anorexia in 14 year old boy?

[worriedmumofson]

My son is very sporty, likes to be fit and healthy but has just told me that he thinks he is fat. From what I can gather he thinks this because he has age 15-16 trousers to get the length as he's 5 foot 9ish. Waist wise he still fits into age 13-14 trousers but they are too short.

He's now told me that he sometimes goes to bed hungry because he doesn't want to eat dinner, I put it down to have a cooked meal at lunch time which is late at his school - 1.45pm - and so not being hungry at 6pm when we usually have dinner.

His BMI is 22. He's on the 92nd percentile for height and the 82nd for weight.

Meant to add, he does about 5 hours of sport a week as he enjoys it, then school PE lessons so I guess 7 hours a week.

Going by the medical definition, it’s not anorexia nervous. Simply because he’s not underweight.

Have a talk with him; try to understand his feelings about food, about his body shape, about how he sees himself. Does he calorie count? Exercise excessively purely to lose weight? Does he view himself as fat even though he isn’t? Is he scared of gaining weight? Does he limit his weight in any other ways?

What are mealtimes like? Do you all eat together at the table as a family? Does he eat most food? Does he puke it up after? Can he eat in restaurants?

He doesn't calorie count and he only does the sport because he enjoys it. We always have meals together, he does spend a long time in the toilet but he's not being sick - he reads in there - and always forgets to flush the toilet (sorry, tmi!)

He will eat in restaurants and doesn't go to the toilet when we are there and will eat most foods but is quite fussy. He rarely finishes a meal though. He hasn't said he's scared to gain weight but he will refuse to eat because he thinks he is fat. He says that he is used to going to bed hungry now.

I've never been one to force him to eat - if he tells me that he isn't hungry and doesn't want dinner or only wants soup then I've gone along with it because I was forced to always finish everything on my plate as a child and I've never wanted to do that with mine - I've only ever said they have to try some of everything on their plate when they were younger; they say they didn't like it without trying it first.

He's a member of the local gym but he doesn't go to the gym, it's so he can play badminton there with his friend as they are both on the badminton team at school - he joined because his friend is a member and they can both play for free now.

thanks for replying. I do worry that it's the start of anorexia/an eating disorder.

It doesn’t sound pathological to me, and hopefully won’t get there. He doesn’t sound like he has a mental illness from what you’ve described.

(I work in CAMHS and see a lot of severe eating disorders).

Just enact healthy, balanced attitudes about food at home. Don’t focus on calorie content, and ensure that treats and unhealthy things are “allowed” on occasion. And keep the lines of communication open to ensure that things don’t get worse. Hopefully they won’t.

Make sure that family mealtimes remain a fixed part of the day, and that everyone is eating the same food.

Thank you, I really appreciate that. I'll keep an eye on it but not too much.

I’ve had similar with my tall skinny 14 year old. Doesn’t help that kids at school make comments about how thin he is (he is with in normal range)
I try to cook food he likes, as he is also fussy.
We have talked about how he needs a range of nutrients to grow and do well at sport - he loves football. Why he needs protein etc.
The rest of the time I don’t mention it a just keep an eye on what he is eating.
There is pressure on boys to have perfect body - even when looking at Fortnite the
Avatars are toned etc.
I think there is this idea that teen boys are always hungry but I find it comes in waves.

We've had the proteins and nutrients discussion as well. I hadn't noticed that on Fortnite but now you mention it, you're right.
Mine is hungry sometimes and not others, he has always gone in phases of eating everything in the house to not eating enough.
Like yours, he's tall and skinny - whilst he's 82nd percentile for weight he's well above that for height and looks tall and thin.

I've just discovered that my 10 year old DS is pretty underweight. We did a bmi calculator on holiday as a laugh but it wasn't funny when it said he was about 8 pounds underweight. I knew he was very slim and he is quite tall and it's apparent he is the probably the thinnest boy in his class. I have tried to get him to eat better for years but it's not working. He is very fussy and I know he turns food down because he worries he will become fat. I'm not sure what to do now.

It's so hard isn't it :-( I don't know what is best to suggest either. Part of me thinks making a big deal of it will make it worse but it can't be ignored. I'm going with the helpful suggestions above.

@Drogosnextwife

BMI is not accurate at all for young people.

Use centiles.

I go with the centiles, my DS is 82nd for weight and 91st for height so I guess that means he is OK. He's got more of a young man figure now than a boy's; his friends are all a lot shorter than him and look very small and 'weedy' next to him - he's very muscular: he's on the swimming team and has the swimmer's triangular torso IYSWIM - broad shoulders, narrow waist and muscly legs.

Thanks Paddy that puts my mind at ease a bit, I'll take him to the docs to make sure.

Actually it sounds like it may be that he isn't seeing his body as it actually is. And you are right to be concerned about him not eating and thinking he's fat.
The poster is right about diagnoses of AN not being given above a certain bmi but I think that the health services are misguided with doing this (they tend to put a diagnosis of atypical AN when someone with AN is over a certain bmi.
But you are doing the right thing by noting this change with your son, he could also do with being reminded that if you eat & use up the energy then you won't gain weight.

My son is 25 & has a severe ED which has been active since he was about 15, despite going to CAMHS unfortunately they didn't diagnose him but discharged him when he knew he was developing anorexia. Sadly once the ed 'got in' he's never been able to get rid of it except for the times he's been in eating disorder treatment units.
If I could go back i would put him in private therapy and remortgage the house to pay for it. At the time I had no clue about what to do.
Its hard to get a balance but what I do know is that people who develop eating disorders of any description tend to be obsessive compulsive & that obsessive tendencies can be focussed on anything.

I suggest doing some nutritional research & agreeing a diet with him that he's happy with? If he isn't eating enough & he's doing lots of sport & normal stuff then he will lose weight so he wants to avoid this.

I also think that the development of Anorexia is often misunderstood & ignored by professionals when this is the exact point that support is needed.

Keep a very close eye on his weight. Healthy children should not be crossing percentiles so should stay on their traditional growth curve.

They do not have to be underweight to be given an eating disorder diagnosis anymore. If you have concerns act on them quickly. Be prepared for some medical professionals to be a bit clueless especially when it comes to boys and eating disorders. There is a website called Feed Your Instinct that has an assessment tool you can print off and take to the GP. Its Australian based but the symptoms are pretty universal.
Here is a link to medical guidelines that clinicians should follow.....again it's pretty universal.
d28lcup14p4e72.cloudfront.net/4830/3996593/AED-Medical-Care-Guidelines_English_02_28_17_NEW.pdf

There are also updated NICE guidelines specific to the UK you can find via google.