Anorexia begins at five
CHILDREN as young as five are being diagnosed with anorexia as experts blame stress and a national obsession with obesity for a shocking rise in the number of NSW youth being treated for the illness.
Pressures from family breakdowns, peers, school and the electronic media meant children were falling victim to the disease years earlier than they were last decade, adolescent health specialist Michael Kohn, from the Children's Hospital at Westmead, said.
The typical age of onset is now between 12 and 14, compared to the average age of 16 as recently as five years ago.
Since 2001 there has been a 20 per cent rise in the number of children younger than 18 being admitted to the hospital with anorexia.
About 45 new patients are admitted every year and a similar number of patients aged between 15 and 20 are treated in Westmead Hospital's psychiatric unit, which handles the majority of child eating disorder cases in NSW.
Dr Kohn said the hospital was now treating children aged between 7 and 11.
In children that young, anorexia is as common among boys as it is in girls although, after 12, females are at least 10 times more likely to develop the illness.
"Young people are under increasing stress and stress comes from so many factors in their lives," Dr Kohn said.
The physical impact of the disease is much greater on pre-pubescent children because the malnutrition coincides with the period of peak growth and development.
Television shows, cartoons, websites, games and toy figurines had promoted a "thin" ideal among children, Dr Kohn said. A focus on the obesity epidemic could also fuel eating disorders.
Eating Disorders Foundation executive officer Greta Kretchmer said the focus on obesity and eating the right food had created a backlash.
"When you have some people who have perfectionist tendencies, it leads to them trying to do it too well by cutting out all fats, all carbohydrates, all dairy," she said.
The foundation has seen a quadrupling in the number of calls about eating disorders over the past five years, with many about children aged 8-13. The youngest was a five-year-old boy who had been diagnosed with anorexia. The child had been teased in preschool and was about to start kindergarten.
"He got it into his mind that if he went to school he could not be fat because he would be teased worse, so he got terrified of becoming overweight," Ms Kretchmer said. "His poor mum was beside herself. How do you reason with a five-year-old?"
Sarah, 26, of West Pennant Hills, who did not want her surname published, overcame anorexia six years ago.
She said wanting to be thin was only part of the problem.
"It was other types of pressures, wanting to fit in to the world," Sarah said.
Sarah now works as a psychologist and counsels other young people with eating disorders.
"We are socialised to be very image-driven and you can see that more and more in younger and younger girls," she said.
"Most of them now are wearing make-up before my generation would have been. I think it is pressure to do well at school and peer pressure, which comes from a social expectation that people will be slim and attractive."
Symptoms to watch out for
¡ Displays confusing behaviour, from being moody, depressed and withdrawn to overly sweet and compliant.
¡ Wears baggy clothes or dresses in layers to hide body shape.
¡ Complains of weight problems, despite being of average or thin build.
¡ Obsesses about the calorific and fat content of food. For example, keeps a food diary.
¡ Exercises continuously.
¡ Visibly restricts food intake or starves themselves.
¡ Afraid to eat around other people.
¡ Has unusual food rituals, including shifting food around on plate, cutting it into tiny pieces or dropping it into a napkin.
¡ Hides food in strange places or flushes it down the toilet.
¡ Makes self-defeating statements after eating.
¡ Hair loss and skin has pale or grey appearance.
¡ Suffers dizziness, headaches, frequent sore throat or swollen glands.
¡ Loss of menstrual cycle.
¡ Poor sleeping habits.
Eating disorders and children 
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