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What parents need to know about eating disorders

3/16/2020 by Cassandra Narr, APRN, CNP, MS

ECH_Eating_Disorder

You've seen your daughter start to cut snacks to "be more healthy". Your son skipped a family outing so he can get in another run. What you're seeing, and might even suspect, are just two signs of an eating disorder. In our society, our relationship with food is complicated, and so are the disorders when that relationship goes off track. 

Eating disorders can develop at any age and any gender, but they're most common in teens and girls, although we're also seeing an increase in boys with eating disorders. Eating disorders are also seen at all sizes and BMIs. Unfortunately, we don't always catch eating disorders in teens, and we often don't see these kids until they're really sick. Two facts: Eating disorders are the third most common chronic illness among adolescent girls. Young people between 15 and 24 with anorexia have 10 times the risk of dying compared to their peers. 

As a parent, you need to know about these disorders and watch for the signs that your teen is affected. But you also need to know that this isn't an illness of choice, that it has a huge mental component and that it isn't due to something you have or haven't done. 

Need to know: The different kinds of disorders

The most common eating disorders are:

  1. Anorexia nervosa. Patients restrict how much they eat, resulting in dramatic weight loss or failure to gain weight as they should for normal growth. Anorexia usually is diagnosed when their weight is less than what would be expected, given your child's growth history. Patients have an unrealistic view of their bodies — they can't really see themselves. They may have an intense fear of gaining weight. 
  2. Bulimia. This disorder is defined by binge eating, a large amount of food eaten in a short time, followed by vomiting or other behaviors to prevent weight gain such as overdoing exercise, fasting, or using diet pills or diuretics. To be diagnosed, they typically binge/purge at least once a week for three weeks. 
  3. Binge eating. Another form of overeating characterized by feeling a loss of control, those affected have at least three of the following behaviors. These behaviors must happen on average at least once a week for three months. 
    • Eating much more rapidly than normal, followed by intense remorse and guilt
    • Eating until feeling uncomfortably full
    • Eating large amounts of food when not feeling hungry
    • Eating alone because they're embarrassed by how much they're eating
    • Feeling disgusted with themselves, depressed or very guilty afterward
  4. Avoidant/Restrictive Food Intake Disorder (ARFID). Also known as weight loss related to "extreme picky eating," this eating disorder is characterized by super-selective eating habits. These include refusing to eat foods, often based on textures, or concern for adverse effects from eating certain foods. It's most commonly seen in children and results in significant nutrition and energy deficiencies and failure to gain weight that can't be explained by another physical or mental illness. 

Need to know: What to watch for

Signals that your child may have an eating disorder include: 

  • Sudden changes in eating habits, such as limiting/counting calories or excluding food groups
  • Suddenly becoming vegetarian or vegan
  • Refusing to eat anything that isn't "healthy"
  • Skipping meals
  • Refusing to eat with parents, family or other people
  • Going to the bathroom after every meal
  • Eating abnormally large amounts of food, then significantly restricting their eating for one or two days
  • Becoming obsessed with their looks or making comments about being overweight
  • Sudden changes in activity habits, such as increasing the amount of time spent exercising or at the gym; "training" extensively for a competition, race or event beyond what would be considered normal; being so strict with their exercise routine that it interferes with work, school, or relationships; getting upset when they don't meet their activity goals on their app; and not eating enough calories to replace those they've burned

You may also notice physical symptoms including but not limited to:

  • Dizziness
  • Nearly fainting
  • Abdominal pain and/or constipation
  • Depression and/or anxiety
  • Dramatic weight loss compared to their baseline, even those who start at a higher weight
  • Fatigue
  • Difficulty concentrating
  • Among girls, not getting their period

As a parent, you should become especially concerned if your child is using diet pills, diuretics, laxatives or misses using their insulin, if diabetic. 

Need to know: What to do

If you think your child or teen has an eating disorder, start by having them seen by their primary care provider. As a note, we may see the signs before you do. At the clinic, they'll be given a thorough exam, along with lab work, to make the diagnosis — and rule out that it isn't something else causing weight loss. You need to be prepared for your teen to not think they have a problem or deny that it's an eating disorder. They may also be mad that you're even considering it. 

Need to know: How eating disorders are treated

Before undertaking any treatment, be sure your child is being seen by a professional trained in eating disorders. If your child has anorexia that can be treated in the outpatient setting, you'll be coached by the provider in Family-Based Treatment (FBT) to restore your child's weight to normal. This includes preparing nutrient-dense foods, and watching them eat three meals a day, plus snacks. Your eating-disorder professional will conduct intense follow-up with you. If your child is too ill for home care, they may need to go to the hospital for treatment. 

Those affected by bulimia or binge eating will undergo either FBT or cognitive behavioral therapy (CBT) to help them learn triggers and new behaviors. There are also certain antidepressants that, when combined with therapy, may also help treat bulimia and binge eating disorder. 

Need to know: Ways to help prevent eating disorders

While parents aren't responsible for causing eating disorders, there are some things you can do to create a healthy approach to food and body image in your home: 

  • Be mindful of your own self-image body talk. Always use healthy body talk and set a good example. Avoid talking about how you look or the desire to "diet" or lose weight. 
  • Have regular family meals.
  • Discourage dieting.
  • Don't label food "good" or "bad". Instead, use language, such as "sometimes food" or "anytime" food. 
  • When talking to impressionable teens, make sure not to always focus on their looks and what they're wearing. Try to emphasize other qualities, such as humor, kindness, intelligence, activities, interests and personality. 
  • Put limits on screen time, since social media can have a big impact on teens and their body image and confidence. 

Cassandra Narr, APRN, CNP, MS, is a nurse practitioner in Primary Care in Rochester/Kasson's Division of Community Pediatric and Adolescent Medicine (CPAM). For the past two years, Cassandra has worked in collaboration with child psychology and community pediatrics to identify, treat and prevent eating disorders in children and adolescents.