Wednesday, April 18, 2012

Eating Disorders:What Families Need to Know

Kyla Boyse, R.N.
What do I need to know about eating disorders?
Most importantly, you should know that eating disorders require medical attention.

The two best-known types of eating disorders are anorexia nervosa and bulimia nervosa. They can occur separately or together in the same person. A person who has an eating disorder is not always skinny. Some people with eating disorders are even overweight. Binge eating disorder is another kind of eating disorder.

Can men and boys have eating disorders?
Eating disorders most often affect girls and women, but boys and men can also have an eating disorder. One out of every four pre-teen kids with anorexia is a boy. Binge eating disorder affects females and males about equally.

What is anorexia nervosa?
To be diagnosed with anorexia, a person would:
  • Be 15% below their ideal weight
  • Have an intense fear of being fat, even though they are underweight
  • Have a distorted view of their body or deny that their low weight is a problem
  • Have amenorrhea (missing at least 3 periods in a row)
  • May or may not also binge and purge
Anorexia usually affects teens, and mostly girls. An estimated 1% of white females have anorexia nervosa. It is more common among people in higher income groups, and in groups that value thinness (like athletes, ballet dancers and models). It usually starts around ages 13-14 or ages 17-18.

What is bulimia?
To receive a diagnosis of bulimia nervosa, a person would:
  • Binge eat (eat more food all at once than most people would normally eat in the same setting )
  • Feel a lack of control during binge eating
  • Purge the food by making themselves vomit, fasting (not eating for 24 hours), exercising excessively (for more than an hour), or abusing diet pills, laxatives, enemas, or diuretics (water pills)
  • Binge and purge regularly over a period of time
  • Have a self-image based mostly on their body shape and weight instead of other traits
People with bulimia may be anywhere from underweight, to normal weight, to overweight. It is estimated that as much as 3% of college-aged women have bulimia.

What is binge eating disorder?
Binge eating disorder is diagnosed when a person:
  • Continues to binge eat over time (eating more food all at once than most people would eat in the same setting)
  • Feels a lack of control during binge eating
  • Eats fast during binges
  • Overeats to the point of discomfort
  • Eats a lot when not hungry
  • Eats alone out of shame
  • Feels disgusted with themselves, depressed or very guilty after overeating
  • Is worried about their binge eating
Binge eating disorder does not include the purging consistent with anorexia and bulimia. It may be the most common eating disorder. About 40% of obese people may have this problem.

What causes eating disorders?
We don’t know for sure. Many factors working together may lead to eating disorders. Dieting is a risk factor, with the greatest risk to severe dieters. Around two-thirds of new cases of eating disorder are in girls and women who have dieted.

Is an eating disorder dangerous to my child’s health?
Eating disorders can cause many dangerous medical and mental illnesses.

Is it dangerous to use medications to lose weight?
The products a person might use to lose weight can be very unsafe. The regular use ofdiuretics (water pills), laxatives, and weight loss pills can cause life-threatening problems. And they don’t even work that well for weight loss. Using syrup of ipecac to cause vomiting can also lead to severe illness or death.

Should I worry if my child is on a diet to lose weight?
Most kids and teens do not need a restrictive diet. Limiting eating to control weight not only doesn’t work, but in fact, dieting promotes weight gain in tweens and teens. Reading dieting advice in magazines may lead to later unhealthy weight loss behavior in girls.

How can I tell whether my child has a healthy weight?
If you are concerned about your child’s weight, you should take them to see their doctor. There are some different measurements the doctor may take.
  • Weight and height can be compared and plotted on a growth chart.
  • Body mass index (BMI) is a good screening number that points toward how much body fat a person has. This number comes from a formula using height and weight numbers. It is a little difficult to compute by hand. You can use the link above to read about children’s BMI, calculate your child’s BMI on the web calculator, and find out their percentile rank.
◦ What does percentile mean? A body mass index (BMI) below the 5th percentile for the child’s age and sex is a sign of underweight. This would mean that 5% of children the same age and sex have a lower BMI than your child. A BMI around the 50th percentile is about average. A BMI above the 95th percentile is a sign of overweight. This would mean that 95% of kids the same age and sex have a lower BMI than your child. Your child would be in the top 5% highest BMIs.
◦ One drawback to BMI is that it does not take into account frame size (either small or large) or high muscle development (like with bodybuilding). A person with a large frame or big muscles may have a high BMI but low body fat. A person with a small frame may have a healthy amount of body fat, but have a very low BMI.
◦ Be sure to use measurements from the doctor’s office when calculating BMI. A small error in height or weight can cause a big error in the BMI result.
◦ has a BMI calculator that allows you to plot trends in BMI over time on a chart. (Follow the “instructions for entering more than one set of measurements.”) Then you can see if your child is gaining or losing body fat. Call your child’s doctor if you have concerns.

How can I tell if my child might have an eating disorder?
Look for these behaviors, signs and symptoms:
  • Eating tiny portions or refusing to eat
  • Intense fear of being fat
  • Distorted body image
  • Strenuous exercising (for more than an hour)
  • Hoarding and hiding food
  • Eating in secret
  • Disappearing after eating—often to the bathroom
  • Large changes in weight, both up and down
  • Social withdrawal
  • Depression
  • Irritability
  • Hiding weight loss by wearing bulky clothes
  • Little concern over extreme weight loss
  • Stomach cramps
  • Menstrual irregularities—missing periods
  • Dizziness
  • Feeling cold all the time
  • Sleep problems
  • Cuts and calluses across the top of finger joints (from sticking finger down throat to cause vomiting)
  • Dry skin
  • Puffy face
  • Fine hair on body
  • Thinning of hair on head, dry and brittle hair
  • Cavities, or discoloration of teeth, from vomiting
  • Muscle weakness
  • Yellow skin
  • Cold, mottled hands and feet or swelling of feet
If your child has some of these signs, you should bring them to the doctor right away. Your doctor can rule out diseases that can appear to be eating disorders. If an eating disorder is not treated, it can become life threatening.

How can I help my child?
  • In a calm and caring way, tell your child what you saw or heard. Use "I” statements and let him or her know you are concerned. For example, "I'm worried about you because you haven't eaten lunch this week.”
  • Listen carefully to what your child says. Teens with eating disorders might feel ashamed or afraid. They may think that life doesn't matter. Feeling out of control is also common.
  • What if they get mad or deny it? It is very common for kids with problems to say that there is nothing wrong. Tell them you want to help. You may need to approach them several times.
  • Parents should be aware of their child’s Internet use. There are many pro-eating disorder Web sites, and even YouTube has videos that promote eating disorders. These sites often use the terms “pro-ana” (for anorexia) and “pro-mia” (for bulimia).
  • How are eating disorders treated? How can I get my child started in treatment?
The first goal in treating severe anorexia is to improve your child’s nutrition and eating habits. Then, the goals will focus on learning about nutrition and normal eating patterns, improving self-esteem, relating to others, interacting with family, and treating medical and other psychological problems.

What is Body Dysmorphic Disorder (BDD)?
Your child may have Body Dysmorphic Disorder (BDD). Having BDD means thinking about what you look like much more than normal. It also involves thinking too much about real or imagined defects in how you look. It is a kind of distorted thinking. It affects males and females about equally.
If you think your child has BDD or body image problems, you should talk to your child’s doctor. Your child’s health care provider can refer you to someone who can help. It’s best to see someone with expertise in treating BDD. It’s also helpful to see someone who treats obsessive-compulsive disorder (OCD), since OCD and BDD often overlap.

What can we do to help prevent these problems?
You may feel you want to protect your child from the hurt of being teased about their weight. Unfortunately, focusing on your child's body may do more harm than good. Your child may begin to value themselves solely on what they look like. They may feel they have to look a certain way to gain approval and acceptance. Do not stress what your child looks like. Instead, put the focus on your child’s inner qualities.
Pay attention to the messages you send your child about appearance and weight. Do you constantly diet, and talk about “good foods” and “bad foods?” Do you make negative comments about your own body in front of your child? Make your home a place to learn healthy attitudes about food and body image. Stop the dieting, and instead focus on eating and serving healthy foods. Make sure your family eats breakfast, and share family mealsas often as possible.
It may also help to discourage your daughter from reading many women’s fashion magazines and from seeking out other media that portray underweight women as being glamorous. Discuss media images of “ideal bodies” with your children. Teach your kids to be media literate, which will help protect them from harmful messages about food, eating, and body size from TV, music videos, magazines, and ads.

What are some recommended books?
  • How to Get Your Kid to Eat…But Not Too Much, by Ellyn Satter. 
This is a book all parents should read, whether their children have eating problems or not. It applies to kids from birth through the teen years. The advice in this book can help you help your child to develop a healthy relationship with food.
  • I'm, Like, So Fat: Helping Your Teen Make Healthy Choices about Eating and Exercise in a Weight-Obsessed World, by Dianne Neumark-Sztainer.
  • Eating With Your Anorexic: How My Child Recovered Through Family-Based Treatment and Yours Can Too, by Laura Collins.
  • Help Your Teenager Beat An Eating Disorder, by James Lock and Daniel LeGrange.
  • Gaining: The Truth About Life After Eating Disorders, by Aimee Liu.
  • When Dieting Becomes Dangerous: A Guide to Understanding and Treating Anorexia and Bulimia, by Deborah Michel and Susan Willard.
  • It's Not About Food: Change Your Mind, Change Your Life; End Your Obsession with Food and Weight, by Carol Emery Normandi.

Organizations and information/support websites:
  • The National Eating Disorders Association is the largest not-for-profit organization in the United States working to prevent eating disorders, eliminate body dissatisfaction, and provide treatment referrals to those suffering from anorexia, bulimia and binge eating disorder and those concerned with body image, eating and weight issues. Their Web site offers information about eating disorders and body image; referrals to treatment centers, doctors, therapists, and support groups; opportunities to get involved in prevention efforts; prevention programs for all ages; and educational materials. Call 1-206 382-3587 for more information. Call the Toll-Free Information and Referral HelpLine at 1-800-931-2237.
  • The National Association of Anorexia Nervosa and Associated Disorders(ANAD) has an international network of support groups, offers referrals to health care professionals, publishes a newsletter, and will mail information packets customized to individual needs upon request. They work to educate the public, promote research projects, and fight insurance discrimination and dangerous advertising. Their national hotline (847-831-3438) can give you a listing of support groups and referrals in your area.
  • Maudsley Parents is a site for parents of eating disordered children. The site offers information on eating disorders and family-based treatment, family stories of recovery, supportive parent-to-parent advice, and treatment information for families that opt for family-based Maudsley treatment.
  • The Something Fishy Website on Eating Disorders has lots of resources of all kinds, including information and online support. (Scales are for Fish!)
  • The Academy for Eating Disorders is a global organization for professionals from all fields who are committed to leadership in eating disorders research, education, treatment and prevention. Phone 703-556-9222.
  • Overeaters Anonymous is a twelve-step program offering support for recovering from compulsive overeating. Phone 505-891-2664.
  • About-Face focuses on the impact mass media have on the physical, mental and emotional well being of women and girls. They challenge our culture's overemphasis on physical appearance and encourage critical thinking about the media. Phone 1-415-436-0212.
  • The American Dietetic Association has information on good nutrition, sensible eating habits. Phone: 1-800-877-1600, ext. 5000 (for publications).
  • The Weight-control Information Network provides the general public, health professionals, the media, and Congress with up-to-date, science-based information on weight control, obesity, physical activity, and related nutritional issues. Phone: (202) 828-1025 or 1-877-946-4627.

Reviewed by David Rosen, MD, MPH.

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