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Catching Eating Disorders Early

Feb. 26 – March 4 is National Eating Disorders Awareness Week. Learn the early signs of the disease in adolescents — and what Kaiser Permanente is doing to help.

Dr. Lauren Hartman

Lauren Hartman, MD, has some sobering statistics to share about eating disorders in the United States. Eating disorders have nearly doubled since the 1960s, and despite the growing numbers, they often go underdiagnosed.

Dr. Hartman, who is board-certified in both Adolescent Medicine and Pediatrics, sees teen patients at Kaiser Permanente in the East Bay for primary and specialty care.

While she says that eating disorders generally appear first in adolescence, she’s now seeing new trends: They are showing up in a growing number of young men, minorities, and children 10 and younger. “The earlier an eating disorder is recognized and treated, the better the prognosis,” Dr. Hartman said. Read on to learn more.

What are eating disorders?

Some of the common forms of eating disorders are anorexia nervosa, bulimia nervosa, and binge eating disorder. They are serious illnesses characterized by irregular eating habits and behaviors and severe distress about body weight, shape, or size. At their most dire, they can negatively impact just about every organ. They have the highest mortality rate of any of the psychiatric illnesses. Avoidant restrictive food intake disorder (ARFID) is increasingly recognized, and typically presents in early childhood and persists into adolescence and adulthood. It is characterized by selective or picky eating or fears about negative consequences with eating, though it doesn’t involve significant body image distortion or fear of weight gain.

What are the root causes?

There is no one source but multiple factors are at play. Genetic and biologic predisposition may make someone 7 to 12 times more likely to have an eating disorder. Psychiatric traits may make people more prone, too. Finally, we are seeing an increase in social and environmental influences.

For example, the obesity epidemic has come in to play, with 30 percent of children with eating disorders also having previously had a high BMI. Overweight children may be told they need to lose weight or may be bullied at school. They then change their diet and exercise habits, get praise over initial weight loss, unhealthy eating behaviors may be overlooked, and illness can set in.

How do you know if someone needs help?

An eating disorder can be subtle. A teen may present with weight loss, failure to grow or gain weight. Other symptoms include dizziness, fainting, fatigue, and frequent headaches and abdominal pain. For girls, it may impact menstrual cycles.

Teens may develop drastic changes in their eating behaviors: restricting the amount of food or entire food groups, establishing food rituals, avoiding social meals, frequent vomiting, and over-exercising.

What are general approaches to treatment?

The most effective treatment for eating disorders involves a multidisciplinary approach, with medical, mental health, and nutrition interventions. First there is typically outpatient, which is monitoring by a physician, dietician, and therapist. The primary therapeutic approach for adolescents is family-based therapy. If a patient doesn’t improve within a couple months, treatment is increased with intensive outpatient programs. After that, there is residential treatment. Once patients get better, they go backward through the tiers until they are monitored again in the outpatient setting.

How can people help?

Don’t focus on kids’ weight, but on health, fitness, and feeling good. Adolescence is the most metabolically demanding time in a person’s life, so teens need a lot of food — preferably healthy food. Eating disorders are difficult to overcome without support, so sufferers should reach out to a physician, therapist, school counselor, and family member with any concerns.