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Posted at 12:01 AM ET, 11/29/2010

Disordered eating needs doctor's attention

By Jennifer LaRue Huget

A report published this morning in the journal Pediatrics shows that eating disorders have become more common among children and teenagers over the past 60 years. The potential health impact of such illnesses is so great that pediatricians are urged to learn to do a better job of recognizing and treating patients who may be anorexic, bulimic or otherwise disordered in their relationship with food.

According to the report, the pattern of eating disorders has changed over the decades. They've become increasingly common among males ages 16 to 19, and the number of eating-disorder-related hospitalizations of kids ages 12 and under has risen sharply. An estimated .5 percent of adolescent girls have anorexia nervosa, and between 1 percent and 2 percent meet the diagnostic criteria for bulimia nervosa.

Eating disorders can cause all kinds of health problems, from simple dehydration to growth retardation, reduced bone mineral density and even suicide.

But physicians are cautioned that some with eating disorders are skilled at keeping their condition secret and may well deny it even if their doctor asks about it directly. So doctors -- pediatricians in particular -- need to familiarize themselves with the host of physical symptoms and aspects of patient history that might point to an eating disorder. Screening for eating disorders should become a routine part of annual checkups and evaluations for sports participation.

A model presents an ensemble by French fashion house Guy Laroche in Paris in 2006. France's lower house of parliament adopted a groundbreaking bill on April 15, 2008 that would make it illegal for anyone including fashion magazines, advertisers and Web sites to publicly incite extreme thinness. (AP Photo/Remy de la Mauviniere, File)

Being aware of or even concerned about one's weight and even dieting are not themselves symptoms of eating disorders, the paper says (though dieting has been linked to the development of such disorders). (This news supports the notion that anorexia may have a strong genetic component.) But the line can be fine, and parents, physicians and even teens' friends should be alert to signs that the line has been crossed.

Last week, I blogged about hoping to avoid gaining weight over Thanksgiving. One thoughtful reader's comment gave me pause: DCinND wrote:

Don't worry about it. It's just two days.
I've enjoyed reading about your weight loss goals and am excited for what you've accomplished, but don't take it too far. You're actually exhibiting some signs of disordered eating by worrying that much about having to stick to a schedule and being in complete control over what you eat. It's normal to fluctuate a few pounds up or down over the course of a day or a week. Constantly stepping on the scale isn't a good idea either.
You have to control your weight, without letting your weight control you.

Now that's what I call food for thought. It made me wonder whether many of us who are determined to manage our weight might be dancing on the edge of disordered eating.

Your thoughts?

By Jennifer LaRue Huget  | November 29, 2010; 12:01 AM ET
Categories:  Eating disorders, Nutrition and Fitness, Parenting, Teens  
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Can you believe I lost 20 lbs in only 2 months! I'm now comfortable in a size 2, down from a size 10 when I started. I can truly say that because of "Hypersonic Weight Loss" system, I am LOVING LIFE!

Posted by: karriengiven | November 29, 2010 1:25 AM | Report abuse

As someone who's sliding toward 60 (rather than flirting with 50), I don't think those of us who attempt to manage our weight are headed toward a disorder. I think many of us find it increasingly difficult to accept the changes to our bodies that come with age. Teens are faced with unhealthy, unrealistic images of the female form -- that photo of the model in your blog was very appalling -- but we over 50 are also barraged with photos of women such as Madonna who, so I've read, spends 2+ hours a day working on her body while her personal chef spends hours preparing her diet-specific meals. I can't and frankly wouldn't want to live that way. My mother and her friends all watched their weight, yet every June they proudly paraded their new swimsuits before settling in for long, gabby summer days at the beach. They seemed far more comfortable with their bodies than my friends and I do. So where IS the balance between a healthy weight and an unhealthy perspective on weight? Who are the women we can look to as models for a healthy body over 50? I look forward to more on the subject in your blog.

Posted by: pflugrad-dpf | November 29, 2010 10:04 AM | Report abuse

Yes, I have thought that you are treading dangerously close since you wrote that you exercise 3 hours a day. THAT is obsessive, and not realistic for someone whose livelihood is outside the fitness/media/entertainment field (i.e., someone who stays thin for a living").

Posted by: KEBV | November 29, 2010 12:14 PM | Report abuse

i believe the stats in this article are way, way lower than the reality.

Posted by: tazdelaney | November 29, 2010 12:56 PM | Report abuse

i believe the stats in this article are way, way lower than the reality.

Posted by: tazdelaney | November 29, 2010 1:08 PM | Report abuse

DCinND probably has a point.

Normal people put on pounds as they age. To take action to avoid that is abnormal. So, if you want to fit into your pants and avoid problems associated with being overweight you have to pursue abnormal behaviors.

Refusing to participate in a family gathering over a holiday for fear of overeating, upchucking your meal afterwards -- those would be extreme harmful abnormal behaviors. Going into the holiday with a plan doesn't seem harmful, so I think what's the big deal?

Posted by: DogNabit | November 29, 2010 1:42 PM | Report abuse

From reading some of your posts (I am a newbie rather than a devoted follower), it seems that your focus is on weight and how you feel. When you state that may "even gain a pound back", you fail to acknowledge the reality of normal weight fluctuation throughout the day. I have gained 2 pounds by drinking tons of water on days with particularly long choir and opera rehearsal schedules, and lost it all after going to the bathroom. I gain weight by eating a reasonably-sized meal, but it is temporary. Food itself has mass, and when it is in your stomach, that adds to that number on the scale. It is simply not reasonable to monitor your weight without including a small range that accounts for these daily differences.

Especially considering public opinion on what is typical and healthy in regards to exercise, portion control, and nutritional content (your article on the inability to gauge weight was spot on, although I refer to medical height/weight charts rather than the BMI index), I am hesitant to label your desire to keep your body in the best shape possible as an eating disorder. The results of your scrutiny certainly have not damaged your body - quite the opposite. Practicing Bikram yoga is a feat to be congratulated, and while 3 hours of daily exercise is not a reasonable goal for many people (some have busy schedules. I myself was born with knees which cannot accommodate that level of movement), it is certainly neither obsessive by default, nor unhealthy. That level of physical fitness is not required in many careers. However, personal activities do not need to be defined by what one does for a living, and a physicist can certainly find joy in being able to participate in a triathlon without feeling constrained by comparisons to fellow workers.

That being said, in your posts, the focus on weight seems to regularly trump any celebration of what your body is capable of. Also missing is the sense of pleasure in eating well not just for the nutritional benefits, but for the joy of the flavors and communal experience. I find the lack of balance in focus to be unhealthy, but not to the point where it is an eating disorder. Your comment in the Thanksgiving post about fearing a loss of momentum is very reasonable. Wishing to maintain exercise and food habits does not automatically indicate a refusal to welcome Holiday indulgences, as some readers believe.

Quite frankly, if you feel good, if you love what your body is capable of doing as a result of your current habits, if you recognize your body's limitations, if your dedication to health is helping you eat well in a world in which it is increasingly difficult to find and afford food which is ethically grown/raised and has high nutritional value (food for thought: )... then rock on. Just remember what is truly important about how you are living: While that number on the scale is a key indicator of health, it should never be the highest goal.

Posted by: MorningGlory42 | November 29, 2010 2:06 PM | Report abuse

@DogNabit - I don't know that it's necessary to pursue abnormal behavior to maintain a normal weight. People do tend to put on weight with age as metabolism slows and physical activity decreases, but not everyone puts on a lot of weight. It's probably not normal to keep eating like a teenager when you're 50, either. For most people (not professional athletes or construction workers), neither your metabolism nor your daily routine demand that kind of caloric intake.

So what is "abnormal"? I think a good benchmark for normalcy is what the letter-writer said - you can take steps to control your weight, but you cannot let those steps control you. Exercising three hours a day is something most working people (other than those whose appearance is part and parcel of their livelihood, like models or actors) cannot manage. If you're at that point, your weight control efforts might be going too far. Same goes for allowing worries about caloric intake on the holiday to diminish your enjoyment of that one day. It's a good thing to want to maintain a healthy weight. A relatively wide weight range can be healthy for any particular person, though, and it's easy to get caught up in the game of seeing if you can shed just one more pound, five more pounds, and lose track of the real goal, which is physical and mental health. At some point it becomes its own sick argument.

I'm a food writer and recipe developer, and in that capacity I meet a lot of other food bloggers, many of whom are obsessed with certain types of eating - no starch, no refined sugar, "clean eating," etc - to the point of disorder. Many of my friends in college had eating disorders (I was in a sorority and the pressure to be thin was very strong, even 25 years ago). I recognize the signs from those days in these writers' habits. Guilt, anxiety, worry, the attachment of moral dimension to food (good/bad, healthful versus "sinful/evil").

Posted by: kgirl2 | November 29, 2010 2:15 PM | Report abuse

The reader's comment "You're actually exhibiting some signs of disordered eating by worrying that much about having to stick to a schedule and being in complete control over what you eat." reminded me about some comments I have heard from the trainers at my gym.

I am trying to slim down, so I walk, workout, and watch my diet. I have lost over 40 pounds and kept it off for several year, but I still want to lose another 50 pounds.

When the trainers give me feedback, it is generally very restrictive -- like I should work out at least 5 days a week for at least 2 hours, and I should avoid fruits and have just vegetables. And heaven forbid I should even look twice at a cookie or cake.

I think they are being unrealistic and they think I am a slacker.

Posted by: MontgomeryCountyMs | December 1, 2010 12:36 PM | Report abuse

Eating and weight are touchy subjects, being so attached to identity and status, however, I'm inclined to agree with my friend Liz, who did keep her bulimia a secret until she realized it was controlling her negatively.

Posted by: CherylPetersen | December 6, 2010 5:53 PM | Report abuse

Eating and weight are touchy subjects, being so attached to identity and status, however, I'm inclined to agree with my friend Liz, who did keep her bulimia a secret until she realized it was controlling her negatively. Liz's story.

Posted by: CherylPetersen | December 6, 2010 5:53 PM | Report abuse

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