TWEENS & TEENS NEWS November 2005 Eating Disorders Educating parents on the warning signs and medical effects. - Laura Cipullo, RD, CDE It is frightening to think that your child may be suffering from an eating disorder. However, it is vital for parents to be informed about these disorders including the sings/behaviors and the potential medical and/or nutrition al consequences. Eating disorders include a spectrum of diagnoses such as anorexia nervosa, bulimia nervosa, binge eating disorder and compulsive overeating. Anorexia, bulimia and binge/compulsive eating are complex emotional disorders that manifest themselves in behavioral patterns with food. They most often develop in adolescence and early adulthood but can develop prior to the onset of puberty or in later adulthood. Anorexia is self-starvation and is characterized by an obsession with food, weight and thinness. The major symptoms and warning signs include: preoccupation with food and dieting; excessive weight loss; moodiness; social withdrawal; sleep difficulties; distorted body image; hyperactivity; extreme self-control and rigidity; eating rituals; sensitivity to cold temperatures; wearing bulky clothing. Bulimia is eating or binging followed by purging the food through vomiting, laxative abuse and/or excessive exercise. The major symptoms and warning signs include: excessive concern with weight and food; frequent trips to the bathroom, especially after meals; moodiness; increased or excessive sleeping; increased or excessive exercising (greater than one hour per day, everyday); secretive eating; eating in a fast, chaotic manner; and a puffy, bloated appearance. Binge eating disorder and compulsive overeating involves eating large quantities of food in a short time or frequent overeating. some warning signs include: high weight with little public eating; diet hopping; depressed mood; distress about eating habits; secretive eating. Eating disorders are not mutually exclusive. Many eating disorders are coupled with multiple eating behaviors. Your child may exhibit both restrictive symptoms (known as anorexia) as well as purging symptoms (known as bulimia), thereby resulting in the physical consequences of both the restriction and the purge. As a parent, you must educate yourself on the many different physical repercussions of eating disorders. The physical repercussions in your child with an eating disorder may or may not be visible. Weight is not an exclusive and/or significant measure to determine the severity and damage being caused by an eating disorder. Laboratory measures including electrolytes and a blood count may be helpful. Yet, to many people's surprise, lab values of children and adolescents may be many times within normal limits despite the severe caloric restrictions and body sabotaging. You must visit a medical doctor if you suspect your child has an eating disorder, or has been diagnosed with one. If your M.D. is not experienced with or comfortable in working with child or adolescent eating disorders, it may be best to seek out a medical specialist. An electrocardiogram should be conducted to assess for heart rate changes. This would help to discern whether the eating symptoms are affecting the body's organs and whether your daughter or son may be at risk for fainting or additional cardiovascular consequences. Chest pain, low blood pressure, slow heart rate and reduced cardiac output are all possible physical repercussions of anorexia and bulimia. Adolescents with symptoms of anorexia are likely to experience significant weight loss in a short duration, hormones imbalances, cardiovascular changes as mentioned above, nutritional deficiencies and even interruptions in the normal growth cycle. The hormone imbalances include a low estrogen level, a low follicular stimulating hormone level and a cease of normal menses known as amenorrhea. The low estrogen level along with the nutritionally deficient diet is also partly responsible for the risk of low bone density known as osteopenia, resulting in osteoporosis. Your child is likely to experience a low heart rate and dizziness (orthostatic hypotension). The medical doctor can determine your child's orthostatic blood pressure by measuring the blood pressure upon lying down and upon standing up. Nutritional deficiencies may include essential fatty acid deficiency and usually a diet deficient in essential amino acids due to the absence of animal proteins and dietary fats. Some teens restrict their intake to a vegan diet—avoiding all animal products including milk products. Many of these teens then develop an intolerance to lactose when they try to reintroduce dairy into their daily intake. Each person experiences different levels of the repercussions, many of which can be overcome with proper nutrition and medical care. Bulimia is more likely to be evident in an electrolyte work up. Potassium is especially prone to be low (known as hypokalemia) in an adolescent purging multiple times a day as well as restricting calories. Hypokalemia is a serious precursor to a cardiac arrhythmia and can be fatal if not corrected. Damage to the esophagus is also a physical consequence resulting from purging behavior. The frequent purging actually causes tears in the esophageal lining, and often results in gastric reflux. The stomach acid also wears away the enamel on your child's teeth. This can be detected at your child's regular dentist visit. Norman Boyd III, DDS of Manhattan, reports clients with bulimia are more prone to multiple cavities and are more likely to need bonding, veneers or even crowns to repair the missing enamel. Parents may notice the visible effect of a purge. The adolescent with purging behavior may have a red bruise-like mark on the hand and/or knuckles following a purge. In addition, during a purge facial blood vessels may be broken and now visible to others. Purging activity is very stressful on the body, making your child extremely tired and moody. Binge eating disorder and compulsive overeating result in overweight teens and obesity. The may raise the risk of your child developing Type II Diabetes and heart disease. As stated earlier, these disorders are psychological with underlying causes. Some of the issues include: feelings of inadequacy, perfectionism, fear of intimacy, low self-esteem, difficulty expressing feelings and the need to please others. Sometimes a traumatic event or a chronic situation can trigger these issues such as abuse, neglect or families that discourage discussion of feelings. While the diet mentality does not cause eating disorders, it certainly reinforces feelings of inadequacy. It is therefore important for parents to be healthy role models in terms of body image, nutrition and exercise. Approaching your child with your concerns may be difficult especially if he is secretive about his behavior. He may respond defensively, but it is also possible that he wants to be "found out" and will be relieved when you approach him with your concerns and support. It is important to stay away from nagging your child about food. Rather, directly express your observations and concern for his health. In taking the next step to get your child help, it is advisable to seek a therapist, a registered dietitian and/or a medical doctor who specializes in the treatment of eating disorders. It is most helpful when the health practitioner works within a team so that the communication between professionals is fluid and regular. Most important is to trust your instinct. The moment you suspect your child may have an eating disorder, speak directly to him or her and take the next step to get the help needed.

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