World Eating Disorder Action Day: Breaking bias and supporting families to intervene early

Each year, World Eating Disorders Action Day shines a spotlight on the challenges faced by people living with eating disorders.

This year’s theme, Breaking Bias and Supporting Families, emphasises the urgency in challenging harmful misconceptions, which can delay help-seeking and cause poorer health outcomes [1], as well as exploring the role families can play in early intervention.

Breaking Bias 

Eating disorders impact over 1.1 million people in Australia, but less than a third of those access the support they need to recover [2], with bias and stigma likely to play a significant role. Research shows that 1 in 7 people believe those with eating disorders could ‘snap out of it’ and 1 in 6 perceive eating disorders are a sign of weakness [3].  

Other common biases and misconceptions include weight bias, where we assume only people living in smaller bodies are affected, and gender bias, where we think that only women can experience an eating disorder. Moreover, racial bias can see us assume only white people are impacted, while socioeconomic bias involves the inaccurate belief that only people from higher socioeconomic backgrounds are affected. 

“We all have views and thoughts of what an eating disorder looks like. Many will have the same stereotype- middle class, white, teenager who looks like they are wasting away. While there are some who fall into this demographic, there are many more who don’t. The idea that there is one way for an eating disorder to look is one of many myths that I had to fight through in order to recognise that I needed help and to access the appropriate treatment. My family didn’t recognise the signs of my eating disorder because I didn’t fit what they had always been told.” – Sarah, lived experience of an eating disorder

These biases result in underdiagnosis and a lack of awareness in the ways eating disorders or body image concerns can impact men, people from diverse cultural backgrounds, the LGBTQIA+ community, and people of lower socioeconomic backgrounds. 

We can all play a role in challenging bias, through increasing our own awareness and education around eating disorders and body image concerns, and can in turn feel more confident in recognising the signs that someone is living with an eating disorder, and take that important action in offering resource and referral information. 

Exploring Butterfly’s website can be a great place to educate yourself, with information around eating disorders explained, risks and warning signs, common myths, treatment pathways, and the recovery journey, which can look different for everyone. 

Butterfly also offers many programs to help improve young people’s self-esteem and body image, including our strength-based Butterfly Body Bright program for primary schools, and our BodyKind program for secondary schools. For families, we also have various resources and workshop available here.
 

Supporting Families to Intervene Early 

Research demonstrates that intervening early can reduce the severity and duration of an eating disorder [4], but it can often be difficult for families to spot the signs and know when an issue requires more professional support.  

New research from Flinders University, published in the International Journal of Eating Disorders, has identified the most common early warning signs of eating disorders in children, to help guide parents and caregivers around when to seek help. 

As the prevalence of eating disorders within young children continues to increase, lead author Dr Jamiel-Lee Pennesi says there can be a delay between parents noticing the warning signs and seeking help. 

“Spotting the early signs of an eating disorder in a child can be difficult, because it can start very innocently with subtle changes to their habits, such as changes in eating patterns, only eating certain foods, not finishing their meal, wearing baggy or oversized clothing, overexercising,” says Dr Pennesi. 

“If these behaviours aren’t addressed, they can quickly develop into serious eating disorders, such as anorexia nervosa or bulimia nervosa. 

The study reports that the ten most common early warning signs for an eating disorder in a child are [5]: 

1. Excessive or compulsive exercise, including exercising in secret like during the night or in their bedroom. 
2. Any obvious weight loss or gain. 
3. Obsession or preoccupation with food or food preparation. 
4. Cutting out major food groups such as carbohydrates or dairy. 
5. Secrecy or dishonesty around food or eating, such as saying they’ve already eaten elsewhere or with other people. 
6. Obsession or preoccupation with body image, weight, shape and size. 
7. Self-induced vomiting or making themselves sick, or signs of self-induced vomiting. 
8. Changes in bathroom habits, such as frequent visits to the bathroom after meals or eating. 
9. Skipping meals, including avoiding food, mealtimes, or situations involving food. 
10. Rituals and rules about food and eating, such as eating food in a certain order, cutting food into tiny pieces, or a fixation on using the same crockery or cutlery.

It’s important to note that not every individual experiencing an eating disorder will have all of these signs and symptoms, and it’s also important to consider differences in how neurodivergent young people may experience feeding and eating concerns.  

How eating disorders can impact families 

When a family member is diagnosed with an eating disorder, this has a significant impact on the entire family unit in different ways. 

Emotional Impact: Family members can experience a very vast range of emotions when a loved one is diagnosed with an eating disorder. From experiencing anxiety around their family member’s health and safety, to guilt as they over-analyse previous interactions and behaviours, to frustration, especially if a family member is resisting support or if there’s a lack of understanding around their experience. Family members may also feel fearful or embarrassed around other people in the community finding out what’s happening, especially as eating disorders are often stigmatised and falsely stereotyped – highlighting why it’s essential we break down myths about eating disorders. 

Family Dynamic Changes: If a family member is diagnosed with an eating disorder, one or more family members may step up to take on a caregiving role, which can impact other responsibilities and relationships within the household. Siblings or other family members may feel left out or overlooked, while the focus is placed on the person living with the eating disorder and their recovery journey. 

“You have just got to be really strong and realise that a lot of the things they do, all things that they do are the eating disorder and not them … You have to be strong and stand up and know that it is the eating disorder. You really have to get a good idea of what mental illness is about.” – Carer in Butterfly’s Maydays Report 

Social and Lifestyle Changes: Family mealtimes may be a time for bonding and connection, however during eating disorder recovery, mealtimes may become a source of tension or conflict, dependent on the current treatment and recovery journey. Given the prominence of bias and stigma around eating disorders, families may withdraw from social events due to fear of judgement, or lack of time. The treatment and recovery journey may also cause a loss of routine for families, as hospital or therapy appointments may change daily schedules, which can be especially tricky for children. 

“There is a strong social isolation. I’m a very social person and for the last 4 years we’ve had little headspace or time to reach out to friends. Because it is very exhausting.” – Carer in Butterfly’s Maydays Report 

This World Eating Disorder Action Day and beyond, let’s reflect on the importance of prevention and early intervention of eating disorders, and strengthen our knowledge around disordered eating warning signs and common misconceptions to ensure more people can get the help they deserve. 

Get support 

If you’re struggling with an eating disorder or body image concerns, reach out for help from professionals that understand eating disorders. 

• For confidential and free counselling, call the Butterfly National Helpline on 1800 ED HOPE (1800 33 4673) or chat online or email, 7 days a week, 8am-midnight (AEDT). 
• Find an eating disorder professional – search Butterfly’s National Referral Database to find eating disorder practitioners closest to you. 

Support for carers

• Screening Tool – complete the ‘Are you at Risk’ Screening Tool with your loved one to understand if their symptoms indicate they should see a trained health professional, such as GP or psychologist.  

• Carer Support Groups – available every fortnight, Butterfly’s Virtual Carer Support Groups are facilitated by trained facilitators who have lived experience of caring for a loved one with body image issues or an eating disorder. Anyone over age 18 from anywhere in Australia is welcome to attend. 

• Understanding Eating Disorder Recovery For Carers – Butterfly’s free 6-week webinar-based workshop can help you develop practical skills to support your loved one in their recovery. 

• Collaborative Care Skills Program – Butterfly’s free program offers evidence-based training in motivational interviewing and effective communication techniques to aid in the recovery from a loved one’s eating disorder. Carers will also be provided with support around self-care and wellbeing to reduce psychological distress, burden, expressed emotion, and boundaries in level of involvement. 

• Butterfly National Helpline – For confidential and free support, call 1800 ED HOPE (1800 33 4673) or visit www.butterfly.org.au to chat online or email, 7 days a week, 8am-midnight (AEDT) 

• Eating Disorders Families Australia – carer support groups and education.  

 

References

[1] Butterfly Foundation, Community Insights Report, 2024, https://butterfly.org.au/who-we-are/research-policy-publications/communityinsights2024/

[2] Deloitte Access Economics, Paying the Price, 2024, https://butterfly.org.au/who-we-are/research-policy-publications/payingtheprice2024/

[3] Butterfly Foundation, Community Insights Report, 2024, https://butterfly.org.au/who-we-are/research-policy-publications/communityinsights2024/

[4] NEDC, Early intervention, no date. https://nedc.com.au/eating-disorders/early-intervention#:~:text=Early%20intervention%20can%20reduce%20the,relapse%20or%20recurrence%20of%20illness.

[5] Pennesi, J. et al. 2024. Early warning signs for eating disorders in children: a realist synthesis of websites summarising caregiver and consumer perspectives. International Journal of eating disorders. https://onlinelibrary.wiley.com/doi/10.1002/eat.24359