Eating Disorders Not Always Obvious
Excerpt By Kathleen Doheny, HealthScoutNews

The first hint often comes through the anxious voice of a parent on the phone.

A mother calls to say her daughter's friends are worried that her daughter might have an eating disorder. While they indulge in pizza on sleepovers, her daughter eats only grapes -- and counts each one of them, she says.

For the pediatrician at the other end of the phone, the recitation of parental worry is always followed by the same question: Should they be concerned and pay attention?

Absolutely, says one doctor who gets these phone calls many times.

When eating disorders are involved, "in a big percentage of cases, loved ones' perceptions are right," says Dr. Ellen Rome, head of the section of adolescent medicine at Cleveland Clinic.

The number of cases of eating disorders has doubled since the 1960s, according to the Eating Disorders Coalition, a cooperative of organizations committed to advocacy on a federal level. The most common disorders are anorexia nervosa, in which those who are normal weight or underweight feel they are fat and diet (sometimes to the point of starvation), and bulimia nervosa, in which a person will binge and then purge by vomiting or using laxatives.

About 0.5 percent of teen females in the United States have anorexia nervosa, and 1 percent to 5 percent have bulimia nervosa, according to the American Academy of Pediatrics (AAP). Boys aren't immune, with up to 10 percent of all cases now thought to occur in boys and men, according to the AAP.

The organization is so concerned about the increases that it recently issued a policy statement, urging its members to take a bigger role in identifying eating disorders in the earliest possible stages.

Exactly how prevalent eating disorders are among youth is difficult to assess, says Dr. Martin Fisher, a New York pediatrician who with Rome served as co-author of the AAP's policy statement. Solid statistics and comparisons with past years are difficult to come by, he says. That's partly because many people have not yet sought help and statistics are gathered in different ways and for different age groups.

The eating disorder problem is fueled, say Rome and other experts, by obsession with appearance and thinness, plus in some cases troubled families or parents who diet obsessively.

While pediatricians may be best equipped to diagnose eating disorders, parents and others can help by being aware of warning signs, knowing which kids are more likely to develop a problem and realizing that early treatment can speed recovery.

Some signs, of course, are more obvious than others, says Rome. "A big red flag should be the kid who keeps saying 'I'm fat, I'm fat,' [when she is normal or underweight]."

Other signs -- vomiting in secret, menstrual irregularities -- are not so obvious.

Attraction to certain sports may be another clue. "The visual sports are breeding grounds for eating disorders," Rome says. Among them are gymnastics, ballet, cheerleading and wrestling.

Personality type plays a role, with perfectionists with low self-esteem at higher risk of anorexia, says Dr. Doug Klamp, an internal medicine physician in Scranton, Pa., who specializes in treating eating disorders. Children and teens raised in dysfunctional families and those with poor impulse control are more likely to suffer bulimia, Klamp adds.

Eating disorders can occur at any age, but tend to peak during phases of intense life changes and self-questioning, Rome says. One peak is at 13, she says; another as students head off to college.

If parents suspect an eating disorder, Rome encourages them to set up an appointment and to alert the doctor to their worries first. The pediatrician should obtain height and weight measurements and note developmental milestones, as well as ask a multitude of questions. These should cover eating habits, satisfaction with body appearance, use of laxatives or diet pills, and exercise habits, which are all clues to the conditions.

If an eating disorder is diagnosed, most pediatricians favor a group approach, enlisting the help of a therapist, a registered dietitian and others. How quickly to expect recovery depends on how entrenched the behavior is, Rome says, noting, "It's like a form of addiction. It's not going to change overnight." If an inpatient stay is required, expect recovery to require three to six years, experts say.

Most who recover "pretty much have food issues all their life," Klamp says, although they can live normal, productive lives.

More information

Feb. 23-March 2 has been designated National Eating Disorders Awareness Week.

For more on eating disorders, visit the Eating Disorders Coalition. For information on how parents can prevent eating disorders, visit the National Eating Disorders Association.

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