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. 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:
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. 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:
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. 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:
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.
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