Eating disorders in Kiwi adolescents have skyrocketed since last year's Covid-19 lockdown, with experts saying upheaval and uncertainty around the pandemic and loss of routine were significant factors.
Experts are seeing increases of at least 50 per cent in the number of people presenting with eating disorders - including anorexia and bulimia - and say most are younger teens aged from 11-14.
They fear there are many more youngsters battling behind closed doors and want to create awareness in the community.
The Herald has heard reports of children as young as 8 dangerously unwell and hospitalised as a result of their eating issues.
Young males are also presenting more often.
High-profile nutritionist Nikki Hart - who is Auckland-based but has clients across New Zealand - said she had seen an increase of at least 25 per cent in young people on her client list in the last 12 months.
And New Zealand Eating Disorders Clinic director and psychotherapist Kellie Lavender says her team have had a 50 per cent increase across the board - with the bulk of the numbers "leaning towards" adolescents.
"It's like a tsunami really," Lavender said.
"Keeping up is really tough. Year-on-year we have had a 10 per cent increase in eating disorders across the diagnostic spectrum - anorexia, bulimia, binge eating disorder and avoidant resistant food intake disorder.
"When lockdown happened last year it did drop off a little bit but we got to May and we got 47 (patients) and in June 51 and in July 49 - literally four months after the lockdown we had a 50 per cent increase in referrals.
"They did tend to lean towards younger people."
Hart believed the eating disorders young Kiwis presented with were usually a symptom of a deeper mental health issue - mainly anxiety - and likely brought on or exacerbated by the Covid-19 pandemic.
She said many young people were simply not coping during the national lockdown.
Some did not have great home lives, others who really enjoyed school struggled with not attending and many just felt the huge pressure of being home with their whole family during lockdown and "losing" their normal life.
"There were also cases with some children who were able to hide their eating disorders at school each day, whose parents noticed and were able to say 'oh shoot, my child has issues'," she said.
"The ages 11 and 12 are where we start seeing these things ... for me, I am seeing much more of it, an increase in both bulimia and anorexia, an increase in males ... but it's usually a symptom of something much bigger.
"It's definitely a symptom of anxiety."
She said feeling like they had no choice or independence in their lives in the year due to ongoing lockdowns, level changes and uncertainty pushed many young people to turn to restricting their food intake as a way of gaining some semblance of personal control.
Losing their normal routines around food, sleep and socialising contributed to the anxiety - as well as more time on social media.
Hart said watching more videos and content on things like TikTok and Instagram led to "more self-examination" which was harmful for some young people.
"We need to talk about youth mental health and make sure eating disorders are looked at as part of it as well - we can't just sweep it under the rug," she said.
Lavender said there was no one reason people spiralled into eating disorders and some of the increase for her clinicians came after parents noticed their children struggling while spending more time with them in lockdown and beyond.
During lockdown there was a lot of narrative around eating and exercising whilst at home and while that was positive and healthy, sadly for some people it led to severe situations.
Hart said colleagues across the globe were reporting similar increases.
She and Lavender both agreed it was important to speak out about eating disorders and mental health in young people - primarily so those suffering were less isolated but also to educate the community about the issue and create awareness.
"We know that early intervention is essential for these young people," Lavender said.
"The longer they go with these eating disorders, the longer they need to be in treatment - we can't be an ambulance at the bottom of the cliff anymore.
"The longer we delay helping them the more risk is involved, the prognosis gets harder."
Both experts urged parents to keep an eye on their children and teens and to follow their instinct if they felt something wasn't right.
Lavender said often the journey started with an effort to eat "healthy" or increase exercise.
While positive in some young people, for others it may be a sign something is not right.
"Any changes in normal patterns - like if you sit down to eat together and they have 'already eaten' or all of a sudden it's 'I don't like that' - that withdrawal from social eating," said Lavender.
"Changes in mood, irritability, wanting to be isolated more - these are all changes to look out for.
"Parents are a bit worried to ask 'are you okay' and some think it's just 'normal' teen behaviour.
"But most parents do get a gut instinct that something isn't right, and we encourage families to act on that."
Hart said the first stop for parents was their GP or usual health provider.
"If you notice your child's behaviour around food has changed - even if you only suspect they are restricting or purging ... or starting to weigh themselves - go to your GP," said Hart.
"Then they can help you get a wraparound service."
Hart said that service included nutritionists or dieticians and a psychologist who all worked together to "normalise food again" and focus on bigger issues like anxiety, sleep and other mental health drivers.
But there also needed to be much more awareness in the community.
"We just need to put it out there, there will be parents dealing with children who have eating disorders and if they knew there was this increase with so many other kids, they won't feel so isolated," she said.
It doesn't matter what size, age or shape you are – anyone can have an eating disorder and every person's experience of an eating problem is unique.
Eating disorders are mental health problems that involve:
• Always thinking about eating, or not eating;
• Feeling out of control around food;
• Using food to meet needs other than hunger;
• Having an obsession about food, weight and body shape.
There is no clear cause of an eating disorder. For people at risk of an eating disorder a number of things could set them off, such as a life crisis or the death of a loved one, family changes, moving home or school, bullying, a relationship break-up, a change of job, school problems, a personal failure.
There are many symptoms of an eating disorder. These may not relate to everybody, and sometimes it can be difficult to notice any signs at all.
Signs of an eating disorder could include:
• Extreme concern about being too fat and thinking about food and dieting all the time;
• Increasing isolation from others;
• Secret eating and purging (vomiting or taking laxatives);
• Food disappearing from the house, especially high-calorie foods;
• Spending long periods in the toilet, especially immediately after meals, sometimes with the tap running for long periods;
• Shoplifting food;
• Strenuous exercise routine, even exercising when injured or unwell;
• Severe weight changes;
• Sudden mood changes, irritability, depression, sadness, anger, difficulty in expressing feelings;
• Poor concentration and being unusually tired;
• Constant pursuit of thinness.
Some of these signs can relate to different problems and not to eating disorders, but if there are several of these signs together, it could mean an eating problem.
If you need help reach out to your GP or local mental health provider.
Or if you need to talk to someone else:
• LIFELINE: 0800 543 354 or 09 5222 999 within Auckland (available 24/7)
• YOUTHLINE: 0800 376 633 ,free text 234 or email talk@youthline.co.nz or online chat.
• NEED TO TALK? Free call or text 1737 (available 24/7)
• KIDSLINE: 0800 543 754 (available 24/7)
• WHATSUP: 0800 942 8787 (1pm to 11pm)
• DEPRESSION HELPLINE: 0800 111 757
• SAMARITANS – 0800 726 666.