Parents faced with a "diet society" should be vigilant for signs of eating disorders
National Eating Disorders Awareness Week is Feb. 25 – March 6, 2005

by Julie Wilson

Right now, about 8 million people in the United States are affected with anorexia nervosa -- 7 million of them are young women. More than twice that number struggle with bulimia and other related disorders. These disorders are serious illnesses that, if left untreated, can lead to permanent physical or mental consequences, or even death. In fact, of all the psychiatric illnesses, eating disorders have the highest rate of death.

The Eating Disorders Program at the Monroe Carell Jr. Children’s Hospital at Vanderbilt treats a range of disorders including anorexia nervosa, bulimia nervosa, binge eating disorders or compulsive over-eating, and morbid/severe obesity. Ovidio Bermudez, M.D., associate professor of Pediatrics and Nursing is director of the program. He stresses that eating disorders are real mental illnesses with real consequences. The knowledge of the complexity of eating disorders is advancing and researchers have found that there are genetic components, personality components, and environmental influences that come together to set the stage for an eating disorder. Bermudez encourages parents to watch for the early signs and know they are not to blame if their child has an eating disorder.

Bermudez answered the following questions regarding eating disorders.

Is the increased number of cases only a result of better diagnosis, or are the numbers truly rising?

Cases increase with societal stress
The increase is real. What probably has not changed is the number of people who are susceptible to developing an eating disorder. If you look back three or more decades, there were fewer people suffering the effects of the disorders, but also fewer of the identified stressors that can trigger an eating disorder, like exposure to complex issues at an earlier age, self-image problems, pressure to perform earlier with good grades, good jobs, etc. And children today have to learn to live with excess, that’s a stress too. You can look at other nations, particularly non-industrialized societies, and you find much lower rates of eating disorders.

What are some warning signs that parents can look for?

Look for changes
The key is recognizing a change in the child’s level of satisfaction with themselves and their body (in weight, size or shape), change in self acceptance or self-view or a change in social interaction. The main warning sign is to look for change. Not all changes your child will go through are concerning or negative. However, it is important to notice change when it is persistently negative towards the child’s own looks, size, and self.

Also, the Children’s Hospital Web site offers a list of additional warning signs for both anorexia nervosa and bulimia nervosa. Visit www.vanderbiltchildrens.com/interior.php?mid=273. You can also visit www.edct.net.

Dieting has become such a common activity. How can a parent distinguish whether their child just wants to lose weight or if he or she actually has an eating disorder?

Dieting is an important risk factor
Dieting is the one of the major risk factors in the development of all eating disorders; even something as common as repeated attempts at dieting. Dieting can trigger physical changes and changes in brain chemistry which can lead to increase in obsessive behavior, anxiety, fears and depression. It is important to recognize that not all people who diet develop eating disorders but all people with eating disorders have dieted.

Should children even be dieting?

Encourage healthy eatin
g I don’t think children should ever diet. Encourage your child to eat healthy, regularly and have a variety of foods. You can promote needed changes in menu choices but not dieting.

Can parents do anything to help prevent their child from developing an eating disorder later in life?

Be a good role model
Parents can be modeling healthy eating and regular physical activity while setting expectations of valuing people for their internal worth rather than for their physical appearance. It is not about parents saying or not saying something, it is more about parents leading by example.

How important is early diagnosis of eating disorders?

Early recognition is important
Early recognition and intervention are the best tools we have today. Delay in recognition and intervention can increase morbidity -- medical and psychological consequences. Children’s Hospital offers a variety of services to help evaluate and treat eating disorders. Visit www.vanderbiltchildrens.com/interior.php?mid=271.

Can a patient with an eating disorder ever truly be cured?

Treatment effective, but reoccurence can happen
Treatment is effective in eating disorders and people can be cured. But the treatment doesn’t change their vulnerability and the disorder can reoccur. The level of care should vary according to the needs of the patient. The treatment can include medical hospitalization, psychiatric hospitalization, eating disorder specialized units and day treatment among others. However, the majority of patients should work with an outpatient team whose treatment modalities include medical care, psychological care, nutritional care, and the use of medication when indicated.