Eating Disorders - McKenzie Pediatrics (PDF)

Guidelines for Teens Eating is something that most people look forward to. It can mean experiencing good food, doing something healthy for your body, and spending time with family or friends. Many social events such as parties and holidays also involve food. But, for a person who has an eating disorder, eating brings about very different feelings. Constant thoughts about eating and an intense fear of gain- ing weight become an obsession for a person who has an eating disorder. Living with an eating disorder is very hard. The road to recovery is not easy but, with treatment, a person can recover and go on to lead a healthy life. Without help, a person with an eating disorder can have a number of medical problems, become very sick, and even die. The American Academy of Pediatrics has developed this brochure to help you learn about some common eating disorders, their causes, symptoms, and possible courses of treatment. What is an eating disorder? The two most common eating disorders are anorexia nervosa and bulimia nervosa. Anorexia is self-starvation. Bulimia is a disorder in which a person eats large amounts of food (“bingeing”) and then rids the body of that food before it can be absorbed (“purging”). A person who is bulimic purges either by vomiting or using laxatives or diuretics (water pills). Some people have symptoms of both anorexia and bulimia. There is no single cause of an eating disorder. Many factors may be involved and are different for each person. Some factors include: • Feeling insecure • An excessive desire to be in control • A distorted body image (feeling fat) and striving for the perfect body • A family history of depression or an eating disorder • Severe family problems • A history of sexual abuse • Extreme social pressures • Pressure from activities such as running, gymnastics, wrestling, or ballet Most anorexics and bulimics are girls; however, boys can suffer from these disorders as well. Adolescents experience many social pressures, especially from the media, to be thin. This pressure to be thin or to diet can be especially strong for teens if their friends are dieting or trying to lose weight. It is easy for teens to get over-the-counter diet pills to reduce their appetite so that they do not eat as much—a practice that can become habit-forming. Diet pills can raise blood pressure, cause kidney damage, make a person dizzy or halluci- nate, or even lead to fatal stroke. It is important, however, for both girls and boys to understand that not everyone has the type of body that is superthin. In fact, only a small number do. If a person is not meant to be naturally thin, that person needs to accept that fact and learn to like his or her body the way it is. It is important to have a healthy attitude toward weight and to feel good about oneself. Anorexia nervosa Anorexia is an eating disorder that mainly affects females between 14 and 18 years of age. A person with this disorder has such an intense fear of becoming fat that she hardly eats anything and becomes dangerously thin. Anorexics often weigh as little as 80 to 100 pounds. Many anorexics also over-exercise and may abuse diet pills to keep from gaining weight. If the condition gets worse, anorexics can die from suicide, heart attack, or starvation. How does an anorexic behave? When a person develops anorexia nervosa, her behavior changes, especially in regard to eating. A person with anorexia may: • Eat only “safe” foods, usually those low in calories and fat. • Cut up food into very small pieces. • Spend more time playing with food than eating it, such as rearranging it on the plate throughout a meal. • Buy, prepare, and cook food only for others. As the anorexic becomes more obsessed with food, her personality changes as well. She may become more self-centered, as all her energy and focus is on herself and staying thin. In addition, a person with anorexia may: • Exercise compulsively. • Wear baggy clothing to hide extreme thinness, or complain that normal clothing is too tight. • Spend less time with friends and family, becoming more isolated, with- drawn, and secretive. • Develop rituals to keep her mind off her hunger, such as chewing each bite of food 30 times before swallowing. • Get angry if she is not able to exercise or if her daily routine is disturbed. How does anorexia affect the body? When the body is being starved of food, many physical changes occur that can lead to kidney and liver damage,very low blood pressure, and heart failure. Other physical changes that can happen include: • The constant feeling of being cold because the body has lost the fat and muscle it needs to keep warm.This may make the anorexic exercise even more in an attempt to get warm. Eyes become vacant and hollow. • Bones stick out and the skin shrinks around the bones, often making the stomach seem like it is sticking out (leading the anorexic to still think that she is fat or overweight). • Hair on the head falls out, while fine hair appears on other parts of the body for warmth. • Hair and fingernails become brittle and skin becomes dry and rough due to a lack of protein and vitamins in the diet. Eating Disorders Part I Anorexia nervosa  • Menstrual periods stop (or do not start at all if a girl developed anorexia before her first period). This puts the anorexic at higher risk of developing osteoporosis, a disease that causes bones to become brittle and break more easily. • Pain in the abdomen, constipation, and bloating. Stunted growth, resulting in permanent short stature. • Anemia. Who can be affected by anorexia nervosa? Teens who develop anorexia are usually good students, even overachievers. They try to get along with others, tend to be perfectionists, and do not like to admit they need help with anything. To others they appear to be in control. However, they are actually unsure of themselves, are self-critical, and have low self-esteem. They are very concerned about whether other people like them and about pleasing others. Some of these negative feelings may come from having a poor body image (the way a person feels about how his or her body looks). Many young people think that losing weight will make them feel better about how they look. This is why most people who develop anorexia start by dieting. The message they get from our culture, including the media, is that a slim body is attractive and desirable. They may also start dieting in response to some kind of major life change, like puberty or going away to college. Because anorexics have low self-esteem, they do not feel confident that they can handle these changes. They do not feel like they have control. Dieting makes them feel better about themselves and becomes something they are able to do well on their own. Over time,the dieting is really no longer about food, but becomes a way for the anorexic to feel like she has control over her life. Recognize signs of anorexia Recognizing the early signs of anorexia is important for successful treatment. Otherwise, it may be too late. If someone answers yes to any of the following statements, that person should get help right away. • I cannot stop dieting, even though my family and friends warn me that I have lost too much weight. • Even though I have lost a lot of weight, when I look in the mirror I still think that certain parts of my body are fat. • I cannot stop exercising. • I do not get my menstrual period monthly. Treatment for eating disorders The chance of successfully treating someone who has an eating disorder is much higher if the disorder is detected early and the person begins to get help. Treatment depends on many things, including the person’s willingness to cooperate, family and support structure, and the stage of the disorder. Successful treatment of eating disorders involves many health profession- als who work together by treating a certain aspect of the disorder. Treatment begins with a visit to a pediatrician, who will examine the person’s medical condition to see how the eating disorder has affected the body. If the effects are severe, the person may need to be hospitalized for treatment. In treating anorexia, increasing the person’s weight is crucial. If the anorex- ic needs to be hospitalized, her treatment will focus on getting her weight back up to a normal level. If she refuses to eat, she may need a feeding tube to get the proper nutrients into her body. Hospitalization often helps the anorexic slowly change her behavior so that when she returns home, she can gain weight slowly with outpatient pediatric and psychiatric treatment. A person with bulimia may need hospitalization to control the cycles of bingeing and purging and to replace needed nutrients in the body. Counseling is necessary to help a person with an eating disorder under- stand how she uses food as a way of handling problems and feelings. It will help her improve her self-image (including body image) and develop independence so that she can take control of her life in positive ways. A mix of individual therapy and family therapy is usually most effective in treating eating disorders. Since an eating disorder usually affects a person’s entire fam- ily, a therapist can try to help family members understand the disorder. The therapist can also help families create a supportive home environment for the person with an eating disorder. Occasionally, people who have eating disorders also have problems with alcohol abuse or other substance abuse, and may need to be treated for those as well. Anorexia and bulimia are both very serious eating disorders that do not go away by themselves. However, eating disorders are treatable with help. A per- son with an eating disorder needs professional help to recover and become healthy again. For other resources and help with eating disorders, contact the following organizations: National Association of Anorexia Nervosa and Associated Disorders Box 7 Highland Park, IL 60035 847/831-3438 American Anorexia/Bulimia Association 418 E 76th St New York, NY 10021 212/734-1114 Anorexia Nervosa and Related Eating Disorders Box 5102 Eugene, OR 97405 503/344-1144  Some people who struggle with eating disorders alternate between anorexic and bulimic behaviors. About half of all people who have anorex- ia at one time or another develop some symptoms of bulimia (mainly the bingeing and purging). The following information shows some of the ways in which the disorders are alike and different. Similarities of people with eating disorders: • Distorted body image • Strong-willed, determined nature • Obsessive thoughts about food, eating, and body shape • Depression • Excessive exercise • Overachiever, perfectionist • Difficulty concentrating • Poor self-esteem • Self-destructive behavior • Irritability • Vomiting and use of laxatives and/or diuretics to keep weight off Differences between people with eating disorders: Anorexia • Age range: persons 14 to 18 years old • Severe weight loss • Shockingly thin body • Withdrawn personality • Denial of hunger • Sexual inactivity • No menstrual periods • Denial of eating disorder • Strong resistance to treatment • Death from starvation or suicide Bulimia • Age range: persons 15 to 24 years old • Slight weight changes • Normal weight appearance • Outgoing personality • Pronounced hunger • Sexual activity • Irregular menstrual periods • Awareness of eating disorder • Accepting to treatment • Death from low potassium or suicide The American Academy of Pediatrics is an organization of 55,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of infants, children, adolescents, and young adults. American Academy of Pediatrics Division of Publications PO Box 747 Elk Grove Village, IL 60009-0747 Web site — http://www.aap.org Copyright ©1996 American Academy of Pediatrics The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. From your doctor