Eating Disorders: When food becomes the enemy
The signs may be subtle and many parents may miss them at first: Your teen is losing weight. She is suddenly self-conscious about the sizes of clothing she tries on. She heads for the bathroom before helping clean up the dinner dishes. Or maybe he’s become stringent about putting into practice nutrition advice learned in health class and is suddenly spending more time at the gym than usual.
Despite the subtle—or not so subtle—signs, local health professionals say eating disorders can take over in some teens if parents are not tuned in to their child’s life, causing damage that can only be mended with the help of professionals.
R.L. Levine, head of the division of adolescent medicine and eating disorders at Penn State Hershey Medical Center, said eating disorders manifest in many ways. “Eating disorders in their broadest sense are conditions where children, teenagers, and adults have significant problems with nutrition in all senses. There are many different ways they can come to that but they always have a problem with their nutritional intake,” Levine said.
Patients with an eating disorder can be diagnosed with anorexia nervosa (losing more weight than is healthy for age and height) or bulimia nervosa (characterized by eating large amounts of food then using means to prevent weight gain). Patients who don’t meet the criteria for anorexia or bulimia are diagnosed with generalized eating disorder, Levine said. All eating disorders should be regarded by parents as serious mental health illnesses that can have life threatening consequences.
How does this happen?
While the diagnosis may be relatively simple to determine through routine testing, the answer of how this can happen to teens isn’t always as easy. “The cause is a whole bunch of different factors. It’s not simple. Part of it is our culture and the emphasis on thinness. Another important part is the psychological pressures. It can be family issues,” Levine said. “Chemical imbalances in the system are one of the triggers for eating disorders and they do tend to run in families.”
Dr. Michael Pertschuk, medical director of the Brandywine Hospital eating disorders program, said when it comes to teenagers, “There are often issues with separation, boundaries—kids in some cases really struggling to find their independence or being frightened of becoming independent. Families in some cases haven’t provided a lot of emotional support or in other cases kids are attached to the hip and not allowed to move. There are various configurations to this.”
Many kids do not have a healthy relationship with food said Susan Lane-Loney, psychologist and program director for the child partial hospitalization program for eating disorders at Penn State Hershey Medical Center. “Some of the nutrition classes at school are focusing a lot on healthy eating and a lot of the kids who are coming into the clinic are really trying to eat healthy but neglecting certain food groups. They misinterpret what they are teaching in the classes … they lose sight of balance and nutrition,” she said. Lane-Loney said these teens need to seek professional help to have a healthy relationship with food before malnutrition and starvation kick in.
Don’t look the other way
The first line of defense against an eating disorder in teens should start at home, but sometimes it’s left up to those outside the family to take the first step of recognition. “Parents sometimes don’t pick up on the problem until it’s fairly extreme. Families have a hard time admitting there’s a problem,” Pertschuk said.
Cora Collette Breuner, member of the adolescence committee for the American Academy of Pediatrics and professor of pediatrics and adolescent medicine at Seattle Children’s Hospital, said parents need to work with their child’s pediatrician or family doctor to monitor their child’s health when it comes to identifying eating disorders early and it starts with education. “Pediatricians and healthcare providers are in an excellent position to teach about proper eating, sleeping and exercise from birth to 21 and can hopefully prevent an eating disorder from occurring. They can teach families about warning signs and when it is not okay to diet or exercise too much,” she said.
Pertschuk recommends that parents who might have concerns seek help from their pediatrician or possibly a nutritionist or psychologist to determine if their teen has a problem. He cautions parents to find help from people who have experience with eating disorders and tells parents not to be afraid to ask many questions. “Just be sure there are people around you who do know something about eating disorders,” he said. “Don’t ignore it. If it needs to be investigated, get an assessment done.”
No matter where you seek help, professionals say that having a team approach to treating your teen is essential. Patients should seek treatment from healthcare professionals including a psychologist, nutritionist, and physician. “Some people build their own treatment team,” said Dolores Becker, registered dietitian and nutritionist at the eating disorders program at Penn State Hershey Medical Center. “The bottom line is that these different disciplines need to act together whether they are centered in one program here or pieced together in the community. The different team members are needed to have that comprehensive coverage.”
Many parents look for help from established programs such as the eating disorders program at Penn State Hershey or Brandywine Hospital eating disorder program. Each program offers customized care unique to the teen with a group of specialists trained and equipped to treat eating disorders. “If people are not sure what to do, (Penn State Hershey) has satellite clinics. They can get an evaluation for a disorder by a satellite clinic in their area and then the doctor can really direct them to where they need,” Lane-Loney said.
No matter what your choice of treatment, doctors say the sooner you seek treatment, the better. “For the young people, the vast majority will recover. It does not have to be a lifelong illness, especially for teens,” Levine said. “It doesn’t get better by itself … it’s not going to go away. Parents shouldn’t ignore it. They shouldn’t try by themselves to fix it.”
“Don’t wait until the kid has collapsed. Get to the primary care (doctor) and tell them what your concerns are,” Pertschuk said. “(Parents) really need to do something about it and not just wait and hope it goes away.”
Marina Shannon is a freelance writer and married mom of two energetic boys in Waynesboro.
The signs and symptoms of an eating disorder can sometimes be tough to pick up on and vary from person to person. If you notice any of the following symptoms in your teen, experts say seek help immediately from a professional.
- Weight loss
- Fatigue and weakness—teen not looking as well as normal
- Excessive exercise
- Unusual coldness
- Loss of menstrual period
- Teen brushes off comments about weight loss
- Comments from counselors, teachers, friends, school nurse, about the teen’s eating habits or weight loss
- Won’t go out to eat or social events with food
- Change in behavior
- Stopped eating meals
- Disappearing after meals—leaving to go to the bathroom repeatedly after eating
- Vomit noted in bathroom or other areas
- Use of laxatives
- Excessive exercise
- Disappearing more than usual
- Change in habits—For example, if your teen always takes showers in the morning and now is taking showers after meals (might be to hide the sound of vomiting)
- Wears baggy clothing or sweats often if they don’t normally dress that way
Anorexia or Bulimia:
- Self-conscious about clothing sizes
- Frequently asking things like, “Am I fat?” or “Do you think I have gained too much weight?”
- Preoccupation with body size
Sources: Dr. R.L. Levine, head of the division of adolescent medicine and eating disorders at Penn State Hershey Medical Center and Dr. Michael Pertschuk, medical director of the Brandywine Hospital eating disorders program