Too many adolescents are hiding painful eating disorders that harbor long-reaching consequences. Is your child at risk?
By Alyson Black
“There has always been an issue with adolescents struggling to find their own identity,” says Walter Rosenfeld, MD. “That’s a normal struggle that will always occur, and that’s a good thing.”
Unfortunately, explains Rosenfeld, chairman of pediatrics for Atlantic Health, Goryeb Children’s Hospital at Morristown Memorial and Goryeb Children’s Center at Overlook Hospital, when that internal struggle goes awry, it can manifest itself as a life-altering—and potentially life-ending—eating disorder.
Since starting the Eating Disorders Program at Atlantic Health ten years ago, Rosenfeld says he has seen an increase in the number of patients being treated for such afflictions as anorexia and bulimia. Although part of the increase is attributed to greater recognition of eating disorders, the widely accepted belief is that there is a true increase in prevalence (anorexia is now the third most common chronic disorder among young women, behind obesity and asthma). “There is a trend that we’ve had over many years to focus on outward appearance,” Rosenfeld says, citing the media’s potential role in the growth of eating disorders. “In TV, movies, and other venues, being thin is the gold standard of beauty. Athletic and entertainment fields celebrate thinness even when thinness is at abnormal levels.”
In June, Leslie Sanders, MD, medical director of the Eating Disorders Program and interim director of adolescent medicine, was invited to attend a meeting of the Council of Fashion Designers of America as the group discussed concerns about eating disorders in their industry and beyond. “If the fashion industry did change the way they portray women,” she says, “it could have an impact on the way women and men see what the ideal woman is intended to look like. That certainly affects young girls a lot: When they see women who are so abnormally thin, they think that’s what they should look like.”
What they don’t see, of course, are the harmful effects of eating disorders.
The Ugly Truth
Anorexia has the highest death rate among psychological disorders in teenagers, Rosenfeld reports, but for those who manage to survive the disease, the picture remains plenty bleak. Eating disorders are associated with suicide, electrolyte disturbances, liver and stomach problems, and increased risk of osteoporosis in adulthood.
“Weight loss can result in a loss of menstrual cycle, which can quickly cause changes in bone density, which can lead to the equivalent of osteoporosis, like in someone who is 80,” explains Sanders. “If you develop osteoporosis as a 14 year old, that’s as good as your bones are going to get your whole life. In your thirties and forties, you may have the same problems someone much older would face. You’ll see injuries you’d expect in your grandmother.”
Not even the brain is spared. Severe malnutrition is to blame for less volume and loss of brain tissue—changes that at this point seem irreversible, says Sanders.
Read the Signs
Eating disorders reveal themselves in many ways; some whisper, others scream. “Usually before you see physical changes,” Sanders says, “parents in retrospect realize there was another kind of change.”
The red flags are plenty.
- Look for any change that seems extreme, Sanders warns. “The diet becomes more and more limited, more regimented—no snacks, no fat, no carbs. Often children will decide they’ll become vegetarian. Or a child is used to drinking milk, juice, lemonade, and now all she’ll drink is water.”
- Reading nutrition labels and measuring food to obsession.
- Parents may find vomit somewhere in house, like in the shower or in Ziploc bags. “The fact that it is hidden, that alone tells you something about the pain a person is in,” says Rosenfeld.
- When exercise becomes associated with food, there is often a need to exercise immediately after eating.
- Weigh-ins become more frequent—perhaps first one time a week, then one time a day, then after every time an adolescent eats.
- Physical signs include fainting or light-headedness, not having a first menstrual period, or losing a menstrual period. “Often, parents and coaches think that is normal. It is not normal,” Sanders cautions.
These “tip-off behaviors,” as Rosenfeld refers to them, can be attributed to things other than eating disorders, but they do need to be looked at.
Take Action
As the ranks of those afflicted with eating disorders expands, so too does the breadth of those affected. “I’m seeing younger and younger girls—a string of nine-year-olds,” Sanders says. “In the past when we saw young children, eating disorders were not driven by body image—they were the result of bad experiences with food. Now we’re seeing nine-year-olds talking about feeling fat when they’re not fat. They’re becoming obsessive about their bodies and food.”
So what’s a parent to do? Rosenfeld and Sanders believe parents need to change how they themselves approach food and diets and body image. “They should talk with youngsters about the need to develop into a good person instead of talking about obesity and weight loss,” says Rosenfeld. “Talk about healthy food choices, physical activity.”
To that end, he says, we need to “work with schools and coaches, trying to let them know we’re not overly concerned about winning—we’re concerned about health and healthy self-esteem.”
Says Sanders, “Parents should never involve children in their diets. In children who are vulnerable to eating disorders, this often leads to becoming obsessed with food. Parents should minimize discussions about weight concerns.”
Get Help—Fast
“People need to understand that eating disorders are not about food,” says Sanders. “Eating disorders often start with concerns about weight and size, but people very quickly learn it has something to do with emotional needs that are not being met. If it was just about weight and food, it would be simple to cure. But these are very complex psychological issues.”
That’s why early intervention and treatment are critical. “If you thought your child had a neurological problem, you as a parent would not try to solve it yourself,” Rosenfeld says. “You would get help.”
“Reach out to a pediatrician, a social worker, a psychologist. If there are physiological problems, certainly a physician needs to be involved.”
The best outcomes come with early recognition, before an eating disorder has become firmly entrenched, Rosenfeld says. Two-thirds of patients have a full recovery or return to point where they’re able to live a normal life. “The prognosis for recovery is not all a downer. There is hope.”
If you think your child is suffering from an eating disorder, contact the Eating Disorders Program at Atlantic Health: (866)-262-9898
The 100-Calorie Question:
Chew on This
Walk through the supermarket these days, and it seems everything from fruits and veggies to cookies and crackers has been doled out into predetermined sizes. And while the proliferation of prepackaged, 100-calorie snacks has been praised in many circles for promoting portion control, Leslie Sanders, MD, medical director for the Eating Disorders Program at Atlantic Health and interim director of Adolescent Medicine, has a different view.
“Why is it that every snack is sold in 100-calorie packs?” she asks. “Parents should boycott them. Why should a first-grader be concerned with how many calories he or she is eating? If you think about it, it’s absurd. It’s the wrong message to be giving young children. Who decided 100 calories is the right amount to have as a snack? It’s marketing that is having a negative effect on our children.”
