Facts About Eating Disorders, including Anorexia and Bulimia
- What is an eating disorder?
- What causes eating disorders?
- How can I recognize an eating disorder in a child or teenager?
- What happens if an eating disorder isn’t treated?
- What can I do?
- What help is available?
What Is an Eating Disorder?
Eating disorders take several forms: anorexia nervosa, bulimia nervosa, and an atypical eating disorder "not otherwise specified." An eating disorder arises when a person develops a distorted relationship with food and weight, but it involves much more than simple dieting, exercise or feeling too full.
Both anorexia and bulimia are about eight times more common in females than in males. Young people often work hard to keep their struggles with food secret, so it's hard to know just how many people suffer from eating disorders. Between 1-13% of American high school and college-age women are estimated to be anorexic or bulimic.
Eating disorders often begin with dissatisfaction in appearance and efforts to "eat healthier" or exercise more. But for some people, these behaviors can lead to changes in thought patterns and behaviors that develop into an eating disorder. The thoughts and behaviors become difficult to resist, and emotional and physical health begin to deteriorate.
Sometimes the problem begins with a weight-loss diet, but then something goes wrong. Once 5 pounds have been lost, the weight goal is lowered another 5 or 10 pounds. Or perhaps the original goal is never quite reached, and instead the teenager's weight goes up and down in a seesaw pattern. Sometimes no actual diet is involved; the teen simply believes that they are much too fat and experiences a relentless drive to be thinner. Eventually, the pursuit of thinness becomes an obsession that assumes more importance than anything else in the person's life.
About anorexia nervosa
The symptoms of anorexia nervosa include severe weight loss as part of a drive to be thin, fear of weight gain, loss of menstruation in females, and body image distortion (not perceiving appearance accurately, such as the belief that one is fat, despite being very thin).
About bulimia nervosa
People with bulimia nervosa have episodes of binge eating at least several times a week, followed by purging through self-induced vomiting, exercise, laxatives, or fasting. This often leads to weight fluctuations-sometimes large, sometimes small.
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What Causes Eating Disorders?
Despite more than 50 years of research, the cause of eating disorders remains largely unknown. We do know that living in a culture that values thinness and promotes dieting increases the risk of kids developing an eating disorder like anorexia or bulimia. In fact, research shows that by the age of 7, many children have already decided that it isn't okay to be fat.
Genetic factors, family history and certain personality traits, such as perfectionism, also contribute to the likelihood of an eating disorder. The pressure to be slender is especially intense for girls and young women in their teens. Two-thirds of girls between the ages of 10 and 15 have tried dieting. Cultural messages about thinness are directed almost entirely toward women, and puberty is a time when young people are confronted with a rapidly changing body.
An understanding of issues that may have contributed to the onset of dieting and exercise leading to the eating disorder is important, but normalizing eating behavior and weight remains the most important intervention. It is often difficult for the person with an eating disorder to admit that they need help. That's why it may be up to friends, family members, coaches or teachers to guide the young person to the help they need.
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How Can I Recognize an Eating Disorder in a Child or Teen?
Young people go to great lengths to deny and conceal their painful struggles with food. Here are some signs that may help you recognize an eating disorder in someone you know:
- Excessive weight loss. Anorexia is diagnosed when someone is 15% below expected weight (whether because of loss of weight or failure to gain with growth).
- Weight fluctuations. Although people with bulimia usually maintain near-normal body weight, their roller coaster dieting may show up in erratic weight gains and losses.
- Unusual eating habits, such as taking tiny bites to stretch out eating time or compulsively arranging food on the plate.
- The person stops eating meals with the family; they might make excuses that they are too busy or eating elsewhere.
- Secretive behavior, especially with respect to eating and bathroom use. A teenager who habitually runs water, plays the radio, or flushes the toilet repeatedly while using the bathroom may be masking the sounds of vomiting.
- Use of laxatives or diet pills.
- Food disappearing on a regular basis.
- Excessive and often obsessive exercise.
- Dull hair and hair loss, splitting or softening nails.
- An absence of menstrual periods related to loss of body fat.
- Dental cavities and gum disease, caused by malnutrition and vomiting.
- Extreme sensitivity to cold, caused by loss of fat and muscle.
- Fine body hair on arms and legs. This is the body's attempt to keep warm.
- Low self-esteem.
- Distorted body image. No matter how thin they get, people with anorexia still believe they are too fat.
- Irritability, depression, or talk of suicide.
- Drug or alcohol abuse. Sometimes, teenagers with eating disorders will turn to substance abuse to relieve feelings of fear, shame and depression.
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What Happens If an Eating Disorder Isn't Treated?
Without intervention, the consequences of an eating disorder can be tragic. Prolonged dieting, bingeing and purging and weight loss can all cause severe malnutrition. Almost every organ system is affected by malnutrition, including the brain, heart, liver, kidneys, bone marrow, skin and reproduction.
For example, the heart rate slows, increasing the risk for potentially fatal heart attacks. Brain tissue is lost, some of it permanently. Girls stop having periods, and the lack of estrogen can lead to osteoporosis (weak bones), which happens in 50% of patients with anorexia. The act of purging causes electrolytes, especially potassium, to get dangerously low, leading to potentially fatal irregular heart rhythms. And vomiting can irritate and even tear the esophagus.
The emotional complications of an eating disorder can be just as devastating as the physical problems. Relationships with family and friends often suffer as the person begins to avoid eating with others or resists efforts by others to help them. The child or teen often feels isolated and depressed. This can get to a point where the person considers suicide, which is the leading cause of death in people who suffer from eating disorders.
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What Can I Do?
As a parent:
- Be a good role model. Set a family standard of eating meals together regularly and encouraging balanced eating and activity.
- Avoid negative comments about appearances, and be aware of comments you make about yourself and family members. Stay positive and emphasize the whole person, not just how someone looks. Don't criticize or tease your child about minor weight gains, and avoid power struggles over food.
- Help your child build healthy self esteem. Give them opportunities to explore different interests and build confidence.
- Remember that no one is to blame when a child develops an eating disorder. Discuss your concerns openly, then seek professional help. The pediatrician or primary care provider is where most families start when they become concerned.
As a friend:
- Don't comment on your friend's eating behavior or size. If your friend has had anorexia nervosa and gains weight, don't praise him or her for it. What your friend will hear is, "You're fat again."
- Remember that you can't solve the problem. You aren't responsible for saving your friend -- you can be supportive and concerned, but encourage your friend to talk to a parent, teacher, or counselor. If they don't, tell an adult close to your friend about your concerns.
As a school nurse, counselor, teacher or coach:
- Discuss your concerns with the child or adolescent first, and suggest that he or she talks with the parents.
- Expect denial of any problem. You may have to talk with the parents, but always let the adolescent know that you will be doing this and why.
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What Help Is Available?
The important thing to remember is that the person with an eating disorder needs professional help. The person is caught in a cycle of destructive behavior that they cannot break alone, even with all the willpower in the world.
If you think someone in your family may be struggling with an eating disorder, speak with your child's physician or call an eating disorders program that specializes in the treatment of children, young adults and teenagers. Children, teens and young adults have different problems and pressures than adults, and treatment approaches should address these special concerns.
For more information about Children's Hospital Colorado Eating Disorders Treatment Program, please call (720) 777-6452.
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