Rate of Eating Disorders in Kids Keeps Rising
MONDAY Nov. 29, 2010 -- Eating disorders have risen steadily in children and teens over the last few decades, with some of the sharpest increases occurring in boys and minority youths, according to a new report.
In one startling statistic cited in the report, an analysis by the Agency for Healthcare Research and Quality found that hospitalizations for eating disorders jumped by 119 percent between 1999 and 2006 for kids younger than 12.
At the same time as severe cases of anorexia and bulimia have risen, so too have "partial-syndrome" eating disorders -- young people who have some, but not all, of the symptoms of an eating disorder. Athletes, including gymnasts and wrestlers, and performers, including dancers and models, may be particularly at risk, according to the report.
"We are seeing a lot more eating disorders than we used to and we are seeing it in people we didn't associate with eating disorders in the past -- a lot of boys, little kids, people of color and those with lower socioeconomic backgrounds," said report author Dr. David Rosen, a professor of pediatrics, internal medicine and psychiatry at University of Michigan. "The stereotype [patient] is of an affluent white girl of a certain age. We wanted people to understand eating disorders are equal-opportunity disorders."
The report is published in the December issue of Pediatrics.
While an estimated 0.5 percent of adolescent girls in the United States have anorexia and about 1 to 2 percent have bulimia, experts estimate that between 0.8 to 14 percent of Americans generally have at least some of the physical and psychological symptoms of an eating disorder, according to the report.
Boys now represent about 5 to 10 percent of those with eating disorders, although some research suggests that number may be even higher, said Lisa Lilenfeld, incoming president of the Eating Disorders Coalition for Research, Policy and Action in Washington, D.C.
Most studies that have been focused on prevalence were based on patients in treatment centers, who tended to be white females, Lilenfeld said. "That does not represent all of those who are suffering," she said. "It's hard to say if eating disorders are on the rise in males, or if we're just doing a better job of detecting it."
Rosen and his colleagues pored over more than 200 recent studies on eating disorders. While much is unknown about what triggers these conditions, experts now understand it takes more than media images of very thin women, although that's not to say those don't play a role, Rosen said.
Like other mental health problems and addictions, ranging from depression to anxiety disorder to alcoholism, family and twin studies have shown that eating disorders can run in families, indicating there's a strong genetic component, Rosen said.
"We used to think eating disorders were the consequences of bad family dynamics, that the media caused eating disorders or that individuals who had certain personality traits got eating disorders," Rosen said. "All of those can play a role, but it's just not that simple. All young women are exposed to the same media influences, but only a small percentage of them develop eating disorders. So what is different about those 1 percent that develop an eating disorder compared to the 99 percent who don't?"
At the same time as eating disorders have risen, the obesity epidemic has also exploded. Concerns about overweight and obese children have prompted some physicians to counsel their young patients about nutrition. That's an approach that can backfire when not handled correctly, however.
"There are lots of kids in my practice who say their eating disorder started when their family doctor told them, 'You could stand to lose a few pounds,'" Rosen said. "As physicians, we need to make sure our conversations are not inadvertently hurtful or impact their self esteem."
For people who are genetically vulnerable, dieting itself is a risk factor for eating disorders, while strict dieting is even a bigger risk, Lilenfeld said.
Parents and pediatricians should look for signs of eating disorders, including a child whose progress on growth charts suddenly changes, very restrictive eating, compulsive overexercising, making concerning statements about body image, vomiting, disappearing after meals or use of laxatives and diet pills.
Eating disorders, especially anorexia, can have long-term consequences for health, including leading to early osteoporosis and death.
"We know the sooner they get some evidence-based treatments, the better the outcome," Lilenfeld said.
"The good news is eating disorders can be 'cured' -- that is to say, the person isn't merely keeping the condition at bay but can actually get over it," Rosen said. With treatment and maturity, many kids move beyond the eating disorder.
"The conventional wisdom is eating disorders are incurable. You have them for life, you never get better and the best you can hope for is to keep it under control like alcoholism," Rosen said. "That's not the reality, particular for children and teenagers with eating disorders. The majority of children and adolescents get all better."
The U.S. National Institute of Mental Health has more on eating disorders.
Posted: November 2010
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