We may not think of them as life-threatening illnesses, but eating disorders are just that. Millions of people are affected by eating disorders, and they can cause permanent health problems—even death. That’s why recognizing the signs and symptoms early can save lives.
Anorexia, a condition in which the individual loses a dangerous amount of weight through caloric restriction and excessive exercise, is the most common eating disorder afflicting teens, and it affects many more girls than boys. However, even anorexia may not be obvious, especially early on.
“What frequently happens is that teenagers start off by eating in a more healthy fashion,” says Dr. Dianne Elfenbein, a SLUCare pediatrician and director of adolescent medicine at SSM Cardinal Glennon Children’s Medical Center. “For example, they’ll start to cut out fat or junk foods, and we usually think that’s a good thing.”
Over time, though, Elfenbein says the individual becomes increasingly restrictive in what and how much she eats. “Parents will notice that the child is not eating with them or is skipping meals. The child eats less and less and less until finally, she’s not eating regular meals. By that time, the parents are noticing the distinctive weight loss.”
Jessica Germanese, a registered dietitian with McCallum Place Eating Disorders Treatment Programs, agrees that weight loss is not the first sign of anorexia. “People have eating disordered thoughts before they lose a lot of weight,” she says. Germanese advises parents to be aware of their adolescents’ conversation about food and body image. Concerns should be discussed early “because the sooner an eating disorder is identified, and the sooner a child gets help, the greater the chance of full recovery.”
Elfenbein recommends that concerned parents should talk to the child’s primary-care physician as a first step. “Every child who is followed by a pediatrician or family physician has a growth chart,” she notes. “The doctor can look at the chart and if growth is starting to dip down, they’re quite vigilant in referring patients on for therapy. Physicians are aware of the dangers of eating disorders in young patients.”
Recovery often is a team process. Therapy with a trained psychologist, education on diet and menu planning with a licensed dietitian, and medical monitoring are three prongs of successful recovery. Parents are involved in the entire process in order to help the child regain a healthy relationship with food and a more realistic body image.
Another treatment approach, known as the ‘Maudsley approach’ or ‘family-based treatment,’ is an intensive outpatient treatment in which parents take responsibility for decisions of what, when and how much the child eats. After weight restoration is almost achieved, control is carefully given back to the patient. Finally, the therapist and family work to restore normal and age-appropriate lifestyle and relations between family members.
“In dealing with teenagers, many of the parents feel very guilty because the old theory was that an eating disorder was the result of poor parenting,” Elfenbein says. “It used to be said it was due to an overbearing, domineering mother who took over setting goals for the child, and that’s usually not the case. It’s common that we see parents who think they did something wrong when really they didn’t. Most parents recognize this is a serious condition.”
Working together, the prognosis for eating disorder recovery is good. Germanese notes that patients must relearn their beliefs about food and weight and realize that all foods can be part of a healthy diet. Even sweets are OK when eaten only occasionally and in reasonable portions. In fact, she encourages patients to try a small amount of dessert as part of their overall eating plan. “At first, they may be very uncomfortable with that, but after a while, they’ll see that it’s OK,” she says.