Is Your Daughter Anorexic?

• Regularly refuse family meals or skip lunch at school.
• Stick to a few “safe” foods, including vegan or low-fat, low-carb options.
• Talk about (and fear) being fat even when they are slim.
• Become obsessed with exercise.
• Attempt to create a “perfect” image in every area of their lives.
• Consistently exaggerate the size of their body or body parts.
• Have an overriding sense of shame about themselves and their body.
• Experience rapid weight loss.

If you notice any of these signs, consider making a trip to your family doctor or pediatrician. “He or she will listen to your concerns, interview your teen alone, and do a physical exam,” says Laurie Mitan, MD, head of the eating disorders program at Cincinnati Children’s Hospital Medical Center. If there is a problem, the doctor will know where to turn next. “Having a mental health therapist, a medical doctor, and a registered dietitian is best,” says Dr. Mitan, “though patients with more severe
diseases will need a psychiatrist.” Anti-depressants are an effective part of the treatment for bulimia and binge-eating disorder, she adds. Many patients with anorexia may appear depressed, but this often results from malnutrition and will improve with weight gain.

Anorexia and bulimia are the most well publicized eating disorders, but they are not the only ones. Here, a brief primer on these complex illnesses.

Anorexia Nervosa

Present in about 1 percent of the general population, anorexia is the third most common chronic illness among adolescents. Sufferers are very underweight, sometimes to the point of emaciation. Terrified of being fat, they severely restrict calories. “Ironically, their fear only tends to heighten as the weight drops off,” says Trisha Gura, PhD, author of Lying in Weight: The Hidden Epidemic of Eating Disorders in Adult Women.

What to look for: A child who skips meals, eats tiny portions, or eats in strange ways (chewing food for half an hour, spitting food out before swallowing). Children with anorexia may avoid food-related events (such as a family barbecue or a pizza party with friends) or make excuses to avoid eating (“I’m not hungry” or “I have a stomachache”).

Bulimia Nervosa

Most bulimics are of normal weight and display few outward signs of their problem, making it difficult for parents to catch on. Affecting about 4 percent of the population, bulimia consists of cycles of binge eating (usually sweets and junk food) followed by unhealthy behavior that rids the body of the calories. About 80 percent of bulimics vomit to purge, but other methods include laxatives, diuretics, fasting, compulsive exercise, enemas, or other medications. Kids can lose major nutrients, especially potassium, which helps to regulate the heart. In chronic cases, the body has so little potassium that physical function suffers and hospitalization is needed.

What to look for: Empty food packages around the house, bathroom smells, or running water (the sound covers the vomiting). Children with bulimia may have scratched or black-and-blue knuckles (from scraping their fingers against their teeth); they may also use the bathroom at unusual times or make frequent bathroom trips, especially right after meals. Note the excessive use of mouthwash and breath mints.

Binge-Eating Disorder (BED)

BED consists of bingeing—like bulimia—but there’s no purging. Those with BED tend to be obese and racked by low self-esteem. They may also be frequent dieters who binge with the sense that they can’t stop themselves. Research shows that between 15 and 50 percent of people enrolled in dieting programs suffer from BED. The consequences mirror those of obesity: high blood pressure, heart disease, diabetes, and gallbladder disease.

What to look for: A child, who eats a lot of food quickly, exhibits a pattern of emotional eating or feels ashamed or disgusted by the amount that he or she eats. Note any irregular eating patterns, especially skipping meals and eating at unusual times (such as late at night).

Why is it so important to catch eating disorders early?

About 76 percent of people treated for anorexia either recover completely or make significant progress. But the earlier treatment begins, the better the outcome. “Getting into treatment in the first six months can make all the difference in a child’s life,” says Dr. Shure.

As the disorder takes hold, the physical and psychological damage becomes much harder to reverse.