As children enter the teenage years, additional medical topics become more relevant. Please review these articles that cover situations teens and their parents may encounter.

You know your child best. Please contact our office with any concerns about your teen’s wellbeing, mental, or physical health.

Eating Disorders: Anorexia and Bulimia

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Eating disorders are conditions that occur in people who experience a difficult relationship with food. They may face extreme guilt with eating, a fear of weight gain, and an unrealistic body image. These thoughts can disrupt and take over their daily lives.

Here is information from the American Academy of Pediatrics about 2 eating disorders: anorexia nervosa (commonly known as anorexia) and bulimia nervosa (commonly known as bulimia). Some people show signs and symptoms of both eating disorders.

What is anorexia?

Anorexia is an eating disorder that results in unhealthy weight loss. People with anorexia may have a distorted body image, and they restrict their calories and/or purge to reach unrealistic weight goals. Calorie restriction often involves increasingly narrow food choices, smaller portion sizes, and skipped meals. Guilt about eating can lead to purging through exercise, vomiting, or medications such as laxatives. Malnutrition can develop, with potential harm to typical growth and development.

Who can develop anorexia?

Although anorexia is more common in females, anyone can develop anorexia. People from all genders, races, ethnicities, ages, and social and economic backgrounds can develop anorexia.

People who develop anorexia frequently start with a reasonable goal of wanting to live a healthier lifestyle. However, at some point, obsessive thoughts about dieting, exercising, and losing weight take over. These lead to unhealthy behaviors and excessive weight loss. The eating disorder may cause the child to become secretive about their eating and restriction. The development of an eating disorder can be subtle and often goes unrecognized by doctors and parents.

What types of behaviors may be signs of anorexia?

People with anorexia control their weight. They may

Eat only a small number of “safe” foods, usually low in calories and fat
Avoid eating food on their plate by moving it around or cutting it up into tiny pieces
Not eat food they cook for others
Do things to keep their mind off their hunger, such as chewing gum or drinking large amounts of water
Exercise in excess

They may also

Wear baggy clothes to hide their body
Spend more time alone and away from friends and family
Tire more quickly
Seem depressed or anxious
Be more emotional, or quick to cry or get angry

How does anorexia affect the body?

Over time, anorexia can affect the entire body because of malnutrition. Most noticeably, it affects the heart, brain, bones, and digestive and reproductive systems.

When the body is starved of food, physical and mental changes may happen.

Physical Changes

Always feeling cold because the body has lost the fat it needs to keep warm.
Dizziness, fainting, or near fainting.
More noticeable bones because of a loss of normal fat layers and muscle.
Hair loss.
Brittle hair and fingernails.
Dry and rough skin.
Affected menstrual periods. If anorexia develops before a girl’s first period, periods may not start. For girls developing anorexia later, periods may stop.
Stomach pain, constipation, and bloating.
Stunted growth that could be permanent.
Anemia (low count of red blood cells) causing tiredness, weakness, and dizziness.

Mental Changes

Feeling depressed, anxious, or irritable
Decreased concentration
Increased difficulty completing tasks, such as schoolwork

Anorexia results in the highest rate of death among people with mental illness. Death can be by suicide or can be caused by malnutrition (the body is not getting enough nutrients).

What is bulimia?

Bulimia is an eating disorder in which a person eats large amounts of food (binges) and then tries to undo the effects of the binge in some way. Usually, the person rids (purges) the food that was eaten.

What is bingeing and purging?

During a binge, people with bulimia eat large amounts of food, often in a fairly short time. Binges usually end when there is no more food to eat, the person’s stomach hurts from eating, or a distraction interrupts the binge. Binges are usually emotionally distressing because the person often feels as if they can’t stop and have lost control.

After bingeing, people with bulimia typically feel guilty and are afraid of gaining weight. To ease their guilt and fear, they purge the food from their body by vomiting or other means. They may also turn to extreme exercise or strict dieting. This period of “control” lasts until the next binge. Then the cycle starts again.

Note: People with binge-eating disorder eat large amounts of food in a short time and feel intense guilt afterward, but unlike people with bulimia, they don’t purge following a binge.

Who can develop bulimia?

Although most people with bulimia are teenaged girls and young adult women, anyone can develop bulimia. People from all genders, races, ethnicities, ages, and social and economic backgrounds can develop bulimia.

People with bulimia aren’t happy with their body. Then, in response to anxiety and other emotions, they give in to their impulses and cravings for food by bingeing. People with bulimia may have underweight (slightly), overweight, or average weight.

What types of behavior are signs of bulimia?

People with bulimia have difficultly controlling their eating behavior. They may

Become very secretive about binge eating.
Spend a lot of time thinking about and planning the next binge. For example, they may
Set aside certain times to binge and purge
- Avoid social activities to binge and purge
- Steal food or hide it in different places, such as under their bed or in closets
- Exercise or use laxatives to “purge” their body of food consumed

People with bulimia often face other problems as well, such as

Depression and thoughts of suicide
Substance use

How does bulimia affect the body?

Bulimia harms a person’s physical and mental health. For example,

Teeth start to decay from contact with stomach acids during vomiting.
Weight goes up and down.
Menstrual periods may become irregular or stop.
The face and throat may look puffy and swollen.
Dizziness and fainting may occur.
Dehydration caused by loss of body fluids occurs.
Upset stomach, constipation, and sore throat.
Damage to vital organs such as the liver and kidneys; heart problems.
Death.

What causes eating disorders?

There is no known cause for eating disorders. However, there are factors that may play a role. These include a family history of mood disorder or eating disorder, environmental factors, and certain personality traits.

How are eating disorders treated?

The earlier an eating disorder is recognized, the higher the chance of recovery. Treatment depends on many things. These include the person’s willingness to make changes, family support, and the stage of the eating disorder.

Successful treatment of eating disorders involves a team approach. The team includes many health care professionals working together. Each one treats a certain aspect of the disorder. Treatment should begin with a visit to a pediatrician who will assess how the eating disorder has affected the body. If the effects are severe, the person may need to be hospitalized. Treatment of the eating disorder will not be successful if good nutrition and physical health are not restored first.

Medical Treatment

In treating anorexia, the team helps a person get back to a healthy body weight. This return to weight is crucial for successful recovery. If a person refuses to eat, they may need to be admitted to a hospital for nutrition.

In treating bulimia, the team may admit a person to a hospital to treat medical complications, such as dehydration or electrolyte imbalance, or to stop the cycle of bingeing and purging.

Counseling and Family Therapy

Living with an eating disorder is difficult on children, teens, and their families. Both emotional and physical health are affected. Without help, a person with an eating disorder can have serious health problems and even die. However, with treatment, a person can get well and go on to lead a healthy life.

Counseling is an important part of treatment and helps a person with an eating disorder

Manage their unhealthy thoughts
Understand how they use food as a way to deal with problems and feelings
Improve their self-image and develop the confidence to take control of their life

Family therapy helps family members understand the problem and guides families to use effective approaches for recovery.

Nutrition counseling with a registered dietitian can help patients and families return to healthy eating habits.

Early Treatment Is Important

The earlier an eating disorder is recognized, the better the chance of recovery.

If you are a parent who has noticed that your child’s eating patterns have changed, talk with your child’s doctor. Do not wait for your child to agree that they have a problem. Teens with eating disorders often do not recognize this change for themselves.
If you are a teen and need help, it’s important that you talk with your parent or your doctor as soon as possible.

Resources

American Academy of Pediatrics www.aap.org and www.HealthyChildren.org

National Association of Anorexia Nervosa and Associated Disorders www.anad.org

National Eating Disorders Association www.nationaleatingdisorders.org

Any websites, brand names, products, or manufacturers are mentioned for informational and identification purposes only and do not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication. The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.