As a mental health nurse, Sarah Lovell has cared for patients with eating disorders.
But little could prepare the single parent for when her own teenager daughter developed anorexia nervosa.
Ms Lovell’s then 15-year-old ended up in Redcliffe Hospital, north of Brisbane, where she was fed through a naso-gastric tube to gain weight after being referred to Queensland Health’s Child and Youth Mental Health Service (CYMHS).
The teenager’s condition was so unstable when she attended her first CYMHS appointment in July last year, she was sent to the hospital’s emergency department (ED) and admitted for more than three weeks.
“I’ll never believe what a state she was in, and I feel terrible as a parent that I didn’t see it sooner,” Ms Lovell said.
“It’s so confronting. She was so medically compromised. Her body at that point was basically just eating itself. She had no muscle on her.
“Her heart was under so much pressure. It was terrifying.”
Ms Lovell’s daughter, who is not named for privacy reasons, had what is known medically as postural tachycardia: her heart rate increased substantially upon standing.
Data shows spike in hospital admissions
The then year 10 student was one of thousands of Queenslanders being admitted to hospitals — both public and private — due to eating disorders in the 2022-23 financial year, Queensland Health figures show.
Department statistics reveal a big jump in Queensland hospital admissions during the COVID-19 pandemic, rising from 5,429 in 2018-19 to 7,609 in 2021-22 – an increase of more than a 40 per cent.
Two admissions last financial year involved Ms Lovell’s daughter.
Parental guilt at not noticing
Early signs of Ms Lovell’s daughter’s eating disorder included the teenager suddenly becoming obsessed with cooking.
“I thought: ‘This is awesome. She’s getting a grip on cooking and looking after herself a bit’,” her mum recalled.
“She wouldn’t let me anywhere near the kitchen. She was like: ‘I just want to do it myself. I just want to cook you dinner,’ all this kind of thing.”
Ms Lovell soon realised her daughter was only making low-carb meals. That was in around April or May 2022.
Weeks later, when they went to the Eumundi Markets on the Sunshine Coast, Ms Lovell was in no doubt of her only child’s eating disorder.
“She loves those little Dutch pancakes and I said to her: ‘Come on, what should we have? Let’s have a nice brunch’,” Ms Lovell said.
“I could see the look of panic on her face.
“I watched her. I was just sitting to the side. She was eating the pancakes and then spitting them out into her coffee cup. That’s when it really hit me. Her periods had stopped.
“And I was just like, ‘oh my God’.”
Ms Lovell took her daughter to their local general practitioner who referred them to CYMHS.
It was the beginning of a medical rollercoaster ride.
“I remember someone saying: ‘You must have noticed she was not eating?'” Ms Lovell said.
“I was like: ‘I work Monday to Friday. My daughter’s in school. She’s not eaten breakfast for a very long time.
“I’d give her money for tuckshop, or she took a sandwich to school, but we were coming home and eating a meal together every night.
“We sat and had dinner and chatted about the day.”
The weather was getting colder as the eating disorder took hold, allowing her daughter to hide her body underneath tracksuits and winter dressing gowns.
When she finally saw her child undressing in the hospital, Ms Lovell was confronted with the severity of the anorexia nervosa.
“I was like, ‘how the hell haven’t I seen this?'” she said.
“But I don’t see her in her underwear. I don’t see her getting into the shower.”
The road to recovery
Ms Lovell took nine weeks off work while her daughter was in hospital — and after she came home — to help her work on weight restoration.
After consulting with friends and colleagues, she was directed to Eating Disorders Families Australia (EDFA), where she found much-needed support from people with lived experience.
“I’ve learnt just so much this last year and I thought I had a reasonable knowledge of eating disorders,” Ms Lovell said.
“That organisation honestly helped saved my marbles. It’s a community of people that understands and gets it.”
Trying to keep her daughter on a meal plan after she came home from hospital was “just really, really hard to do”, Ms Lovell said.
“You think it’s the most normal thing in the world to sit and watch your child eat,” she said.
“I remember buying round crumpets for her and she was really enjoying them. So I thought: ‘Ok, I’ll get more of these’, because it was a way of having a snack that she was enjoying.
“And then I bought square crumpets, and she just had a complete meltdown because the … square crumpets were a bit bigger.”
Three months after the first hospital stay, Ms Lovell’s daughter was admitted for a second time when she started to lose weight again.
She stayed for another month.
About eight months later, the now-16-year-old is doing well.
But her mother remains vigilant and watchful for potential signs of a relapse.
She’s teaching her daughter to drive, and a favourite trip in the evenings — to increase the teenager’s night driving experience — is to the shops for ice cream.
“It’s so insignificant but, for her, it’s massive,” Ms Lovell said.
“She’s got a much healthier relationship with food.”
The impact of body image, COVID
The 50-year-old said her daughter had talked about body image issues dating back to primary school days.
“I remember her saying to me — she must have been about seven, and there was a swimming carnival at school — she said: ‘Mum, do you think my tummy sticks out?'” Ms Lovell said.
“I said: ‘What are you on about?’
“And she said: ‘Oh just one of the other girls, her tummy goes in, but mine sticks out a little bit’.
“I went: ‘We’re all just different shapes and sizes. We’re all built different’.”
When COVID hit and learning moved online, Ms Lovell’s daughter was denied one of the things she loved the most – being in the classroom.
“I do wonder if COVID was a contributor,” she said.
“It’s just the isolation at home.
“She’s always loved school. You’d say to her: ‘Do you want to have a day off and we’ll go shopping?’
“She’d go: ‘Oh no, I’ve got maths today’.”
Queensland’s chief psychiatrist John Reilly described the COVID years as a “very stressful time” that may have been a trigger for people vulnerable to mental health conditions, including eating disorders, to present to hospital.
“There were increases in deliberate self-harm, mood disorders … not just with eating disorders,” Dr Reilly said.
“The presentations were quite dramatic back in 2020 through to 2021, and then continued last year but in a reduced form … it seems they’re gradually settling back down to a more normal pattern of presentation.”
Dr Reilly said Queensland Health had committed $34 million over five years to expand specialist eating disorder treatment services across the state.
The funding will support existing facilities as well as assist in developing new eating disorder services on Brisbane’s south side, West Moreton and on the Darling Downs.
A mental illnesses ‘you can directly die from’
An estimated 10 per cent of people who developed anorexia nervosa would not survive the illness, said principal research fellow in eating disorders at youth mental health organisation Orygen, Andrea Phillipou.
“It’s essentially one of the only mental illnesses that you can directly die from just because of the physical effects due to the starvation associated with the illness,” said Associate Professor Phillipou, who is also an EDFA board director.
“Suicide rates are very high for people with eating disorders as well.”
An online survey of more than 100 EDFA members, conducted by the University of Melbourne and Deakin University, shows higher rates of anxiety and depression in people caring for someone with an eating disorder compared to the general population.
The researchers, who will present the data at the Australia and New Zealand Academy of Eating Disorders Conference on the Gold Coast next month, found 46 per cent of the respondents had mild to extremely severe anxiety and 52 per cent were experiencing mild to extremely severe depression.
More than half described their caring activities as a 24/7 commitment.
“Families and carers often have little knowledge of how to provide effective support to their loved one when they are diagnosed with an eating disorder,” Associate Professor Phillipou said.
“They often face stigma and a lack of understanding from the broader community and struggle alone.”
The Albanese Government recently announced $1.7 million in funding across three years for free online counselling through EDFA to provide education, skills, and support to carers, better equipping them to aid their loved ones in recovery.
EDFA executive director Jane Rowan said the service aimed to reduce the social isolation, anxiety and fear experienced by carers and was expected to “lead to more positive outcomes for those with an eating disorder”.
Her teenager is in year 11 and has plans to study science or medicine at university.
A year after Ms Lovell’s daughter was first admitted to hospital with anorexia, the mental health nurse is grateful she sought help as soon as she became aware of her daughter’s illness. Research suggests early intervention has the potential to save lives.
For information about the Eating Disorders Families Australia, which has more than 3000 members nationwide, head to the website or phone 1300 195 626.