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When Eating Becomes Disordered

I was thumbing through the newspaper today while my teen was eating breakfast before school.  Watching her measure out a serving size of cereal “just for the fun of it” makes me a tad bit nervous, considering she doesn’t have an ounce of fat on her. I quickly searched for the health section – it gives me an idea of what my patients will ask about during the work day (such as the “swine” flu), and it can also be a good starting point for blog ideas.
The front page of the health section Tuesday had a picture and quote from a beautiful teen who had died of bulimia several years ago.  She looked familiar.  My eyes scanned down to the name below the quote, and upon recognizing the name, my eyes immediately welled with tears.  She had been my patient years ago, and I didn’t know she died.  She was a great, sweet, smart teen who was well aware of her bulimia and the possible consequences.  And she died.
At the very least, eating disorders can ruin their own lives and those of their families.  And they kill.  Although statistics vary based on the study, about 0.5% to 1% of teens and women in the United States have anorexia nervosa, an illness that involves significant weight loss and food refusal.  About  1% to 3% of young American women have bulimia, a condition that includes regular binging and purging.  Over 1 million males have an eating disorder and the numbers are climbing.  Eating disorders are difficult to treat, especially once a pattern has been established and it has become a “way of life.”  The earlier they are recognized, the more likely treatment will be successful.
These days, children have unrealistic expectations of what they should look like and how much they should weigh.  Think about it.   Their role models have changed dramatically over the past several decades.  Girls and teens are exposed to ultra-thin, beautiful women wherever they turn – on TV, in magazines, music videos, and  movies.   And if that weren’t enough, moms, aunts, sisters and other teens and adults they know talk about food all the time – about eating too much, counting their calories, watching their weight, feeling “fat.”  It’s no wonder that almost one-half of first through third grade girls want to be thinner and that over 80% of 10 year olds are afraid of being fat!
Our country’s obsession with food and it’s trickling down effect is readily apparent when we look at the results of the Youth Risk Behavior Survey for middle schoolers, a survey conducted in 10 states in 2005 (see end of blog) .  By 6th grade, almost half of the students surveyed were trying to lose weight (even though only 14 to 18% were actually overweight), 5 to 7% vomited or took laxatives due to weight concerns, and 10 to 20% didn’t eat for at least 24 hours because they wanted to lose or didn’t want to gain weight!  And we can’t forget that boys develop eating disorders, too.  They tend to be diagnosed later than girls, possibly because we aren’t expecting to see males develop these illnesses.
What can we do?  Society must take some responsibility for the large number of teens and adults with eating disorders.  Genetics appears to play a role also.  While these factors are out of our control, others are not.  First of all, we can build our children’s self-esteem and confidence with regards to their academic and moral aptitude, rather than their outer appearance.  We can make sure that we don’t discuss weight and eating around our children and that we act as good role models by eating well and maintaining a normal weight.  We can limit TV, movies, and fashion magazines in our home and spend time together as a family.  We can try to make our expectations for our children realistic and feasible.  We can watch our children and teens closely for signs of an eating disorder, particularly if they are involved in sports, such as ballet, gymnastics, and wrestling, which focus on specific body types.  And, if we are concerned about them, we can immediately make an appointment for them to be seen by their pediatrician and therapist to be weighed and to discuss any concerns.  I can assure you it won’t be a wasted visit, even if your child turns out to have a healthy weight and eating habits.  Don’t ignore signs of an eating disorder, as one of my patients did in the past.  Upon hearing that her daughter weighed a mere 70% of her ideal body weight, her mom said that she was fine and that she, too, had gone through a similar “phase” when she was a teen.  Eating disorders are real, and they kill.


Specific Results of the YRBS for Middle School Students

Across states, the percentage of students who were overweight ranged as follows:
• 6th grade: 14.4% to 18.7% (median: 18.6%)

• 7th grade: 10.0% to 15.8% (median: 14.0%)

• 8th grade: 8.0% to 14.9% (median: 13.0%)
Across states, the percentage of students who described themselves as slightly or very overweight ranged as follows:
• 6th grade: 19.6% to 26.7%
• 7th grade: 24.7% to 29.7%
• 8th grade: 24.2% to 29.7%
Trying to Lose Weight
Across states, the percentage of students who were trying to lose weight ranged as follows:
• 6th grade: 40.7% to 48.4% (median: 46.8%)
• 7th grade: 42.7% to 51.9% (median: 44.2%)
• 8th grade: 41.6% to 49.6% (median: 45.9%)
Ate Less Food to Lose Weight or to Keep From Gaining Weight
Across states, the percentage of students who ever ate less food, fewer calories, or foods low in fat to lose weight or to keep from gaining weight ranged as follows:
• 6th grade: 35.0% to 47.9% (median: 41.4%)
• 7th grade: 39.1% to 47.5% (median: 41.6%)
• 8th grade: 41.1% to 47.5% (median: 46.6%)
Went Without Eating for 24 Hours or More to Lose Weight or to Keep From Gaining Weight
Across states, the percentage of students who ever went without eating for at least 24 hours to lose weight or to keep from gaining weight ranged as follows:
• 6th grade: 10.0% to 19.2% (median: 15.6%)
• 7th grade: 13.9% to 18.3% (median: 16.6%)
• 8th grade: 18.1% to 21.6% (median: 19.5%)
Vomited or Took Laxatives to Lose Weight or to Keep From Gaining Weight
Across states, the percentage of students who ever vomited or took laxatives to lose weight or to keep from gaining weight ranged as follows:
• 6th grade: 4.8% to 7.5% (median: 6.3%)
• 7th grade: 4.0% to 6.2% (median: 4.7%)
• 8th grade: 6.4% to 8.2% (median: 7.3%)


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3 Responses to “When Eating Becomes Disordered”

  1. Blossom says:

    While I think that it is critical that diseases such as anorexia nervosa and bulimia be addressed (one cousin died of anorexia nervosa psychosis-induced suicide)… I am amazed at the number of obese and morbidly obese teenagers, particularly female teenagers, that I see on a regular basis. Perhaps it's because I live in fly-over country or maybe it's because I travel to Orlando quite a bit; I more often see teenage females that are very overweight. The teenage females that I see who aren't overweight, they're often hunch shouldered and pot-bellied (extremely poor posture). I confess that I don't understand the weirdness of the female teenage weight distribution curve (over-concerned and over-thin versus not-concerned and over-weight/obese; not a normal distribution at all). However, it appears to me that teenage males present a more normal distribution curve.
    Anyway, the point of my comment — not only is under-weight and/or weight-obsessed-disorders a concern, but the rampant obesity and morbid obesity also have long-term, far-reaching consequences.

  2. Blossom says:

    While I think that it is critical that diseases such as anorexia nervosa and bulimia be addressed (one cousin died of anorexia nervosa psychosis-induced suicide)… I am amazed at the number of obese and morbidly obese teenagers, particularly female teenagers, that I see on a regular basis. Perhaps it's because I live in fly-over country or maybe it's because I travel to Orlando quite a bit; I more often see teenage females that are very overweight. The teenage females that I see who aren't overweight, they're often hunch shouldered and pot-bellied (extremely poor posture). I confess that I don't understand the weirdness of the female teenage weight distribution curve (over-concerned and over-thin versus not-concerned and over-weight/obese; not a normal distribution at all). However, it appears to me that teenage males present a more normal distribution curve.
    Anyway, the point of my comment — not only is under-weight and/or weight-obsessed-disorders a concern, but the rampant obesity and morbid obesity also have long-term, far-reaching consequences.

  3. I doubt the overweight crowd is “unconcerned” as Blossom mentions. In fact, I know they are not. When I taught jr. high, the shame and harassment overweight kids faced was so sad. I think society’s obsession with food/ looks pushes often pushes people into these extremes. It is interesting how we are more sympathetic to people who don’t eat enough and not those who eat too much. In fact, when a girl I know was developing an eating disorder and lost weight, the praise heaped upon her was amazing. Both of these are conditions where a person’s relationship with food is out of balance. One we put on the cover of a magazine, one we shame to no end.

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