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Eating Disorders

separator The incidence of eating disorders has been on the rise since the 1950s, according to the American Academy of Pediatrics. A recent article in the journal Pediatrics states that

  • One half of one percent of adolescent females meet the criteria for anorexia nervosa
  • One to five percent meet the criteria for bulimia nervosa
  • Up to five to 10 percent of eating disorders occur in males

Criteria for anorexia and bulimia
The two main eating disorders are anorexia nervosa and bulimia nervosa. Features of anorexia include:

  • Refusal to maintain minimally normal body weight
  • Intense fear of gaining weight
  • Disturbed perception of the shape or size of the body

Typically, girls who have reached puberty and have anorexia will stop menstruating. If anorexia develops in a child who has not reached puberty, failure to gain expected weight may be the more common feature, rather than losing weight.

Anorexia can be fatal. In fact, about 10 percent of people who are admitted to the hospital with anorexia nervosa have a mortality rate of 10 percent. The cause of death is most commonly starvation, suicide or electrolyte imbalance.

Features of bulimia nervosa include

  • Binge eating (defined as eating an amount of food that’s larger than most people would eat under similar circumstances, usually in less than 2 hours)
  • Inappropriate behavior to compensate for the binging. About 80 to 90 percent of people with bulimia vomit their food after binging. Others use laxatives to stimulate bowel movements.

People with bulimia are usually in the normal weight range, although they may be slightly under- or overweight. Their frequent vomiting can cause permanent loss of tooth enamel and enlarged salivary glands. People who use laxatives may suffer from rectal problems.

In rare cases, some complications, such as esophageal tears, gastric rupture and abnormal heart rhythms can be fatal.

While anorexia and bulimia are the most common eating disorders, there’s other behavior that falls under the category of “eating disorder not otherwise specified.” Behavior can include chewing food and spitting it out, vomiting after eating only a small amount of food and binge eating without the vomiting.

Disorders often kept secret

People with eating disorders do their best to keep their disorders secret from family and friends. Many parents aren’t aware that there are Web sites that actually promote easting disorders. The sites give tips on how to make your family think you’re eating. They promote the notion that being skeletally thin is virtuous and indicates self-discipline.

People with eating disorders will admit to spending hours online, and they describe the sites as a kind of “support group” for them.

Usually, when parents express concern about a child’s thinness, or if they notice vomiting or other eating-disordered behavior, the child will become angry or defensive and deny that there’s anything unusual going on.

Parents, pediatricians can play pivotal roles
Breaking the eating disorder pattern early is crucial. In January, the American Academy of Pediatrics issued a policy statement urging pediatrician to become more active in identifying and treating eating disorders in their patients. Pediatricians can not only detect the disorders, but they can also take an active role in terms of referring families to other therapists if necessary, and then working closely as a liaison between patients, parents and therapists.

But it’s not likely that the person with the eating disorder will go to the pediatrician and ask for help with the problem. That’s where parents should not hesitate to get their children to the doctor at the first suspicion that an eating disorder is present.

The American Academy of Pediatrics; The American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Washington, D.C., 2000; Pediatrics, January 2003.
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