Recognizing eating and body image disorders
BY LINDA M. KOLLAR, MSN, CPNP
*First published in Fall 2011/Winter 2012
Your teen may be spending a lot of time in front of the mirror lately, most likely trying to adjust to the normal, rapid physical changes of early puberty. Adolescent girls become curvier, with more “fat” on their hips, breasts and upper arms, while boys become leaner after their growth spurt.
In addition to physical growth, teens experience social changes, spending more time with peers, away from their parents. As they move into junior high school, they may be adjusting to a new schedule, new level of sports, new teachers and a new peer group as well.
As parents of young adolescents, we have many concerns about their health and safety. Nutritional risk is one more area for special attention. Dieting is the most common entry point in the development of an eating disorder. Whether an adolescent is overweight or thin, any dieting is risky and should be supervised by a health care provider — ideally a dietitian — due to the unique growth and developmental needs of puberty. Nutritional intake must always continue to meet an adolescent’s energy needs.
As you help your adolescent develop definitions of health, well-being and physical attractiveness, note that she may be at risk for body image issues and unhealthy eating habits.
Adolescents see images and receive messages from the media that associate being thin with beauty and success. Young girls in particular are influenced by what they see on television and in teen magazines. Media messages do not directly cause eating disorders, but they may help place an unrealistic value on body size and shape. Researchers report that women’s magazines have ten and a half times more ads and articles promoting weight loss than men’s magazines. Many covers of women’s magazines include at least one message about changing one’s appearance — with diet, exercise or cosmetic surgery.
Eating Disorders, Defined
Because eating disorders are a potentially life-threatening health problem, diagnosing them requires careful evaluation by a health care provider.
Anorexia nervosa is described as self-starvation with excessive weight loss. Someone with the disorder would experience symptoms that include:
❉ Refusal to maintain normal weight for height, body type, age and activity level.
❉ Intense fear of gaining weight or being fat.
❉ Feeling fat or overweight, even after significant weight loss.
❉ Loss of menstrual periods.
❉ Extreme concern with body weight and body shape.
Bulimia nervosa is characterized by cycles of binge eating followed by purging, usually done secretly. Someone with the disorder will consume large amounts of food quickly, then get rid of it by vomiting, using laxatives or with extreme exercise. Symptoms include:
❉ Repeated episodes of bingeing and purging.
❉ Feeling out of control during a binge, and eating beyond the point of comfortable fullness.
❉ Frequent dieting.
❉ Extreme concern with body weight and body shape.
Disordered eating can include a combination of the signs and symptoms of anorexia nervosa and bulimia nervosa, but do not meet the full criteria for either.
The exact cause of eating disorders is not known. Most health care professionals believe a combination of genetic, biological, psychological, family, environmental and social factors — including the following — contribute to the development of an eating disorder.
❉ A history of dieting is one of the most important predictors of a new eating disorder in teenagers.
❉ Childhood preoccupation with a thin body and social pressure about weight are associated with the development of binge eating disorders in adolescence.
❉ Sports and artistic endeavors in which being lean is emphasized (such as ballet, running or wrestling) and sports in which scoring is based partly on judging (such as skating or gymnastics) are associated with a higher incidence of eating disorders.
❉ Some research studies support the role of genetics. A young woman with a mother or a sister with an eating disorder is up to ten times more likely to develop an eating disorder.
Parents and Prevention
At a time of great societal concern about obesity, it can be tricky to talk with kids about their eating habits. Here are guidelines to help prevent your teen from developing an eating disorder.
❉ Nurture your teen’s self-esteem, and encourage healthy attitudes about nutrition and appearance.
❉ Emphasize health, rather than weight.
❉ Eat as a family, which will steer an adolescent toward developing healthy food habits and eating patterns. Family meals, which ideally would be free of distractions from television and texting, have also been associated with higher self-esteem. Eating together also allows an opportunity to observe any changes in eating behavior.
❉ Be attentive to your own negative messages. When you put yourself and others down for not conforming to an unattainable thin ideal, or jokingly refer to parts of your body you don’t like, the message is that those standards apply to your teen, too. Helping your child feel good about her body begins with your own behavior. You may find yourself competing with your peers and images from the media. If you’re overweight and need to diet, discuss your weight-loss goals in terms of improving your health rather than becoming a certain weight or shape.
❉ Model good exercise habits by incorporating exercise into your daily routine, rather than only when on a weight-loss program. Find activities that you enjoy doing as a family, so that fitness is fun rather than a chore.
❉ Remain attentive if your teen is involved in sports — particularly running, ballet, gymnastics, wresting and others that as mentioned earlier have a higher risk for the development of eating disorders. The first step is finding the right coach and keeping the lines of communication open. Make sure the coach is aware of the dangers of eating disorders and trained to recognize the symptoms of an athlete with such a problem. Increased physical training requirements may affect eating habits. Athletic participation should focus on doing one’s best rather than demanding the number-one ranking.
Know the Warning Signs
Recognizing unhealthy eating patterns and acting early on your teen’s behalf are key to preventing the development of an eating disorder. It can be challenging to distinguish between normal self-image concerns and symptoms of an eating disorder. You should investigate the following behavior, particularly if it represents a change in your child.
❉ Eating alone.
❉ Having very limited food choices.
❉ Ritualized eating habits (insistence on a special plate, eating food in a particular order, etc.).
❉ Excessive food intake.
❉ Extreme concern about health and fi tness.
❉ Frequent weighing.
❉ Excessive exercise.
Sometimes another parent, an astute coach, a teacher or one of your child’s friends can point out risk factors or concerning behaviors. You should take these concerns seriously, talk to your child and speak to your health care provider. Having a wait-and-see attitude can be risky. Ideally, your health care provider will speak to your teen alone to allow her to feel more comfortable discussing weight and body image concerns.
If your teen has been diagnosed with an eating disorder, your health care provider can assist your family in establishing a multidisciplinary care team — specializing in adolescents — which may include the health care provider, a dietitian and a mental health specialist. Treatment focuses on coping with disordered eating behaviors and establishing new patterns of thinking about and approaching food.
It’s very important that the entire family offer support and understanding to a teen who is receiving treatment for an eating disorder.
Linda Kollar, MSN, CPNP, is a PNP with the Surgical Weight Loss for Teens Program at Cincinnati Children’s Hospital Medical Center. She has worked with adolescents and families her entire career.