By Denise Winterman
BBC News Magazine
Nearly half of the British children with an eating disorder feel unable to talk about their problem, says a report from the Eating Disorders Association (EDA).
It is estimated that more than a million people in the UK have anorexia or bulimia and many of them are young.
The report says eating disorders are still misunderstood and mistaken,
sometimes seen as trivial and self-inflicted when they are actually serious and life-threatening mental illnesses.
Early treatment is vital if people are to avoid long-term consequences to their physical and mental health, but many youngsters keep their condition secret - including one such teenager who has kept a diary of her relationship with food.
Sarah - not her real name - lives in Manchester with her mother and sister. The 18-year-old student has had an eating disorder for four years. Here she details how food dominated her last week.
Monday usually starts with a list of resolutions about what food I am not going to allow myself to eat in the next week. I want to control what I eat and get a feeling of excitement at the strict targets I set myself. When I am at college it is easy to do. The hard part starts when I get home from college. My family know I have a problem and insist on family meal times.
I started focusing on food when I was in my early teens. My parents divorced and I felt it was my fault. I felt unworthy and stopped eating. I felt I no longer deserved food and controlling what I ate would help me get control of my life. It became the only positive aspect of my life. I feel I have succeeded at something if I get through the day only eating what I have planned. If I don't succeed I have a voice in my head that tells me how bad and weak I am.
I stick to my eating plan again and I also cook a meal for myself and my mum. When I cook I usually make complicated dishes as I like dealing with food, but in the end don't have much myself. I try to avoid eating but not being around food. I will cook and watch cookery programmes, surrounding myself with food, but not eating it makes me feel strong willed.
"It's very important to me, it's about control"
I have set up strict rules for myself. I try not to eat before a certain time and after a certain time. I measure out everything, even the skimmed milk I put in my tea, and will restrict how much water I drink. It is a ritual and I feel scared when I can't do it, when my routine is disturbed. It's very important to me, it's about control and I don't like not to be in control.
Had an argument with a friend today. Not eating can make me irritable and snappy. I know I have lost friends over the years. Controlling my eating ends up controlling my life and that doesn't make me the most fun person to be with, or to live with. You can't rely on people anyway, but on food you can.
I weigh myself at the same time each day. I do it when I get up as I will be at my lightest. I do it before having a shower because even having wet hair might make me weigh more. It's not about what I look like or what size clothes I wear, as I never want to show off my body anyway. It is about how much I weigh.
Another argument today, this time with my mum and sister. I know I am hard to live with and they worry. The row makes me feel low so I binge on bags of crisps, which makes me feel worse. I end up throwing up in the garden. I can't really do it in the house if they are there as they know and try and stop me. You get very clever about hiding stuff.
I was referred to my local hospital for help a few years ago after my mum took me to the doctors. I weighed under seven stone (44kg), which was low for my height. I've had help and am now seven-and-a-half stone (48kg). Everyone wants me to gain more weight but this is as far as I can go. The help I get is focused on food and not why I control what I eat. Food is just the tool I use, the problem is something different but no one seems to want to listen to that.
I am cutting out even more stuff today to make up for my binge yesterday. If I have a craving for something like chocolate I will often just put it in my mouth to taste it but don't swallow it. It takes a lot of control to spit it out but I feel good when I do.
It's estimated that over 1m people in the UK have an eating disorder
I know I have improved my eating over the years and I am not so strict with myself, but I can't imagine a time when I won't think about what I am putting in my mouth. I know everyone around me wants me to be normal but what does that word mean anyway? Everyone I know worries about something and does stuff to make themselves feel better or to forget. My friends drink and take drugs, is controlling my eating any worse than that?
Go to the gym today. Exercise is also an important part of my life. It is all wrapped up with my eating. Often I feel quite faint after a session as I like to push myself but don't have much energy because I haven't eaten much. It's quite a nice feeling for me.
Sometime I think of the health implications of what I do, but it is a fight between my head and my body. My body might be wanting food but my head is always questioning if I really need it and trying to talk me out of it. People tend to think anorexia is about being skinny because that's what the media says is good. For me, it's about something different. I don't want to show my body off, I want to feel as if I am good at something. I want to feel good about myself.
Sunday is the day when I assess how I have done and think about my targets for the following week. This week I feel quite proud of myself but if I've had a bad week I can feel quite low. New targets all depend on what I have managed the week before.
I do wish I wasn't like this. But this is me, this is what goes on in my head and this is what I do to my body. I have had help but I know the changes have to come from within me and that's the frightening thing, I don't know if I can do it.
I've suffered from a less exposed eating disorder for over 10 years now - Binge eating disorder. I am surprised that it isn't mentioned as an eating disorder in this story as the EDA do offer information and help on it too.
I sometimes have behaviours like those of anorexics or bulimics too, and I spent several months of my youth throwing up what I ate.
Now I am 21 and still suffering. I am now overweight so no matter how much I talk about my mental problems with food and eating to doctors and the NHS all they see is the weight! I was put on weight loss medication to lose weight, but offered no help to sort out my issues with food and eating. I'm not losing weight and still continue with this eating disorder as a daily battle! I hope eating disorders awareness week (5th - 10th feb) can make doctors and professionals more aware of these problems that girls, young women and men face.
Heather Jeeves, Hayes, UK
I had a friend with an eating disorder too, and it really bugs me when people focus on the impact the media has. As Sarah says, it's not about image, it's about control. If it wasn't food, it would be hand washing or something. Anorexia is similar to Obsessive Compulsive Disorder, and should be treated in a similar way.
Debbie, Witham, Essex, UK
It's frightening to see how similar one persons symptoms are to anothers. I am 23 and have been anorexic for roughly the same time (about 4 years). All of the habits are the same and i am scared to death of breaking my routine. I over exercise and undereat considerably. Unfortunately no-one seems willing to help within the medical fraternity. When i was 21 i weighed a meager 8.5 stone (56Kg), considerably underweight for a 5ft 9in man. Now i weigh 10 stone and am still suffering
This story is sad but not surprising. This girl is just like an alcoholic, drug addict, or smoker who wants to stop but can't. I do hope she can triumph over this battle before she permanently damages her body.
Annette , Nottingham
17 years ago I went through something similar, but being just over 5 foot my weight was much lower before people realised something was wrong. I didn't set goals as such. My 'meal' was one small, green apple per day and I tried to see how long I could go before I ate it.
Now I'm a healthy weight, but I am constantly looking at losing 'a few pounds'. The issues I have with weight and food are now being passed on to my 10 year old son and I'm worried for him.
Pauline Yates, Suffolk
Can honestly say I am glad I read this. Good to know I'm not alone
This is a really sad thing to read. A voice somewhere inside *Sarah* isn't being listened too. Its obvious that she needs much more and much more structured help then she is getting. I suspect that deep inside her she is happier with the problem than she would be if she was trying to deal with the problem.
Sometimes facing up to our demons gives us much more to deal with then we ever expected.
I too have an eating problem, in my case binge eating. Its very hard to control something that you have to keep using to live.
Good Luck Sarah, and good luck to your family, i'll be thinking of you.
The article gives an accurate view of how someone who has an eating disorder has to deal with the illness on a daily basis.
However, one thing that is somemtimes overlooked in both reporting and by the medical profession is the effect that EDs have on people close to the sufferer. Having to live with someone who is ill in such a way, and having to deal with the violent emotions of someone you love can be as mentally damaging as having the illness yourself.
A male friend of mine died after 5 years of anorexia. Serious damage is done to heart muscle if such starvation is continued, and this can be lifelong, even if the anorexia is defeated.
What a sad inditment of our mental health-care system - this young woman is suffering, and knows what she needs to help her, but the know-it-all psychologists have ignored her and failed her.
Jill Cockerham, Leeds, UK
My GP in Singapore suddenly gasped when I visited her for a prescription. I was 65kg at the time, after the birth of my daughter. In image concious Singapore it put me under immense amount of pressure to loose a couple of pounds. Which made me wake up at 5am 5-7days a week to exercise. I cut down on all carbs and started using my childrens, utensils to eat. I lost the weight but I was deprived. There a healthy weight always meant to be around 48kg to a 52kg if you are bigger built. I was irritable to be around and was always lethargic. It all depends on the society you're in, how pushed you are doing in to some thing which is unacceptable. You will go to any lentgh to achive it. No matter what the circumstances are.
Faz, Munich Germany
I was anorexic at the age of 15 to 19. I am now 55. Over the years I have had huge weight ups and downs and it was only when I had my child at the age of 40 that i could eat normally for the first time. Today i am overweight but fit and active but have to watch every morsel i eat...food is a continuing nightmare
I started displaying disordered eating behaviour at age 11, and at 24 am still not fully recovered. I had no support from my family or school, even when I was at my lowest weight of 7.5 stone at the age of 17. I eventually was taken to the doctor by a close friend and began the painful road to health at age 18.
The main issue behind eating disorders is control; my family moved around a lot and this was one of the main reasons for my problems with food. I had no control over many aspects of my life and could not effectively communicate my feelings as I was so young. As I grew older, the negative attitude to my body and lack of opportunity or ability to discuss these issues led to self-harming behaviour and a complete lack of self esteem which left me vulnerable to abuse by controlling boyfriends.
I am now at risk of osteoperosis, and will spend the rest of my life struggling with food; my first instinct in times of stress or unhappiness is "don't eat anything, it'll make things better". Eating disorders are serious problems with far-reaching consequences that are unlikely to ever be fully overcome by the sufferer. More support and better education are vital to help stem this growing problem.
It's good that awareness of diseases such as anorexia and bulimia has increased over the past decade or so.
Now, hopefully, we can have the same care and time spent on spreading awareness of those who over-eat for very similar reasons. Maybe then we can shatter the myth that all fat people are lazy/stupid/etc. and the truth that many overweight people have suffered terribly in their past and bear the burden of great mental health disorders as a direct result of this.
Sharon Irvine, London, UK
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