What do Mary-Kate Olsen, Ashlee Simpson, Christina Ricci and Jessica Alba have in common? If you don't know, your preteen or teenage children probably do. All of them have publicly admitted to suffering from eating disorders.
Everywhere we look, from television and movies to magazines and advertisements, the unhealthy message seems to be that "thin is in." This is very disheartening because our cultural image of perfection is unrealistic and unhealthy for most people.
The last week in February is the annual National Eating Disorder Awareness Week. The goal of this event is to encourage people to "Be Comfortable in Your Genes," and learn to accept a healthy body image.
It is estimated that up to 1% of all adolescent and young adult women suffer from anorexia nervosa, 1% to 3% have a diagnosis of bulimia, and up to 5% suffer from binge eating. The struggle our teens and young adults face with eating and weight is an issue that continues well into adulthood if it is not identified early on and then properly treated.
What Is an Eating Disorder?
It is not easy to figure out who may develop an eating disorder, when and why. Eating disorders may be part cultural, psychological, familial and possibly even genetic, but they always include a focus on weight and food.
There are emotional and behavioral struggles for these individuals with eating disorders; they often take extreme measures to lose weight. Eating disorders can lead to serious, even life-threatening medical problems.
The major types of eating disorders include:
- Anorexia nervosa, starving yourself in an effort to lose an excessive amount of weight — People with anorexia are severely (more than 15%) under ideal body weight, yet they continue to see themselves as overweight. They usually are overly concerned about their bodies, with an overwhelming fear of becoming fat or gaining weight.
- Bulimia nervosa, secretly overeating and then forcing yourself to purge (known as forced vomiting) — Someone with bulimia does this overeating and purging on regular cycles and may abuse laxatives or use over-exercising as the way to try to best control weight. These individuals may keep a normal weight, which can make identifying this disorder more difficult.
- Binge eating disorder, impulsively overeating, but without forced vomiting — Someone with this condition may have severe feelings of shame or self-hate. Body weights may range from normal to severely overweight.
Back to top
Why Should We Care?
In addition to being more common than most people realize, eating disorders are extremely dangerous (and sometimes even deadly). Common medical signs and complications that are seen with eating disorders can include a slowed heart rate, low blood pressure, loss of regular menstrual cycles, dehydration and associated kidney failure, loss of muscle, tiredness, weakness, dry skin, feeling cold all the time, rotting of the teeth and damage to the esophagus from vomiting, irregular bowel movements, and constipation.
It's important to remember that these generally occur when the eating disorder has gone on for some time, so a child who doesn't have these symptoms still could have an eating disorder.
Each eating disorder also has a strong psychiatric component, resulting in harsh body image ideas, depression, self-hatred and social problems such as isolation. Anorexia, the most serious eating disorder, is estimated to cause death in as many as 5% to 20% of all people who suffer from it.
Most eating disorders begin in early to mid-adolescence, but, incredibly, they have been reported in children as young as 6 years old. Eating disorders occur 10 to 20 times more often in girls than in boys, but it is important to remember they can affect anyone. Nearly 5% to 10% of all eating disorders occur in boys.
Back to top
Recognizing the Signs
Besides the obvious physical sign of weight loss for some eating disorders, there are specific behaviors you can watch for that may make you think about the possibility of an eating disorder. These include:
- Skipping meals or not eating in front of people
- Having frequent excuses for not wanting to eat, such as "I'm not hungry" or "I ate at my friend's house"
- Becoming unusually involved in meal planning, reading food labels or calorie counting
- Developing rigid or ritualized eating behaviors
- Avoiding foods that were once favorites
- Spending time in the bathroom immediately after eating, when secret vomiting may occur
- Hiding large amounts of food in the bedroom
- Eating secretly when alone
- Using laxatives, diet pills, water pills or anything else for weight loss
- Saying that they hate themselves or do not like how their bodies look (poor body image)
- Exercising excessively
- Showing signs of depression, including poor sleep, wanting to be alone (isolation), concentration problems, decreased interest in hobbies or activities, feelings of guilt, or being irritable
Back to top
What Can You Do?
If you ever suspect your child has an eating disorder, the first thing you should do is to get help. Your pediatrician will help you set up a team of health care professionals to work with your child, you and your family. This team may include doctors, nutritionists, psychiatrists, counselors, therapists and nurses. A supportive family can make a huge difference; in many cases, family therapy is very helpful.
It is important for you to talk with your child openly and make it clear that you are concerned about his or her health. Eating disorders are often very hard for parents, siblings and friends to understand. It is easy to assume that the solution is to "just eat," or "just stop purging," but treatment is much more complex than that. It may take years to fully overcome an eating disorder because it has such a profound effect not only on the physical body, but also on the overall emotional health and well being of your child.
Eating disorders may require aggressive medical and psychological treatment. The prognosis is better if they are caught early, and recognizing the warning signs and promoting a healthy body image can prevent eating disorders. With more severe cases, patients may need to be hospitalized for treatment.
Back to top
Healthy Eating and a Healthy Body Image
As with most things, children learn about body image from the people around them. Teach your children that everyone is born with a different body type, and not all people are meant to be thin. Remind them that there is much more to a person than appearance, and help them see all their strengths and talents.
As a parent, you play a huge role in promoting a healthy body image for your child. Children look up to you, and whether you realize it or not, your own weight and body issues impact your child.
It is unhealthy for your children to hear you talk negatively about your own body, or for you to lose control of your own weight. It is also important for you to be a positive role model for your children, and to practice and promote healthy exercise and eating behaviors. Here are some suggestions:
- Make sure your children don't skip meals, especially breakfast.
- Give your children heart-healthy foods: low-fat, high-fiber, lots of fruits and vegetables. Remember to give calcium-rich foods as well.
- Snacks are important for growth and nutrition. Teach your children to choose healthy snacks, such as yogurt or fruit, instead of chips or other junk food.
- Discourage calorie-counting. Instead, teach them to think about whether or not foods are healthy for them.
- Eat together. Not only does this allow you to model good eating habits, it gives you a chance to check in with your child every day.
- Help your child find exercise options that are enjoyable, such as a hip-hop dance class, karate or yoga. This can help the reluctant exerciser get moving, and give the obsessive one a different perspective on exercise.
- Exercise together. Go roller skating or biking, or take a walk. It's another opportunity to be a role model — and to have some important family time.
Back to top
Claire McCarthy, M.D. is an assistant professor in pediatrics at Harvard Medical School, an attending physician at Children's Hospital of Boston, and medical director of the Martha Eliot Health Center, a neighborhood health service of Children's Hospital. She is a senior medical editor for Harvard Health Publications.