Eating Disorders Not So Obvious in Real Kids. (Catch Signs before It's Too Late)

By Bates, Betsy | Clinical Psychiatry News, April 2003 | Go to article overview

Eating Disorders Not So Obvious in Real Kids. (Catch Signs before It's Too Late)


Bates, Betsy, Clinical Psychiatry News


Just flip through any teen magazine, tune into prime-time television, or drive by a fashion billboard in any U.S. city to see how society bombards children and teenagers with images of thinness, Dr. Michael S. Jellinek says.

Physicians' voices on weight and health are contradicted by pervasive social images of extraordinarily gaunt and pale girls and women, and, to a lesser extent, young men, says Dr. Jellinek, chief of child psychiatry at Massachusetts General Hospital and professor of psychiatry and pediatrics at Harvard Medical School, Boston.

Unfortunately, the warning signs of anorexia or bulimia in real kids are often not quite as obvious as the not-so-subtle messages conveyed by mainstream advertising.

Eating disorders run the gamut from mild to severe. A fairly normal teenage track star, for example, might become too focused on losing weight under the stress of making the transition to college but might be able to recalibrate her eating and exercise habits through her own awareness or when the pressure eases off, Dr. Jellinek says.

Another girl may become locked into a pattern of calorie counting and excessive exercise, compelled by a distorted sense that she is fat.

Still a third might be so committed to body distortion that she abuses diuretics and laxatives, vomits repeatedly, and suffers from such extreme metabolic imbalances that she requires hospitalization to save her life. In extreme cases, elements of psychosis might be involved in the teenager's distortions of self-image and relationships.

The problem is widespread, Dr. Jellinek says. Studies have found that between 7.5% and 11% of adolescent girls and 2%-4.5% of adolescent boys used diet aids or laxatives or induced vomiting for weight control in a given year. Thirty-seven percent of elementary school children have tried to lose weight.

The American Psychiatric Association estimates that 5% of people with anorexia nervosa die from the disorder, half of them by committing suicide.

Physicians might have an opportunity to catch what's happening before it's too late, Dr. Jellinek says. It makes sense to pay attention to the height and weight charts tracking the growth of patients. If an older child or teenager is substantially thinner than she is tall, or if he's falling off the curve, that information could be used as an opportunity to talk about self-image. …

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