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Eating Disorders and Adolescents

Eating Disorders and Adolescents
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We’ve been talking a lot in the blogosphere about body image and eating disorders recently (see Introduction to Eating Disorders). The bounty of comments here and elsewhere confirmed my suspicion that none of us is immune from horrible, soul-sucking, negative body image issues. Many of the women who commented have or have had true, full-blown eating disorders.

I’ve been thinking a lot, however, about conflating negative body image — and some really bad eating habits — with full-blown, clinically diagnosed eating disorders.

This past week, a friend of mine returned – again – to a residential program for an eating disorder she’s had since she was 13 years old. I cannot begin to explain how heartbreaking it is to watch someone cycle through the ups and downs of an eating disorder. As much as my brain slays my body every day (I’m working on it!), it truly pales in comparison to what my friend has gone through for more than half her young life.

In an effort to avoid doing a disservice to those who truly need clinical intervention, today I’m writing strictly about eating disorders.

How Common Are Eating Disorders?

The negativity with which we view our bodies seems ubiquitous. There is, however, a big difference between having a negative body image and developing an eating disorder, which is a mental illness with complex roots. The National Eating Disorders Association (NEDA) says in its Parent Toolkit:

“Eating disorders are usuallyrelated to emotional issues such as control and low self-esteemand often exist as part of a dual diagnosis of major depression, anxiety, or obsessive-compulsive disorder….

While sociocultural factors (such as the ‘thin ideal’) can contribute or trigger development of eating disorders, research has shown that thecauses are multifactorial and include biologic, social, and environmental contributors*….*

Eating disorders such as anorexia nervosa have been documented in the medical literature since the 1800s*, when social concepts of an ideal body shape for women and men differed significantly from today—long before mass media promoted thin body images for women or lean muscular body images for men.”* (emphasis is mine)

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The statistics on eating disorders for adolescents are disheartening. According to the National Institute of Mental Health (NIMH), the lifetime prevalence for any eating disorder in the U.S. for adolescents (aged 13-18) is 3.8% for girls and 1.5% for boys. (Lifetime prevalence means, simply, the percentage of people in a given population who have had the disorder up until that point.)

NEDA’s Parent Toolkit includes the following information:

Among U.S. females in their teens and 20s, the prevalence of clinical and subclinical anorexia may be as high as 15%.Anorexia nervosa ranks as the 3rd most common chronic illness among adolescent U.S. females. Recent studies suggest that up to 7% of U.S. females have had bulimia at some time in their lives. At any given time an estimated 5% of the U.S. population has undiagnosed bulimia. Current findings suggest that binge-eating disorder affects 0.7% to 4% of the general population.” (emphasis is mine)

This is not a joke or a nuisance. It’s a disease.

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Eating Disorders Are Gender Blind

The other day I was waiting for a friend for lunch in Williamsburg, Brooklyn’s hipster central. There were two young men — obviously dressed to impress one another with their physiques – seated beside me discussing their weight and musculature.

“I’m working to get down to my ideal weight. The lowest I’ve been is 159. That was last summer,” one said.

I glanced over at him. He looked pretty thin to me already and kind of tall for 159 to be a healthy weight.

“You look good now,” the other replied. “You must have been, like, a stick.”

“I just want to be healthy.” (Really?)

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As this anecdote highlights, men are not immune to societal pressure about their bodies. Nor are they immune to the real possibility of preoccupation with weight and appearance turning into a full-fledged illness.

In fact, NEDA claims that 10 million men in the U.S. will develop an eating disorder at some point in their life. And a November 2012 article in Pediatrics entitled “Muscle-enhancing Behaviors Among Adolescent Girls and Boys” concluded:

“Muscle-enhancing behaviors were common in this sample for both boys and girls. For example, 34.7% used protein powders or shakes and 5.9% reported steroid use.Most behaviors were significantly more common among boys*.”* (emphasis is mine)

Symptoms of an Eating Disorder

As a parent, how do you know if your adolescent is just being difficult or if there really is a problem? The Mayo Clinic has a succinct page on symptoms of the three main eating disorders, Anorexia Nervosa (self-starvation), Bulimia Nervosa (purging food) and Binge Eating Disorder (overeating without compensating by purging or starvation).

The Mayo Clinic cautions parents not to assume every whim or phase is an eating disorder. They list some “red flags” that may indicate an eating disorder, including:

  • Skipping meals
  • Making excuses for not eating
  • Eating only a few certain “safe” foods, usually those low in fat and calories
  • Adopting rigid meal or eating rituals, such as cutting food into tiny pieces or spitting food out after chewing
  • Cooking elaborate meals for others, but refusing to eat them themselves
  • Collecting recipes
  • Withdrawing from normal social activities
  • Persistent worry or complaining about being fat
  • A distorted body image, such as complaining about being fat despite being underweight
  • Not wanting to eat in public
  • Frequent checking in the mirror for perceived flaws
  • Wearing baggy or layered clothing
  • Repeatedly eating large amounts of sweet or high-fat foods
  • Use of syrup of ipecac, laxatives, the over-the-counter weight-loss drug orlistat (Alli), or over-the-counter drugs that can cause fluid loss, such as menstrual symptom relief medications
  • Use of dietary supplements or herbal products for weight loss
  • Food hoarding
  • Leaving during meals to use the toilet
  • Eating in secret

And if you think you might have an issue yourself, try these two brief quizzes from the Renfrew Center. And see a doctor. Really.


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