Pulsations : Eating disorders often begin during adolescence. Why?
Prof. Nadia Micali : It's probably multifactorial. Adolescents experience many changes in their bodies and their social lives. Research shows the role of hormonal factors. It is often on favourable genetic ground and in a particular context that disorders are triggered in adolescence.

Are there any warning signs during childhood?
From the results of previous studies, which my team is trying to verify, it seems that eating difficulties during childhood (selective feeding, nitpicking, lack of appetite) are a risk factor. Current research shows that genetics and the environment (trauma, sexual and physical abuses, mockery, the importance that society gives to appearances, etc.) are others, but eating disorders have multiple causes.

What is the role of education and parents?
When a youth has eating disorders, parents suffer greatly. Today we know that the difficulties observed in the family are rather the consequence of the disorders, and not the other way around, as we have long thought. We must therefore stop making parents feel guilty. On the contrary, the family has an important role in identifying the problems and deciding to call health professionals.

What should parents know?
First, every child is different in his or her relationship to food. Some have more difficulty accepting new foods, have specific tastes, are more comfortable with some textures than others. In addition, there are eating behaviours (difficulties in accepting new type of foods) that are part of his development and that improve naturally. But we must be concerned if the child - from 11-12 years old or even earlier - becomes more rigid, if he imposes a very hard diet on himself, if he suddenly distances himself from certain foods, if he does things in secret or if he lies. And consult a doctor if the eating behaviour has physical or psychological repercussions such as weight gain or loss, fatigue, headaches, sleep disorders, difficulties in social interaction, (withdrawal, isolation) and at school.

There is a lot of talk about anorexia and bulimia. Why?
Because these are the most frequent and dangerous problems. Anorexia, which affects 1 to 2% of young people, is one of the most serious psychiatric disorders (mortality in 10 to 20% of cases). Bulimia nervosa (2 to 3% of young people), which is characterized by eating compulsions with compensatory behaviours to avoid fattening, also has serious somatic consequences, especially cardiac. Even more frequent (5% of young people), bulimic hyperphagia increases the risk of overweight and obesity and its attendant morbidity. It is distinguished from bulimia nervosa by the lack of strategies to prevent weight gain.

Do these two extremes meet ?
Anorexia and bulimia nervosa are at the same time very different and related. In both cases, there is a strong emphasis on weight, silhouette, and common behaviours (restrictions and compulsions). Psychologically, there is emotional deregulation, anxious temperament, suffering and shame, sometimes. As one grow up, one can move from one diagnosis to another.

How can these diseases be treated?
It has now been proven: highly specialized and early treatment improves prognosis, which is what is being developed at HUG. When there is a problem, we must not wait. Parents are a great resource for helping their child. For anorexia, the specific systemic therapies developed at Maudsley Hospital (London), where I trained, have the best evaluations. Cognitive and behavioural therapies have been shown to be effective against bulimia nervosa and bulimic hyperphagia.