EATING DISORDERS

Over the past few years, we have been seeing an increasing number of patients with eating disorders.  Most of these children are adolescent females, but we have also seen younger patients and males.  This trend has been attributed to a number of factors, such as the prevalence of obesity in children and adolescents, which has led to an unhealthy emphasis on dieting and weight loss in children, especially in the suburbs, and the media, which often portrays women as extremely thin.

There are three subclasses of eating disorders, Anorexia Nervosa, Bulimia, and for those patients who do not meet all the diagnostic criteria, a classification called Eating Disorder Not Otherwise Specified.  Anorexia nervosa involves an intense fear of becoming fat or gaining weight, refusal to maintain body weight at or above a normal weight for age and height, disturbed body image and amenorrhea (absence of at least 3 menstrual cycles).  Bulimia has recurrent episodes of binge eating (eating substantially larger amounts of food in a shorter period of time than would be eaten by most people in similar circumstances and lack of control of the eating during the binge), recurrent inappropriate behavior to compensate for the binge (self-induced vomiting, laxative use, diuretics, excessive exercising) and disturbed body image.  The binges occur at least twice weekly for at least 3 months.

The complications of these eating disorders can be electrolyte abnormalities, cardiovascular (low blood pressure and arrhythmias), intestinal malfunction, liver abnormalities, kidney problems, anemia, amenorrhea, seizures and death, among other problems.  Some of these adolescents need to be hospitalized for these complications and for treatment.  If they have minimal nutritional, medical and psychosocial issues, they may be treated as an outpatient.

As always in pediatrics, prevention is key.  There are usually self esteem issues, so attention to improving that is extremely important. If a child/adolescent wants to lose weight, it’s important to do so only when he/she is truly overweight and then be done with supervision, appropriately.  As part of our ongoing health care here, we monitor weight, height, body mass index and ask screening questions about eating patterns and body image.  If there are concerns which are addressed early, we may be able to prevent the complications and psychological consequences.

If we suspect that there may be an incipient eating disorder or there are obvious eating or weight issues, we will first address them here with a complete history and physical exam.  We then often do a laboratory evaluation and possibly a cardiogram (EKG).  We do some initial counseling here, with probable referral to a nutritionist, mental health professional (psychologist, psychiatrist, therapist) and follow up visits here.

If you have any concerns that your child has an eating disorder, even if it’s early, you should discuss it with us and have your child evaluated by us.



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