Act Now

You don't know what to do.

Thirteen-year-old Sheila has been losing weight for 6 months. At first you thought it was normal teenage dieting. But she's too thin now. She has stopped eating with you but insists on cooking everything for the whole household. Last week she made four desserts but wouldn't eat any of them. She has a book with a list of the calories in everything most of us eat, but she doesn't need it anymore because she knows it by heart. Besides, at present, she eats only three things: raw vegetables, tofu, and dry cereal. She's still doing well in school. Her straight As, though, seem more of a burden than a source of accomplishment to her. When she isn't studying, she's going for a run or doing sit-ups. She ignores calls from her friends and seems more and more depressed. When you try to encourage her to eat, she fumes and says it's none of your business. She insists she's fine.

You don't know what to do.

You caught 17-year-old Donna throwing up. She said she was sick. But it wasn't the first time. You have heard her before. Always heading off to the bathroom after every meal. She says it was nothing—she only had an upset stomach. You've noticed she hardly eats breakfast or lunch, but when you come home in the evening, lots of food is gone from the pantry, especially cookies, potato chips, and bread. You've had to go to the store midweek to restock. One of her friends told you she was worried about Donna. You are too.

You don't know what to do.

Tom used to be a great high school diver. He's too weak now to perform his toughest dives. He eats only protein bars and fruit drinks. He is constantly exercising to get perfect abdominal muscles, but you can see his ribs. He says he's still too fat. Where there used to be muscle, there's mostly bone and skin now. At first his coach complimented Tom on his weight loss because it had improved his dive entries. Now the coach has called you and suggested Tom take a leave from the team. Tom's best friend called him "skeleton" to tease him, but you know he's worried too.

You don't know what to do. Should you do something?

This is the first problem you face if you're concerned that your son or daughter may have an eating disorder. You know most eating problems in children are transient. You remember lots of struggles over junk food and sweets with your other children, or you've seen it in other families. Many children commonly go through periods of being picky eaters, eating more than usual, eating less than usual, and even complaining about upset stomachs or having periods of mild digestive problems and constipation. You've asked other parents and relatives about these types of behaviors and learned that, although usually short-lived, eating problems are nearly universal. As children enter puberty, many, especially girls, are very much interested in their appearance and weight and may try dieting or other weight-loss strategies. You expect this because you know it's normal to become more concerned about appearance in the teenage years and because you've known your son's or daughter's friends to express similar thoughts and engage in the same types of behavior. You don't want to create a problem where there isn't one.

How do you know if there's a real problem?

If you think your child's thoughts and behaviors resemble those of Sheila, Donna, or Tom, however, it's time to take action to help. Left untreated, eating disorders can lead to chronic health problems, depression, and even death. With the severe weight loss associated with anorexia nervosa, for example, starvation leads to lower body temperatures, decreased blood pressure, and decreased heart rate, as well as rough and dry skin, loss of hair, cessation of menstruation in young women, and osteoporosis. Because the body isn't being fed, it turns to muscle for fuel. This causes weakness, fatigue, and, in particular, decreased cardiac mass (the heart being a large muscle in the body), which can prompt dangerous changes in heart rhythm and may thereby cause cardiac failure and death. Over time, the risk of death as a result of the complications of anorexia is estimated at 6–15%. This mortality rate is the highest for any psychiatric disease.

For bulimia nervosa, the risk for death appears to be lower, but there still are risks of severe medical complications. One of the most common of these complications is depletion of potassium (hypokalemia), which results from loss of body stores of this essential electrolyte due to purging stomach contents. Without potassium, which is required for many basic physical processes but is very important for muscle contraction, cardiac arrhythmias are possible, leading to cardiac arrest and death. In addition, with chronic vomiting, the linings of the esophagus and stomach can become eroded, causing bleeding, ulcers, erosion of tooth enamel, and even death if the bleeding cannot be stopped. Chronic use of laxatives and purgatives leads to intestinal problems, including pain and severe and unremitting constipation. Both vomiting and the use of laxatives lead to severe depletion of water from the body (dehydration), which can cause low and changing blood pressure, increasing the likelihood of fainting and falls. For binge-eating disorder, the medical risks include obesity, hypertension, and diabetes. The specific medical risks associated with avoidant/restrictive food intake disorder are not known, but in cases of severe weight loss accompanying this disorder, the risks of malnutrition are similar to those found in anorexia nervosa.

We discuss these complications in more detail in Chapter 4. By now, though, you can undoubtedly see that eating disorders have serious health consequences. To be complacent in the face of a possible eating disorder is the greatest risk a parent can take in the battle to prevent such serious problems from developing.

WHAT DOES AN EATING DISORDER LOOK LIKE AS IT DEVELOPS?

If you're to catch a problem before it becomes an eating disorder, you have to know what to look for over time. Sheila, Donna, and Tom's problems did not develop in a day. Like most eating disorders, their problems developed gradually and sometimes in secret. If you understand the path by which more typical, temporary eating problems and weight concerns can become real eating disorders, you can get a sense of where your own child is on that trajectory.

Extreme Dieting: The Path to Anorexia...