Young and Dying to be Thin

"Magic mirror on the wall, who is the fairest one of all?"— "Snow White and the Seven Dwarfs" (Walt Disney, 1937)

What happens when you pass by a store window? Do you instinctively glance over to check your reflection? Most people do. 

Sometimes they are happy with their appearance and sometimes not, but regardless, the appraisal of themselves is quickly forgotten as the rest of the day unfolds.

For a teen with an eating disorder – anorexia nervosa, bulimia nervosa or binge eating – this experience is very different.

The image he or she sees in the glass is a grossly overweight and unattractive body. Intense feelings of self-loathing and hopelessness, triggered by believing this distorted image, intensify as the day goes on.

In the eating-disordered mind, the solution to this perceived problem is to engage in unhealthy and potentially lethal practices of overeating, extreme dieting and/or purging. These behaviors are particularly dangerous, as the adolescent brain and body are still developing and need sufficient and balanced nutrition to mature properly. 

Most disturbing is that anorexia, bulimia and binge eating – once thought to begin in the early to mid-teens – is being seen in elementary school students. Clinicians are now treating a significant number of girls and boys under the age of 10 for fully developed eating disorders. In fact:

• one in 10 youths diagnosed with an eating disorder is between the ages of 7 and 10.
• four out of every 100 hospitalizations for eating disorders are children younger than 12 years of age.

There is no reason to believe that the statistics are any different for East Windsor, Hightstown or Cranbury youth.

Experimentation vs. Disorder

Normal adolescence is a time of mood changes, trying out new behaviors, rapid changes in belief systems, and reliance on peer values. Both eating-disordered and normal teens may experiment with fasting, being a vegan, eating only meat, eating small portions, eating one meal a day or excluding an entire category of food.

The difference between the two groups is in the intensity, duration and the presence of fear.

The non-disordered teen simply may be curious to experiment in order to get to know his or her body. The eating-disordered teen, however, is terrified of food and desperate to lose weight. He or she will try any strategy to accomplish this end.

Our job as adults — whether parent, teacher, coach or clergy — is to hear this unspoken cry for help and to be sensitive to behavioral changes that might indicate a serious condition that requires professional help.

Signs and Symptoms

An anorexic youth will experience self-starvation and excessive weight loss. Other symptoms may include:

• Loss of menstrual periods for girls
• Fear of gaining weight and obsessively weighing food portions or body weight
• Feeling fat and criticizing body shape
• Wearing baggy clothes to hide extreme weight loss

A bulimic adolescent will binge-eat in public and immediately purge by vomiting, using laxatives or frantic and excessive exercising. Other symptoms may include:

• All the anorexic symptoms listed above
• Chronically eating and bingeing. (Watching a bulimic teen during the binge phase is very uncomfortable. They experience no enjoyment in eating; it’s just the need to get down as much food as possible in a short period of time.)
• Frequent dieting

A binge-eating-disordered or compulsively overeating teen will binge in public like the bulimic but will not purge, even if he or she is physically uncomfortable. Guilt and shame for eating so much often follow. Other symptoms may include:

• Depression and/or anxiety
• Social isolation
• Intense, short-lived fad diets that fail
• Not caring about appearance

Note that a teen compulsive overeater may not even be overweight. It is his or her relationship to food – being fearful and feeling out of control -- that is important. 

Modeling Healthy Eating

From the time kids are exposed to the media, they are bombarded with conflicting messages about body image and food. "Thin is in" if you are a fashion model, dancer, actor or actress, or want to be asked out on a date. A war on childhood obesity has been declared by First Lady Michelle Obama. 

Yet fast-food opportunities are relatively inexpensive, dotting every landscape, and kid-size meals offer attractive prizes. Portion sizes in most restaurants are at least double the recommended size.

Despite the above obstacles, parents have the power to model healthy food behavior, lead family discussions regarding food and weight, and recognize signs of anorexia, bulimia or compulsive overeating in their child. 

If you have a sense that your teen or pre-teen may be experiencing an eating disorder, talk to your pediatrician and ask for a referral to a specialist.

February 20-26 is National Eating Disorders Awareness Week.* This year's theme is "It's Time to Talk About It." 

Let's do that, both as a community and around the family dinner table.

* National Eating Disorders Association: www.nationaleatingdisorders.org. The association supports individuals and families affected by eating disorders and serves as a catalyst for prevention, cures and access to quality care. Each year it organizes the National Eating Disorders Awareness Week