorexia. I heard from readers of all ages, female and male, of all body sizes and experiences, from bulimia to anorexia to binge-eating disorder.
I met a mother whose anorexic daughter died in her arms, and teenage girls who watched their best friend starve to death at a leading private girls’ school. I met a healthy woman who went on the 5:2 diet to combat “middle-aged spread” and ended up weighing 4 stone, and a young man who took so many laxatives that he suffered a heart attack.
The question is always the same: what can we do? Sadly, the cure is at the heart of every anorexic’s worst fear: put on weight. To outsiders, anorexia is illogical: it makes no sense that an emaciated person would fear “getting fat”. It’s confusing on the inside too. Even at my sickest, I could see what I was doing: I was frightened and I hated my skeletal body and I didn’t want to die — yet I was still unable to eat. At a certain point, starvation becomes involuntary, and when you are starving you cannot think straight.
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But regaining weight is the first, most essential step. The brain is a muscle, and like any other muscle it requires energy. So, while enforced feeding is problematic — many patients get caught in the revolving door, regaining weight in hospital and losing it all again when they are discharged — nevertheless it is the only solution.
What else can we do? For parents it can be a minefield, but picking up on the early signs is vital. They can be as trivial as anxiety around mealtimes and excessive exercising.
Ultimately, though, the cure has to come from within. Sufferers need to be honest with themselves. As I tell those who ask me for advice: the sooner you ask for help, the sooner you can sort the problem out.
With more research and openness about child mental health, we can start to turn the tide on the curse of eating disorders.