Be alert to signs of a serious eating disorder

Parents face many food-related battles as their children grow up, from the toddler who eats vegetables only when they are cut into shapes, to the adolescent who prefers chips and video games to the family dinner table.

Most of these battles are temporary and harmless. However, at times, parents may need to turn to medical professionals for help when a clinical eating disorder is suspected, even if the child is not underweight or overweight. When left untreated, anorexia, bulimia and other eating disorders can lead to life-threatening physical and psychological consequences.

TYPES OF EATING DISORDERS

Most eating disorders fall into four main categories and are not always as easily identifiable as one might believe:  

■ Anorexia

Individuals with anorexia view themselves as overweight, even when they are dangerously underweight. They often use extreme methods to lose weight, such as severely limiting calories, exercising excessively, vomiting after eating or using laxatives. 

■ Bulimia

Individuals who are bulimic might appear to be normal weight or even overweight. However, bulimia involves eating large amounts of food in a short time and then trying to purge the excess calories by vomiting, excessive exercise or using laxatives.  

■ Binge-eating disorder 

Individuals who binge-eat might be normal weight, overweight or obese. Binge-eating is similar to bulimia in that it involves eating large amounts of food, even after the person is full. However, binges are not followed by purges.

■ Avoidant/restrictive food intake disorder

Individuals living with avoidant/restrictive food intake disorder often fear eating. Eating food in general or foods with specific tastes, smells, etc., is often avoided. Typically, this fear is caused by a previous incident of choking or an allergic reaction.

SIGNS AND SYMPTOMS

Although eating disorders can occur at any age, they are much more common during the teens and early 20s, especially among females. It’s important for parents to understand the signs of eating disorders so they can take action before health changes become dangerous.

Signs and symptoms can vary depending on the eating disorder involved, but might include:

■ Constantly feeling cold due to loss of body fat

■ Hair falling out

■ Disruption of the menstrual cycle

■ Decreased energy

■ Increased exercise

■ Sudden dietary changes, such as becoming vegan

■ Unusual behavior at the family dinner table, such as cutting food into very small bites, hiding food under a napkin or eating very slowly

■ Food missing from the pantry

■ Leaving the table immediately after eating

■ Tooth decay, due to repeated vomiting

■ Knuckle abrasions from inducing vomiting

■ Withdrawing from friends and activities

■ Things being out of place in the bathroom, such as a toothbrush taken into the shower to induce vomiting

Parents who are concerned that their child could have an eating disorder should alert the child’s primary care provider before an office visit, so the doctor is ready with appropriate questions and exams. This is important, because a child or teenager with an eating disorder typically tries to hide the problem behavior from everyone, including medical professionals.

PROGRESSING THROUGH TREATMENT

Once an eating disorder is diagnosed, the doctor can treat and monitor the physical ramifications of the disorder, which could include constipation, electrolyte imbalance, heart arrhythmia, acid reflux and decreased bone density. In most cases, the pediatrician also refers the family to other providers, such as a counselor, dietician or psychotherapist.

Most patients can be treated on an outpatient basis, using a team approach. Another option is intensive outpatient therapy, which might involve several evenings each week with meals and individual or group therapy. Physicians usually turn to inpatient treatment only when a patient’s health is at immediate risk, such as when weight has fallen dangerously low.

Parents and children alike should remember that the road to recovery can be long and often has bumps along the way. The earlier the diagnosis, though, the better the chance of recovery, especially among adolescents.

For more information about eating disorders, visit the National Association of Eating Disorders website at www.nationaleatingdisorders.org.

Dr. Jennifer Seidenberg is a pediatrician specializing in eating disorders with Penn State Medical Group, located at 476 Rolling Ridge Drive, Suite 101, State College.