Q&A: Eating disorders
Estherann Grace, MD
What eating disorders can pediatricians expect to see in their
Anorexia nervosa, bulimia and binge eating disorder (BED).
How are these disorders recognized and diagnosed?
Patients with anorexia nervosa have lost greater than 15 percent
of their ideal body weight, restrict their caloric intake, have
a distorted body image (seeing themselves as fat despite their
emaciated appearance) and are amenorrheic. Bulimic patients self-induce
vomiting after eating and may binge prior to purging. There is
frequent use of laxatives, diuretics and diet pills. Patients
with BED consume large quantities of food, failing to recognize
their own sense of satiety. Typically obesity is a consequence
Who is likely to develop an eating disorder?
Females are at greater risk than males, although males are increasingly
suffering from this disorder, as well. The typical age is 15 to
18, although girls as young as 9 are presenting with anorexia.
In recent years, more males have been engaging in the behavior.
Certain sports (such as wrestling, gymnastics, skating and distance
running) encourage strict weight control and may foster the behavior.
Also, having a close relative with an eating disorder increases
the risk of developing one.
Why do eating disorders develop?
The actual etiology is unknown, but there are many theories.
Societys norm of an extremely thin, sculpted body is unattainable
by the vast majority of females. Failure to achieve the perfect
body results in a nearly universal dissatisfaction with
body image. The media reinforces the artificial ideal rather than
the healthy norm.
What are the health risks associated with an eating disorder?
For the prepubertal child, inadequate nutrition (anorexia nervosa)
will stunt growth and delay pubertal development. In early- to
mid-adolescence, the starved state affects all systems of the
body, but has a particularly harmful effect on the endocrine system
and bone metabolism, resulting in irreversible osteoporosis. The
primary concern in bulimia is death secondary to hypokalemia.
Also, the regurgitated stomach acid can cause severe gum disease
with resultant loss of teeth. BED results in significant obesity
with associated insulin resistance, resulting in menstrual irregularities
and eventually type II diabetes.
facts on body image
• 81% of 10 year olds are afraid of being fat.
• 51% of 9- and 10-year-old girls feel better about themselves
if they are on a diet.
• 35% of “normal dieters” progress to pathological dieting.
• Of those, 20–25% progress to partial or full-syndrome eating
Source: National Eating Disorder Association
What are the recommended treatments?
Medical management, nutrition consultation and both individual
and family therapy all play important roles. Should the outpatient
treatment team fail, inpatient care is advised. There are a variety
of inpatient programs specifically designed for eating disorders
of all ages.
What are the criteria for a medical admission?
Acute food refusal, bradycardia (pulse less than 40), a weight
less than 75 percent of ideal body weight, and symptomatic orthostasis
Are medications recommended for patients with eating disorders?
The SSRI class of drugs, which have been well tolerated by patients
with eating disorders, are prescribed to deal with the depression
frequently associated with an eating disorder. They stabilize
moods, improve sleep patterns, reduce fatigue, and in bulimics
decrease the incidence and frequency of vomiting.
What is the prognosis for patients with eating disorders?
Treatment is a slow process usually lasting three to five years.
The vast majority will enter a recovery phase, but there appears
to be a life-long struggle with food and consequent weight loss
or gain. The mortality ranges from three to five percent and is
usually caused by a cardiovascular event. Suicide is a significant
risk in older patients.
How can eating disorders be prevented?
To some extent, providing guidance to new parents can help prevent
disorders in their children. Encourage parents to avoid using
food as a behavioral reward and to provide variety in appropriate
portion sizes. Parents should carefully monitor growth and development,
helping their children avoid obesity through sensible eating and
physical activity. Parents should stress health and fitnessnot