It's Beth's ninth birthday and the pictures tell a lovely story - a girl in a red dress, smiling eyes, glossy tumbling hair as she leans over a beautiful chocolate cake with candles, surrounded by family and friends.
But already the rot has set in. Beth (not her real name) will not eat a piece of chocolate cake again for years. You cannot see it but the anxiety has taken a grip. Flip forward to the day before her tenth birthday and the pictures tell a different story. A skeletal child, her head appearing too large and heavy for her body to hold, pinched blue skin, dark patches under dimming eyes, sits scrunched and unsmiling. Her younger sister, arms around her, reads her a story for comfort. In another picture she is listless, laid on her father's chest. He has been crying for hours. On her birthday she is in hospital, close to death.
Beth is now 11 and making a courageous recovery, but looking back both she and her mother, Catherine, can remember the day when the anxiety, which triggered anorexia, started.
Her primary school, which gained a healthy schools award while Beth was still in hospital, had begun a series of nutrition lessons for Year 4 which started with the teacher talking to the class about the importance of eating healthily because of the high number of overweight children in society. Beth was neither thin nor fat but a healthy, rounded girl.
Nevertheless, she had been teased in the playground that day for having a double chin when she looked down at her feet, and the calorie content of lunchboxes was a regular topic of conversation among her peers. She thought that the teacher was directing the lesson at her.
From that day on she took whatever was said in the school's nutrition lesson as gospel, believing that a low-fat or even no-fat diet was what she should be eating. She constantly begged her mother not to put anything with fat or sugar in her lunchbox, and worried that other girls were eating less and doing more exercise than she. She called herself "a childhood obesity".
When it came to the following Christmas, when Beth was by now very ill, she worried about what she could eat "as there was going to be so much fatty food". Catherine said: "She asked her teacher what she could eat at Christmas and she was told it was perfectly alright for her to have an extra chocolate a day. That was it. She worked out how many calories would be in a chocolate a day and would eat nothing extra but that. She quoted the teachers constantly. Every meal time was a terrible battle."
Catherine became really alarmed when she found the otherwise excellent school had given her younger son worksheets on food shopping. They included a diagram of "good" and "bad" shopping lists. In the "good" list were things like bananas, carrots, skimmed milk, low-fat spread, fish, wholemeal bread. In the "bad" list were full-fat milk, chips, sausage, chocolate bars, cheese. The child then had to answer which list was healthy and balanced, which list wasn't. Catherine said: "This is clearly wrong, but the children were taking it in as gospel. I think some of those teachers may have had an issue with food themselves, but there seemed to be no checks." The hospital was also shocked by these worksheets, she said.
When Beth came out of hospital and was back in school, the family asked a teacher to sit with her at lunchtime to make sure that she ate all of her food. "But that teacher sat with her and ate nothing but yoghurt," said Catherine. "What kind of message was that sending out?"
Beth's story highlights the difficulties for schools of having to carry out the Government's healthy schools agenda.
Research shows that the healthy eating drive is in danger of creating as many problems as solutions. Loughborough and Cardiff universities claim that the Government's focus on the danger of obesity, along with its obsession with exams and results, is leading to a rise in eating disorders.
Dr Emma Rich of Loughborough university said: "The messages children receive are: be or get thin, exercise more, diet if you can - with no accompanying health warning that all these activities, in certain circumstances, can be bad."
Jane Smith, who runs a parent support service and helpline called Ache (Anorexia in Children, Help and Encouragement) is a former junior school headteacher. She also questions, in Eating Disorders Week, whether busy teachers, called on to cover so many things, should be teaching a complex subject like nutrition.
She said: "I have done the nutritional talks in school myself, but the important thing is to get the balance right so children do not become phobic about food.
"Teachers need to be aware of issues of self-esteem and the links between emotions and food. I have calls from teachers who are upset because children in their classes who are losing weight and have become withdrawn and they don't know what to do about it. A child with low self-esteem who goes to a nutrition class and is told this is bad for you and that is bad for you might think, 'I am feeling bad so I'll cut out the bad things and then I'll feel better.' Eating disorders are about being in control."
Catherine questions whether primary school teachers can be qualified to teach nutrition. "It's a complex subject, easy to misinterpret and misrepresent. We use up calories even when we are not active and everyone has a different metabolic rate. A child not told these things, as Beth was not, might conclude that you do not need to eat except when you are very active and that if you feel more hungry than anyone else, you should ignore those feelings. Beth was a very active child but was made to feel that to feel so hungry was wrong."
If nutritionists have to be free of any eating disorder in order to work for certain organisations, Catherine said, should teachers, who may have personal hang-ups about food themselves, be teaching nutrition?
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