Eating disorders in teens: A slippery slope

On the surface, people with eating disorders may look normal or may look like they are struggling with their weight. Under the surface, there is so much more. 

The different eating disorders are like “apples and oranges:”

  • Anorexia nervosa (AN) is weight loss in a person who believes that he or she is “fat” despite being underweight.
  • Bulimia nervosa (BN) is repeated episodes of binge eating coupled with behaviors intended to prevent weight gain, such as vomiting, fasting or excessive exercise (“purging”). Binging leads to feelings of loss of control and panic over weight gain. Purging gives a temporary sense of control and relief.  However, feelings of shame and disgust lead to a vicious cycle of binging and purging.
  • Binge eating disorder (BED) is repeated episodes of binge eating without purging behaviors. 

Why teens and why eating disorders?  The peak onset of eating disorders is between the ages of 12 and 25   AN peaks twice: ages 12 to 14 and ages 17 to 18.  BN tends to peak later in adolescence and early adulthood.  Some of the reasons for these years of increased risk have to do with genetics, neurotransmitters, social pressures to be thin, and the normal weight gain during puberty.  For AN, there is often a stimulus, such as a young teen girl who reacts to a comment like “it looks like you’ve put on weight” by severely restricting the food that she is eating. For BN, onset often follows an attempt at dieting.

Eating disorders are increasing. An estimated 0.5 percent of adolescent girls have AN and 1-2 percent have BN. What’s more, eating disorders are increasing in males, minority populations and younger children. A study showed that hospitalizations for eating disorders in children under the age of 12 have more than doubled recently.  Up to 14 percent of other people have eating disorders but do not meet all of the diagnostic criteria: they still need treatment, and the sooner, the better.

On the surface, people with AN  are underweight; under the surface, they are experiencing:  

  • Severe restriction of food intake…like a girl who dropped from 131 pounds to 99 pounds in four months by eating only 500 calories/day.
  • Intense fear of gaining weight…like a girl who weighed herself multiple times a day and couldn’t stop thinking about what she ate or was going to eat.
  • Disturbance in body image…like a boy of normal weight who thought he was overweight and started going to the gym for two hours every day.
  • Binging and/or purging…like a girl who vomited after eating a small dinner.

On the surface, people with BN are usually normal or overweight; under the surface, they are suffering with:

  • Recurrent episodes of binging followed by purging…like a college student who, in an hour-long frenzy, consumed over 2,000 calories of junk food from vending machines and then vomited to compensate.
  • Self-concept that depends on body shape and weight…like my patients who feel negatively about themselves because they are not “skinny.”

On the surface, people with BED may or may not be overweight; under the surface, they are distressed with:

  • Binging without purging…like a distressed college student who repeatedly binged gaining 40 pounds in her first semester of college.

A team approach is the best approach in treating eating disorders. AN, BN and BED are classified as emotional or mental disorders, but serious medical problems can result. Complications include osteoporosis, stomach ulcers, blood chemistry imbalances, and even death, so the team needs to include a medical doctor. Individuals with eating disorders may also have obsessive-compulsive disorder, anxiety, substance abuse, depression and suicidal behavior, so the team needs to include a mental health professional. A nutritionist, who can help a person achieve and maintain a normal weight, is an important team member, too.

Why a “slippery slope?” On the one hand, eating disorder rates are increasing. On the other hand, obesity rates are also increasing. The slope is slippery because a person may have an eating disorder or obesity, an eating disorder and obesity, or an eating disorder followed by obesity, or obesity followed by an eating disorder. 

My advice to parents:  

  • Be aware of the slippery slope: encourage healthy eating and exercise before puberty.
  • Be careful: comments about your child’s weight may set off an eating disorder.
  • Be observant: if you notice changes in your teen’s eating behavior and/or weight, start by talking with your teen’s doctor.

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