Children and Adolescents
Much to Worry About
When it comes to eating disorders and our youth, the trend is alarming. They are being diagnosed at a much younger age and more often. It is estimated that about 1% of teenage girls have anorexia while 5% have bulimia. About 42% of first-to-third graders want to be thinner. And about 46% of 9 year olds and 81% of 10 year olds report fear of getting fat. The earliest diagnosed case of anorexia stands at age 4. Eating disorders have also become more common among boys, ethnic groups other than whites and lower socioeconomic classes. About 10% of all young people with eating disorders are now boys. Five percent (5%) of those with anorexia, 15% of those with bulimia and 35% of those with binge eating disorders are boys. Eating disorders also cause significant medical morbidity in young people. In this context, the third most common chronic illness in adolescent females is eating disorders. Finally, almost 87% of all diagnosed with eating disorders in this country are younger than 20.
Types of eating disorders
The most common types include anorexia nervosa, bulimia nervosa and binge eating disorder. We discussed the symptoms of the first two disorders among adults in parts I and II of this article. The symptoms are very similar in young people. Binge eating disorder is a condition in which a child/teen engages in devouring a large amount of food in a short period of time, but does not engage in purging. What causes eating disorders in our youth? The overriding factor seems to be genetic or biological which is the case with most neurobiological disorders. Most eating disorders seem to run in families. However, family dynamics (e.g. how family views thinness or eating habits), sociocultural issues (e.g. pressure to be thin) and psychological factors (e.g. low self-esteem, poor body image etc.) all play important roles.
Warning signs of eating disorders in youth
It is clear that the earlier the treatment begins for eating disorders, the better the outcome. So, early detection is crucial. However children and adolescents are very adept at hiding their symptoms for years. Parents are usually the first people to notice any indication of an eating disorder. Now, besides the obvious behaviors associated with eating disorders, the following may serve as the ‘red flags’ if your child or teen has an eating disorder:
• Inexplicable dizziness or weakness.
• Chronic constipation.
• Intolerance to cold e.g. frequent flu-like symptoms.
• Declining school performance • Inexplicable mood changes
• Undue hyperactivity.
• Frequent nightmares.
• Inexplicable dental problems.
• Inexplicable heartburns.
• Dramatic fluctuation in weight.
• Undue preoccupation with exercise/food type/calories/body size etc.
Parents should also bear in mind that kids with eating disorders tend to be perfectionists and with low self-esteem. Medical consequences of eating disorders in youth Theses could be devastating and in cases of anorexia and bulimia, include:
• Delayed or arrested puberty.
• Delayed breast development (girls).
• Growth retardation
• Decreased muscle and bone mass.
• Decrease in blood pressure and heart rate.
• Irregular heart beat
• Electrolyte imbalance
In contrast, kids/teens with binge eating disorders may develop (due to excess weight) the following:
• High cholesterol and triglycerides.
• High blood pressure.
• Atherosclerotic heart disease.
What are the other risks?
Like adults, kids and teens with eating disorders are more likely to suffer from mood disorders, anxiety disorders, substance abuse disorders, body dysmorphic disorder etc. What to do when your child/teen has warning signs of eating disorders? The most important thing for parents to realize is that it will not get better on its own and that your child/teen will not be able to ‘will it away’.
Here is what to do:
• The first step is to gently talk to child/teen about the problem. • Mobilize your resources by talking to and consulting the family physician, teachers, clergy and close relatives. • Have the child/teen evaluated both medically and psychologically/psychiatrically. • Address psychological issues e.g. low self-esteem by being supportive and/or involving a therapist. • Establish a healthy eating lifestyle for the whole family: this should include better choice of foods, at least three balanced meals a day, eating together, parental determination of daily menu (child/teen should determine the portion) etc. • Establish an ¬active lifestyle for the whole family: this should include regular but modest exercise, avoidance of excessive sedentary activities e.g. watching T.V. or playing video games, family physical activities e.g. walking, jogging, etc. • Create a ¬¬¬supportive and cohesive family environment: this should include doing non-physical activities together e.g. reading, refraining from commenting on child’s/teen’s weight or shape, listening, promoting healthy communication, encouraging expression of feelings, promoting self-worth of child/teen etc. • Examine and adjust (if needed) your attitudes towards eating, body weight etc. Remember your child/teen will most likely model after you
Again, to re-emphasize, the earlier the treatment is started, the better the long-term outcome. As in adults, treatment should be provided by a multi-disciplinary team consisting of family physician, psychiatrist, therapist, dietitian etc. Various components of treatment are the same as those described for treatment of adults in the preceding parts of this article.
The purpose of this article is for educational purposes only. It is not intended to diagnose or treat any medical or psychiatric issue. Dr. Rakesh Ranjan is a practicing psychiatrist and a researcher. He is a recipient of several research awards and has authored several peerreviewed journal articles and book chapters on psychiatric illnesses and their treatments. He is a national speaker for several organizations and serves on the medical advisory board for the NAMI of Greater Cleveland. If you or a loved one is experiencing any symptoms that would lead you to believe that there could be a mental imbalance, please email your questions to Dr. Ranjan at firstname.lastname@example.org. Each Wednesday, Dr. Ranjan will address some of these questions in this column. All contact info will be kept confidential.