Today, I wanted to switch gears from our New Year’s posts and talk about a critical topic: Eating disorders in kids.
Weeks ago, the American Academy of Pediatrics released a report with the following findings:
- From 1999 to 2006, hospitalizations for eating disorders increased most sharply – 119 percent – for children younger than 12 years.
- Approximately 0.5 percent of adolescent girls in the United States have anorexia.
- Approximately 1 to 2 percent meet diagnostic criteria for bulimia.
- Up to 5 to 10 percent of all cases of eating disorders occur in males.
(You can download the report here.)
To get some insight on these findings and EDs in kids, I spoke with Ovidio Bermudez, M.D., medical director of the Eating Recovery Center’s Behavioral Hospital for Children and Adolescents.
A True Increase Or Better Recognition?
At first, I wondered if our improved ability to recognize eating disorders explained these results. But, according to Dr. Bermudez, our environment provides the perfect trigger for eating disorders.
Remember that eating disorders are a complex combination of factors. Genetics is a big component. Like many experts have said, genetics loads the gun, and environment pulls the trigger.
For kids predisposed to eating disorders, the environment acts like the last straw that broke the camel’s back.
Environmental triggers include the culture of thinness and stress in general. As Dr. Bermudez said, people are reporting high levels of stress and this impacts children. Anxiety disorders in kids are also on the rise, he said.
Hysteria over the obesity epidemic can also make kids more vulnerable.
“Fundamentally the message should be eat well and live healthy. It’s not lose weight, diet and eat less, but that’s how we end up saying it. The message to a person with morbid obesity and with anorexia should be the same. It’s not put on weight and lose weight. The message should be that you have to take care of your health; be strong so you can be healthy,” he said.
According to the author of the report, David Rosen, M.D., on HealthDay:
“There are lots of kids in my practice who say their eating disorder started when their family doctor told them, ‘You could stand to lose a few pounds,'” Rosen said. “As physicians, we need to make sure our conversations are not inadvertently hurtful or impact their self esteem.”
Eating Disorders Different In Kids
Eating disorders seem to manifest differently in kids.
Bulimia is seen less frequently. Kids seem to suffer more often with symptoms of anorexia.
There’s also a lot of overlap with EDNOS (“eating disorder not otherwise specified,” a term in the DSM-IV; people are diagnosed with EDNOS when they don’t meet criteria for bulimia or anorexia but clearly have an eating disorder), Dr. Bermudez said.
In kids, these seem to be common symptoms: selective eating, extreme pickiness and eating-related phobias of choking, swallowing or vomiting.
The biggest warning sign is change, Dr. Bermudez said.
For instance, your child may be well-adjusted, growing emotionally and physically healthy. Then, you notice that they’re becoming preoccupied and dissatisfied with themselves and their words turn to size and weight.
Dr. Bermudez said that maybe your child talks about wanting to look different or be different from who they are.
“It’s OK that kids struggle with changing grades, new groups of friends and changing teachers. This should be followed by positive adjustment,” he said. However, if it’s followed by negative adjustment, talk to your child. See what’s really going on.
According to HealthDay:
Parents and pediatricians should look for signs of eating disorders, including a child whose progress on growth charts suddenly changes, very restrictive eating, compulsive overexercising, making concerning statements about body image, vomiting, disappearing after meals or use of laxatives and diet pills.
If you’re a parent, you may have no clue how to help or what to do. So I asked Dr. Bermudez about how parents can prevent eating disorder behaviors (remember that you can’t prevent EDs entirely; biology and genetics play a prominent role in vulnerability).
He distinguished between primary and secondary prevention:
Primary prevention. Before there’s ever a problem, examine your own attitudes and beliefs about food, weight, size and the thin ideal. Be a good role model from birth.
Also, “be sensitive to the context in which we live.” For instance, decades ago, it might’ve been OK to call your child chubby as a term of endearment. Today, it’s detrimental.
So be sensitive to what kids are exposed to, like bullying. If your child comes home and says, “Everyone is saying I’m the chubbiest in the class,” don’t dimiss that by saying “No you’re not.” Sit down and listen to them.
Secondary prevention. If you know your child is struggling, recognize that “dieting and exercise, especially during puberty, are not benign behaviors,” Dr. Bermudez said. For someone who’s genetically vulnerable to an ED, dieting is a risk factor.
The problem is that many parents don’t realize the dangers of these behaviors, because we live in a diet-obsessed culture.
Like Dr. Bermudez said, if your child came home saying they’re going to smoke, you’d adamantly forbid this behavior.
If they came home, and said they’re cutting out fat and want to join the gym, you’d probably praise them.
He also added that “if you’ve got a perfectionistic, high-achieving, harm-avoidant child who’s body conscious, ballet wouldn’t be the best” activity for them. If you have a boy, avoid sports where you have to make weight, like wrestling.
If your child is struggling with disordered eating or an eating disorder, don’t blame yourself or focus on what you might’ve done wrong. Instead, focus on creating a solution and helping your child, Dr. Bermudez emphasized. Educate yourself about eating disorders.
And see a professional for a comprehensive assessment. “Early recognition and timely intervention are among our best tools,” he said. “Not every child with an eating disorder needs to be hospitalized but they do need care and they need expert assessment and expert treatment.”
Thanks so much to Dr. Bermudez for taking the time to speak with me!
What do you think about the increase in eating disorders in kids? If you’re a parent, what would you like to know about eating disorders in children?