Pediatric eating disorders

Dissatisfaction with body shape is common among teens and preteens. In fact, studies show that 50% to 70% of normal-weight girls consider themselves to be overweight.  The pressure to be thin can reinforce the desire to lose weight — resulting in out-of-control dieting among young people. These disorders may occur from preteen age to adulthood and can affect females and males of any ethnicity and socioeconomic status. Although dieting of any sort carries risks, eating disorders can lead to serious health problems. But how can parents tell the difference between normal dieting and the type of behaviors that indicates an eating disorder?

What is an eating disorder?

An eating disorder is an emotional and physical problem that is associated with an obsession with body weight or body shape. Two types of eating disorders are anorexia nervosa  and bulimia nervosa.

• Anorexia nervosa:  People suffering from this disorder severely limit their food intake. A person with anorexia refuses to maintain weight at, or above, a minimally normal weight for age — meaning the person’s weight is more than 15% below normal. Children with anorexia may fail to gain weight during a period of normal growth. In addition, people with anorexia have intense fear of becoming fat even though underweight and may have a distorted view of their body shape. If the individual is female, she may have missed at least three menstrual cycles.
• Bulimia nervosa:  Individuals with bulimia follow a routine of binge eating — ingesting an abnormally large amount of food within a set period of time — followed by inappropriate behaviors to prevent weight gain, such as excessive exercise, self-induced vomiting and/or misuse of laxatives. People with bulimia engage in these types of behaviors at least twice a week for a period of three months. While bulimia often occurs independently of anorexia, half of all anorexics develop bulimia.

It is important to note that some children do not meet the exact diagnostic criteria for anorexia or bulimia but still have some of the symptoms. For example, a child may experience weight loss without body distortion or without the preoccupation with weight that is typical in anorexia. Teens and preteens who occasionally binge and purge but who do not do it often enough to meet the criteria for bulimia also fit in this category. Although these children may appear to be less ill, they are still at risk for the same long-term complications as those who meet the full criteria for anorexia and bulimia.

How common are eating disorders and why do they occur?

According to the National Eating Disorders Association, approximately 10 million girls and women and 1 million boys and men in the United States struggle with eating disorders. Studies indicate that as many as 1 in 100 females between the ages of 12 and 18 have anorexia. Bulimia afflicts approximately 1 to 3 percent of adolescents in the U.S.

Recent studies in the US, the UK, and Canada confirm that dieting behavior and dissatisfaction with body shape is common. In Canada, increasing numbers of girls see themselves as overweight as age increases. By 18 years of age, more than 50 percent see themselves as too fat even though 80 percent of them are of normal weight. A recent US study found that nearly half of underweight girls wished to lose weight and that 80 percent of this underweight sample were unhappy with their weight.

Unfortunately, the onset of eating disorders seems to be occurring in younger age groups. During recent interviews with 6- to 12-year-old girls about dieting, weight, and body-shape, researchers found that 60 percent believed they were overweight, and 35 percent reported being on at least one diet. Another study found that 81 percent of 10-year-olds are afraid of being fat. It is unclear what causes eating disorders, but experts have identified certain factors that may increase an individual’s risk of developing an eating disorder, such as having a close relative with an eating disorder. Multiple studies have shown that female athletes in sports that emphasize a thin body or appearance are more at risk for eating disorders than participants in other sports. Female gymnasts, figure skaters, distance runners, and swimmers are particularly vulnerable. Among boys, wrestlers are at greater risk.