Eating Disorders Not Always Obvious

Parents should learn to recognize early warning signs

The first hint often comes through the anxious voice of a parent on the phone.

A mother calls to say her daughter's friends are worried that her daughter might have an eating disorder. While they indulge in pizza on sleepovers, her daughter eats only grapes—and counts each one of them, she says.

For the pediatrician at the other end of the phone, the recitation of parental worry is always followed by the same question: Should they be concerned and pay attention?

Absolutely, says one physician who gets these phone calls often.

When eating disorders are involved, "in a big percentage of cases, loved ones' perceptions are right," says Dr. Ellen Rome, head of the section of adolescent medicine at Cleveland Clinic.

Eating Disorders Cases on the Rise

The number of cases of eating disorders has doubled since the 1960s, according to the Eating Disorders Coalition, a cooperative of organizations committed to advocacy on a federal level. The most common disorders are anorexia nervosa (or simply anorexia), an eating disorder characterized by low body weight (less than 85 percent of normal weight for height and age), a distorted body image, and an intense fear of gaining weight, sometimes to the point of self-starvation, and bulimia nervosa (or simply bulimia), defined as uncontrolled episodes of overeating (bingeing) usually followed by purging (self-induced vomiting), misuse of laxatives, enemas, or medications that cause increased production of urine, fasting, or excessive exercise to control weight. .

Anorexia nervosa is estimated to occur in one out of every 100 females between the ages of 16 and 18 years old. Five to 10 percent of teens diagnosed with anorexia are males. An estimated 1 percent to 4 percent of females in the United States are reported to have bulimia.

AAP Policy Statement

The American Academy of Pediatrics (AAP) is so concerned about the increases that it recently issued a policy statement, urging its members to take a bigger role in identifying eating disorders in the earliest possible stages.

Exactly how prevalent eating disorders are among youth is difficult to assess, says Dr. Martin Fisher, a New York pediatrician who with Rome served as co-author of the AAP's policy statement. Solid statistics and comparisons with past years are difficult to come by, he says. That is partly because many people have not yet sought help and statistics are gathered in different ways and for different age groups.

The eating disorder problem is fueled, say Rome and other experts, by obsession with appearance and thinness, plus in some cases troubled families or parents who diet obsessively.

Be Aware of Warning Signs

While pediatricians may be best equipped to diagnose eating disorders, parents and others can help by being aware of warning signs, knowing which kids are more likely to develop a problem and realizing that early treatment can speed recovery.

Some signs, of course, are more obvious than others, says Rome. "A big red flag should be the kid who keeps saying 'I'm fat, I'm fat,' [when she is normal or underweight]."

Other signs—vomiting in secret, menstrual irregularities—are not so obvious.

Attraction to certain sports may be another clue. "The visual sports are breeding grounds for eating disorders," Rome says. Among them are gymnastics, ballet, cheerleading, and wrestling.

Personality type plays a role, with perfectionists with low self-esteem at higher risk of anorexia, says Dr. Doug Klamp, an internal medicine physician in Scranton, Pa., who specializes in treating eating disorders. Children and teens raised in dysfunctional families and those with poor impulse control are more likely to suffer bulimia, Klamp adds.

Eating disorders can occur at any age, but tend to peak during phases of intense life changes and self-questioning, Rome says. One peak is at 13, she says; another as students head off to college.

If parents suspect an eating disorder, Rome encourages them to set up an appointment and to alert the physician to their worries first. The pediatrician should obtain height and weight measurements and note developmental milestones, as well as ask a multitude of questions. These should cover eating habits, satisfaction with body appearance, use of laxatives or diet pills, and exercise habits, which are all clues to the conditions.

If an eating disorder is diagnosed, most pediatricians favor a group approach, enlisting the help of a therapist, a registered dietitian, and others. How quickly to expect recovery depends on how entrenched the behavior is, Rome says, noting, "It's like a form of addiction. It's not going to change overnight." If an inpatient stay is required, expect recovery to require three to six years, experts say.

Most who recover "pretty much have food issues all their life," Klamp says, although they can live normal, productive lives.

Always consult your child's physician for more information.

The following are the most common symptoms of anorexia. However, each child may experience signs differently.
Symptoms may include:

• low body weight (less than 85 percent of normal weight for height and age)
  
• intense fear of becoming obese, even as individual is losing weight
  
• distorted view of one's body weight, size, or shape; sees self as too fat, even when very underweight; expresses feeling fat, even when very thin
  
• refuses to maintain minimum normal body weight
  
• in females, absence of three menstrual cycles without another cause
  
• excessive physical activity in order to promote weight loss
  
• denies feelings of hunger
  
• preoccupation with food preparation
  
• bizarre eating behaviors
  

Symptoms of Bulimia

The following are the most common symptoms of bulimia. However, each child may experience signs differently. Symptoms may include:

• usually a normal or low body weight (sees self as overweight)
  
• recurrent episodes of binge eating (rapid consumption of excessive amounts of food in a relatively short period of time; often secretive), coupled with fearful feelings of not being able to stop eating during the bingeing episodes
  
• self-induced vomiting (usually secretive)
  
• excessive exercise or fasting
  
• peculiar eating habits or rituals
  
• inappropriate use of laxatives, diuretics, or other cathartics
  
• irregular or absence of menstruation
  
• anxiety
  
• discouraged feelings related to dissatisfaction with themselves and their bodily appearance
  
• depression
  
• preoccupation with food, weight, and body shape
  
• scarring on the back of the fingers from the process of self-induced vomiting
  
• overachieving behaviors
  

The symptoms of eating disorders may resemble other medical problems or psychiatric conditions. Always consult your child's physician for a diagnosis.