BACKGROUND:  My daughter developed anorexia when she was 11. I took her to our doctor who basically said he could put her on a waiting list to see a psychiatrist, but it could be some time. Mental health help just didn't seem like enough of an answer to me, so I got in touch with a woman who had anorexia when we were at high school together and asked for advice as to what finally worked for her (after nearly four years of being ill and twice being admitted to the mental health ward). Below is a summary of advice she gave me.

1.They first need to acknowledge they have a problem and they want to do something about it. You can't cure an eating disorder for someone else.  They have to do it, but with your help and  support. If they're stubborn about admitting a problem ask if they are happy, if they're sleeping  well with no bad dreams and maybe challenge them to eat a former favourite food and then sit  still for half an hour. It can end up as quite a confrontation but don't back down - this is not a problem that will just go away.

2.The emphasis has to be about HEALTH not weight. For an anorexia sufferer it is just too hard to see the numbers on a scale going up even when they know in their heart that it has to happen.  Because of this the SCALES HAVE TO GO. This is hard from a parent's point of view, because you want the reassurance of seeing the numbers go up. My daughter agreed that it was too hard to see an increase in weight so we got rid of the scales, as did her grandparents. That way she wasn't tempted to weigh herself when there and suffer a setback.

3.See a nutritionist. An eating plan worked out by a professional (preferably one who has worked with eating disorders before) gives them legitimate permission to eat the food.

4.Get a good multi-vitamin.  This will help to cover some of the nutritional deficiencies in the short-term and a pill is easy to swallow.

5.Distraction.  People with anorexia are totally obsessed by food, often reading about it and cooking for other people but not eating it themselves. They need other things in their life so a new interest really helps.  Not sport though, as that will just make the weight loss worse. Art, sewing, knitting, musical instruments, photography, etc are the best. My daughter had sewing lessons with her grandmother which turned into a special time for them both.

6.Have high nutritional food available. Their stomachs shrink so that eating a big meal becomes uncomfortable and even painful. It is both physically and mentally hard to have to face eating a large meal.  Having nutrition-dense foods like muesli bars, nuts and dried fruits can make it easier to eat the necessary calories. Also good quality protein and fruits and vegetables. The sufferer is more likely to give herself permission to eat food she considers “healthy”.  After the evening meal go for a leisurely walk together. Some exercise will make them feel better about eating, but you obviously don't want it to be enough to undo the good of the meal.

7.Take the pressure off. Let them know that nothing matters as much as their health. THEIR HEALTH IS THE ABSOLUTE PRIORITY.  It doesn't matter if it is an exam year. Exams can be made up later, but health effects from anorexia can be long-term and the sooner it is turned around the better.  If they've had a dreadful nights sleep (from the bad dreams that malnutrition brings) then give them a day off school rather than send them upset and wiped out. The hardest part is to get them to take the pressure off themselves as people with anorexia tend to always be pushing themselves to do better.

8.Let them know how much you love them. As a parent you take it for granted that your child knows this and I come from a family that isn't big on saying it, but I learned to.  Tell her how you would gladly swap places and take on the anorexia, how you would die for her if necessary and consider your life well spent. It sounds over-the-top written down, but it's how most parents feel and the children just don't know that.

9.Let them know that who they are is good enough.  Most people with anorexia are high achieving and get parental pride for their achievements mixed up with parental love.  They often think that unless they are achieving we can't love them as much. My youngest son is severely handicapped and was a good example of the difference for my daughter.  I asked if she thought I loved him and she said "I know you do" then I asked if she thought I was proud of him and she went quiet. I do love my son, but he has never achieved more than taking a few steps independently and is never likely to. They need to know that our love for them is constant and will be there if they never pass an exam or do anything "noteworthy" with their life.  Those things might make us proud, but they can't make us love them any more.

10.Discuss the physical long-term consequences of anorexia.  Downy hair all over the body, major fertility issues, terrible teeth if they vomit a lot, etc are all things that don't just go away when the weight issues are resolved.  My daughter's anorexia was turned around within six months, but she didn't start her periods until she was nearly 17 and they didn't become reasonably regular until her 20s.  It remains to be seen if she'll need fertility treatment to get pregnant.

11.Toughen up.  Your child needs you to be her parent not her friend.  Once she has a diet plan you have to make her stick to what has been agreed.  Be prepared for her to tell you she hates you and you're just trying to make her fat.  My constant answer was "I'm sorry you hate me because I love you. I'm not trying to make you fat, I'm trying to help you get healthy."

My friend told me that just as you wouldn't stand by and let your child cut herself with a knife, you can't stand by and let her damage her health and maybe even kill herself with lack of food.

12.Don't trust them.  Let them know that you don't trust them and you will be checking up on things they do and say.  If they are a secret exerciser then the bedroom door stays open. If they purge then check the bathroom after they've been in there and take away the air freshener. Check drawers, etc for laxatives.  Tell them you long to trust them and can't wait for that to happen. Anorexia makes people sneaky and openly acknowledging that and checking up makes it harder for them.

13.Don't take the getting well process away from them.  My friend said one of the worst things was her parents talking with doctors about her behind closed doors.  It made her feel paranoid and very alone as she felt everyone was plotting against her. Everything needs to be discussed with your child. Don't talk about her with anyone without her permission.  She has become sick by controlling her food and she has to get herself well by having some control and input into the system also. Curing anorexia is not something that can be done TO somebody, it is something that has to be done WITH them. This should possibly be point Number 1 and is hugely important!

14.Find an incentive.  Get her to plan something special if she meets goals like sticking to the diet plan for a month.  My friend suggested giving her a budget and letting her plan a family holiday. We did that just for a weekend in the Bay of Islands. My daughter chose the motel we stayed in, the restaurant we ate our evening meal in and the activities we did. On the Sunday afternoon she asked for a waffle ice-cream cone (not on her eating plan) and actually managed to eat half of it! It was a turning point when she was looking to food as something to enjoy again.

15.Coaches, friends and family need to watch their comments.  There can not be any mention of weight as she begins to get better. If someone says, "You look so much better now you've put some weight on" it could easily trigger a setback.

16.Help her deal with other issues.  I had my daughter make a list of everything she felt was wrong with her life (it was very long but repetitive).  Every night at bedtime we'd discuss one of the issues and think of ways to help deal with it. Most of her issues were related to her anorexia and her feeling isolated from her friends.  It is really about giving her back a feeling of her controlling her life rather than it controlling her.

As the footnote, my daughter is now in her mid-20s and is leading a very full and active life.