The teen years can be a time of tremendous change, physically, emotionally, and socially. I remember that those years were some of my favorite as I continued to discover myself and my capabilities. But along with managing those changes often comes peer pressure and angst. It is during this time of great change that tweens and teens may become self-conscious of their bodies. Recently, I sat down with Dr. Mery Taylor, a pediatric psychologist at CHOC Children’s, to discuss what parents need to know about eating disorders.
Eating Disorders in the US
According to the National Association of Anorexia Nervosa and Associated Disorders, 30 million people of all ages and genders suffer from an eating disorder. Eating disorders can have significant effects on our cardiovascular, gastrointestinal, neurological, and endocrine systems. Anorexia Nervosa disorder, specifically, has the highest mortality rate of all mental illness due to consequences of starvation, substance use and suicide.
According to Dr. Taylor, restrictive eating behaviors can begin in children as young as 8 years old. The average age of Anorexia Nervosa onset in the US is between 14 to 17 years old. Approximately 86 percent of people with an eating disorder will experience an onset before age 19. Females are more likely to suffer from an eating disorder. Dr. Taylor notes she is seeing more males with eating disorders, which is in line with new statistics showing that males represent 25 percent of individuals with an eating disorder. That fact is worth noting, particularly because males may restrict weight initially because of a higher body mass index, or BMI. As they begin to drop weight, their BMI may be “appropriate” for the age and height, but the rapid weight loss result in signs of malnourishment.
What is an eating disorder?
According to the guidelines set out by the American Psychiatric Association, an eating disorder is defined as severe disturbances in eating behavior and related thoughts and emotions. Individuals with eating disorders are typically pre-occupied with food and their bodies.
Concerning eating behaviors include may include the following:
- Eating too much food
- Restricting food types (e.g. fats, carbs)
- Eating smaller and smaller meals
- The use of compensatory behaviors such as excessive exercise, purging, or laxatives to achieve weight loss
For children, it is critically important that their clinicians look at the child’s previous weight and height patterns to determine whether the child’s eating
behaviors and resulting weight loss or /gain has affected their typical growth curve.
What are the early signs and symptoms of eating disorders?
As parents enter into the tween and teens years with their kids, it is helpful to understand the early signs and symptoms of eating disorders. Eating disorders in children can become very serious in a short amount of time. Early intervention is key in mitigating the long term physical and psychological effects of eating disorders.
- Rapid weight loss
- Preoccupation with weight and body image
- Secretive behaviors (i.e. not wanting to eat at the dinner table)
- Skipping meals
- Avoiding certain foods
- Increased aversion to foods
- A sudden, radical change in diet
- Excessive exercise
What role do peers/society play in eating disorders?
There is no single known cause of eating disorders. A combination of biology and personality often lead some children to develop a pre-occupation with food and their bodies.
According to Dr. Taylor, certain personality types may be more likely to adopt eating disorder behaviors, including those who are overachievers, or those who are good at setting and accomplishing goals and known for their perseverance. They may also be eager to please, and self-critical. A smaller group of individuals with an eating disorder may tend to be more extroverted, risk-taking, impulsive, and have difficulty maintaining relationships.
As kids navigate adolescence, media and social pressures may play a role in the development of an eating disorder. For example, a teen may receive accolades for their weight loss efforts, which reinforces restrictive eating. Because a child of this age does not have full capabilities when it comes to judgment and decision-making, he/she may not know how much weight loss is too much. Parents can be proactive about displaying acceptance of all shapes and sizes to mitigate the pressure from society and the media.
When Should You Seek Help For A Suspected Eating Disorder?
If you suspect that your child has an eating disorder, a visit to the pediatrician is warranted. He or she will determine if your child is maintaining an appropriate trajectory in their weight and height. If your child has fallen off the growth curve or plateaued instead of growing taller, further evaluation may be necessary to determine whether or not this is a result of eating disorder behaviors.
During the visit, the pediatrician will gather information about a child’s regular food intake, the progression of development, and any changes in their eating behaviors. It may be that a child simply needs increased visits to the pediatrician to monitor the situation. If the pediatrician determines that further consultation is warranted, he/she will likely refer the child to a pediatric/child psychologist who specializes in eating disorders.
As Dr. Taylor mentioned, eating disorders can become very serious, very quickly. A child who sustains a 10-15 pound weight loss can lose up to 20 percent of their total body weight. This can occur over a span of three months to one year and can result in significant medical and psychological consequences. Early intervention is key.
How Do I Talk to My Child About Eating Disorders?
When a parent suspects an eating disorder, it is helpful to begin to identify what normal eating behaviors are for their individual family. Dr. Taylor recommends setting the expectations of mealtime such as sitting down together as a family at the table, avoiding the exclusion of foods such as carbs and fats, and not having secretive behaviors. It is also important for families to adopt the perspective that every size fits. An environment of love and acceptance surrounding height, weight, and size can be helpful when navigating this tricky time in an adolescent’s life. Parents must also understand that it is not appropriate for a child to be on a diet unless it is medically prescribed by a physician.
What Resources are Available in the Community and at CHOC for Children With Eating Disorders?
CHOC Children’s has several outpatient programs dedicated to the treatment of eating disorders. CHOC’s adolescent medicine clinic specializes in eating disorder assessments and medical follow-up. Their team includes adolescent medicine specialists, psychologists/therapists, psychiatrists, and nutritionists. The team provides nutritional and psychological education, monitors progress, and collaborates with other care providers. Speak to your child’s primary care physician about a referral if you believe they need additional treatment.
CHOC Children’s and the community have some other innovative programs specially designed to help children and their families who are struggling with eating disorders. CHOC’s mental health program can help families identify and access the program(s) that best meet their child’s needs.
For additional resources and information on eating disorders, visit CHOC.org.