‘She’d do anything to avoid eating – it took over two hours to get her to have a yogurt’
The three-year anniversary of the first pandemic lockdown takes me back to my family’s darkest time. As the government enforced working from home, prevented people from mixing and closed schools, thousands of families like us were dealing with the fallout from their decisions – fallout that might have been avoided or mitigated.
In March 2020, children were sent home from school for the beginning of almost two years of disrupted education. In June that year, my 13-year-old daughter Izzy began secretly to log her food intake on the MyFitnessPal app, something we didn’t find out about until far too late.
Over the summer, she got thinner. Her newly acquired periods stopped, her baggy tracksuits and hoodies became even baggier, but on the rare occasions she wore leggings, her hip bones jutted out so much I thought it was her mobile phone. Concerned, I spoke to our GP and was told to come back in the new year. By January, Izzy was clinically underweight and was diagnosed with anorexia, the disease with the highest mortality rates of any mental disorder. She had lost 20 per cent of her body weight over six months, weight she could ill afford to lose.
Did lockdown cause this? The statistics suggest that it contributed – just this year the Royal College of Psychiatrists warned that referrals to eating disorders specialist services for children were up 51 per cent compared with 2019. This rise, along with an increase in other paediatric mental health disorders, is replicated across the developed world.
Genetically, Izzy was vulnerable as there are sufferers of anorexia in our wider family – an aunt and a grandmother – and she has long had a tendency towards obsessive behaviours. Maybe she was always going to get it and the timing is a coincidence.
But we could not design a more perfect petri dish in which to incubate eating disorders that we did during lockdown. We removed our children from sports and fun clubs, their peers and comforting routine. We stuck them at home with a background noise of health anxiety, amplified messaging around the dangers of obesity and unrestricted social media. We allowed them to scrutinise themselves constantly on screen during Zoom lessons.
She was on her phone much of the time, not unusual, and we failed to police its content. I now know that her TikTok and Instagram algorithms picked up on a new interest in diets and bodies. Almost immediately it began pumping “What I eat in a day” and “flat abs in a week” content from influencers who ostensibly promoted fitness but had never been anything but extremely slim.
She expressed a desire to eat more healthily and go for a run three times a week. At the time, we were bombarded with warnings about the lockdown lifestyle and the need to use our daily activity allowance, so we encouraged her.
We didn’t know then that these new habits are classic signs of an incipient eating disorder, along with wanting to become a vegetarian, vegan, gluten or dairy-free. An NHS dietician later told me that they call almond milk “anorexia milk”, such is its popularity among the eating disordered. The therapist Signe Darpinian, author of Raising Body Positive Teens: A Parents’ Guide to Diet-free living, Exercise, and Body Image, has said: “If my daughter came to me and said she wanted to eat healthier, I would respond to it in the same way as if she told me she wanted to start smoking cigarettes.”
Adolescent girls need huge amounts of food. Yet, while I’ve often heard mothers of boys laugh about their “hollow legs”, we don’t celebrate appetite in girls. To an adult, it looked like she was eating a reasonable amount. I thought “real anorexics” ate nothing – she ate something, just not nearly enough.
Izzy didn’t object to me making an appointment with the GP in October 2020, especially since it was conducted by phone. The doctor told us that it was normal at that age for periods to be irregular and her weight was still, just, in the normal range. She was reassuring, but possibly, had she seen Izzy face to face then we might have caught the anorexia then rather than three months and a few kilos later.
Christmas 2020 came and we couldn’t see the family who might have been fresh eyes on her weight loss. On Christmas Day itself, Izzy was stressed about the chocolate in her stocking, insisted on a morning run and pushed her lunch around her plate. We called the GP as soon as they opened on the Tuesday.
I can only praise the speed, efficiency and compassion of the initial NHS response. We were referred to the nearest hospital, triaged by phone and, by the end of January, Izzy and I were sat socially distanced and masked in a room filled with half a dozen NHS specialists. They took her blood, weighed her, tested her heart rate and blood pressure before giving us the diagnosis of anorexia. I can still remember the sensation of my cloth mask becoming sodden with tears as I pulled it up to hide my distress. “I should have done something sooner,” I cried. “Every parent says that,” they reassured me, “but you’re here now.”
The next 18 months were a relentless round of anxiety, arguments and occasional violence. And food. Thinking about, buying, preparing and pushing food. The best treatment of anorexia is family-based therapy, trying to avoid inpatient stays by re-feeding the patient at home.
It places huge pressure on parents to supervise three large meals and three large snacks every day, however long it takes, and to sit with their child for at least half an hour after each one (to prevent purging). One day it took over two hours to get her to eat a yogurt. By the time she’d struggled through it, she was due her protein bar as an afternoon snack. She would do anything to avoid eating – hiding under the table, running away into the street barefoot and hiding food in her sleeves. If supervising meals sounds like a full-time job, it’s because it is one – I gave up work and was lucky that we could afford this.
We entered an upside-down world where everything we’d ever thought about food and exercise was questioned. Full-fat milkshakes and near bedrest replaced salad and sport. Her weekly weigh-ins were anticipated with the intensity of a boxer or jockey. We celebrated when she put on a few hundred grams, she’d resolve to reverse that gain. Her hip bones continued to jut, her hair fell out, her skin was a purplish-grey. The funniest girl I know barely smiled.
On the good days, there were tears. On the bad ones, threats of violence to both us and to herself. She held a kitchen knife to her arm and said she’d rather die than put on another gram. The car door was thrown open and she tried to jump out as we drove to A&E after 24 hours of no food. We called the police when she ran away one night in response to a request that she drink a food supplement. I sat in the car screaming louder than I ever have in my life. Our other children were neglected and bewildered, caught in the middle of a barnstorming row over a single slice of peach.
As the country emerged from the various lockdowns, we remained in our private one, unable to go out or leave her for more than an hour as that was the longest gap between the relentless feeding. Her friends were back in the classroom full time, but she would go in only occasionally, before missing a whole term of school at her worst.
Towards the middle of last year, something clicked for Izzy, a realisation that life could offer more than not eating ever would. She announced that she was going “all-in recovery” and she did. This change remains both mystifying and gratifying, while I grieve for the many friends who are still suffering.
I don’t know if lockdown caused her anorexia, but I know it didn’t help. Dr Lucy McBride, an American mental health advocate, has observed that healthy young people and children were at lowest risk of Covid but at “highest risk for social isolation, depression, suicidality, loneliness, blues”.
In other words, we engineered the most dangerous environment for young people in order to make a safer one for others. This may have been necessary and unavoidable, but having done so, the least we could have done was to recognise these dangers and invest in the protections and treatments when it was their turn as the vulnerable.
We’re OK now. In fact, we’re better than that. Izzy is funny, smart and flourishing, on track to get her GCSEs and move onto sixth form. She’ll likely be able to go away to university, when I once thought she’d stay at home forever, stuck with her parents forcing her to eat her morning snack.
Names have been changed
For more information and support on eating disorders visit beateatingdisorders.org.uk