Lexi Crouch has been recovered from anorexia nervosa for 11 years.
But the 34-year-old first started experiencing disordered eating from the age of just seven.
It soon developed into a severe eating disorder that could have killed her.
"I did experience bullying about my weight when I was younger at school, and that just opened a door into a whole world of the ways of disordered eating," she says.
"It was counting calories, watching my food … I really fell into the grips of an eating disorder. By the age of 14 it very much ruled my life."
Lexi was hospitalised, did numerous stints in intensive care and had to leave school to focus on treatment.
She describes her recovery as a "stop-start pathway" that took more than a decade.
"Being so unwell for so long, from seven til about 25 which was when I started the recovery journey, I took it to the brink," she said.
"I really couldn't have taken it any further.
"The quality of life was just so low and it [recovery] was really hard work."
Now working as a clinical nutritionist, Lexi says she's conscious of creating positive attitudes to food and eating around her daughter Mabel, who is the same age as she was when her life was first affected by disordered eating.
"Basic chats really affect kids. 'Mummy can't have dessert tonight because it's not good for you' kind of installs something in their heads," she says.
"Kids are little sponges. They're picking up all this information in the house, and we've got digital platforms now as well."
But Lexi says there are still significant gaps in education — for both young people and parents — around the difference between a balanced diet and lifestyle and an obsession with health and fitness.
"Research has shown that balance is the healthiest diet, and that really needs to be included in a child's life to set them up for good eating behaviour," she says.
"It all starts in the home, really."
More than a fifth of young people experience disordered eating — but what is it?
Research published last week in the medical journal JAMA Pediatrics found that about 22 per cent of children and adolescents from 16 different countries showed signs of disordered eating.
The study, led by José Francisco López-Gil from the University of Castilla-La Mancha in Spain, also acknowledged that both eating disorders and disordered eating are "underdiagnosed and undertreated".
"The term 'disordered eating' is often used to describe and identify some of the different eating behaviours that do not necessarily meet the diagnostic criteria for an eating disorder and therefore cannot be classified as eating disorders per se. Notwithstanding, although its impact on health is often minimised, disordered eating should be closely evaluated because it can evolve into eating disorders," the research states.
The Butterfly Foundation's Head of Prevention Danni Rowlands says the study's findings are fairly consistent with Australia's own statistics — including early-stage or milder disordered eating going unnoticed.
"That's the real tricky thing with eating disorders generally. Typically they are underreported until it's quite serious, maybe requiring medical intervention," she says.
"We know that disordered eating is a pathway to an eating disorder, but people can live with disordered eating their whole entire life without actually seeking any support for what it is that they're experiencing."
Ms Rowlands says there's a wide spectrum between healthy behaviour, unhealthy and harmful behaviours, and clinically diagnosed eating disorders.
"Disordered eating can impact a person's mental health, it can absolutely impact a person's physical health and wellbeing, it's incredibly distracting because thoughts and feelings are manipulated by what's happening with food, exercise and body image.
"It's quite a complex space."
Dietitians Australia explains the difference between eating disorders and disordered eating like this:
Disordered eating is a disturbed pattern of eating that is unhealthy. It has many, but not all, the signs of an eating disorder. For example, it can include restrictive dieting, compulsive eating, skipping meals, binge eating, unbalanced eating (restricting a major food group), or using diet pills.
An eating disorder is defined as disordered attitudes, thoughts and behaviours towards food, eating, weight or body shape, that impair an individual’s functioning and quality of life. Eating disorders are serious psychiatric disorders and include anorexia, bulimia, binge-eating disorder, avoidant restrictive food intake disorder and other eating and feeding disorders.
The organisation's president Tara Diversi says the latest statistics are "of huge concern".
"Eating disorders have many different faces, anyone can experience an eating disorder or disordered eating — all genders, ages, races, ethnicities, body shapes and sizes, sexual orientations and socio-economic statuses," she says.
"We must be educating our younger Australians earlier, on how to nourish their bodies and foster them to make food choices that support their health and wellbeing."
Recognising the signs and intervening early
The new research encourages parents, families and health professionals to be on the lookout for disordered eating symptoms such as weight loss dieting, binge eating, self-induced vomiting, excessive exercise and laxative use, even if it's not at a level that warrants a clinically diagnosed eating disorder.
But Lexi knows first-hand that it can start small.
"Eating disorders can be very sneaky," she says.
"I'd be declining invitations from friends if they wanted to go out to dinner, making excuses. I think that's a good tell-tale sign, if someone's not wanting to engage in normal teenage or kids' activities, like going to the movies because it's going to involve popcorn or something."
The study found young girls were significantly more likely to report disordered eating than boys, but recognised that boys were "presumed to underreport the problem because of the societal perception that these disorders mostly affect girls".
Ms Rowlands says things like over-exercising can be a warning sign in both girls and boys, and boys are more likely to seek out supplements which can also lead to disordered eating tendencies.
"With boys and men, they're often celebrated and put on a pedestal for their discipline or their willpower," she said.
"That's a really dangerous aspect of what happens with boys with disordered eating because their identity can get caught up in their muscularity or size or training routine."
Ms Rowlands says for people who are concerned about their own relationship with food or family members concerned about loved ones, getting correct advice early is crucial.
"We don't want to be scaring parents, we want them to be empowered. All parents should be getting across this information, we don't want to be waiting until you have to be seeking out the information," she says.
"Nobody wants their child to be struggling, but if we can intervene early, they can struggle less."
