Pediatrics Common Questions, Quick Answers

Eating Disorders: Anorexia and Bulimia

Donna D'Alessandro, M.D.
Lindsay Huth, B.A.
Peer Review Status: Internally Reviewed
Creation Date: May 2002
Last Revision Date: May 2002

• What is an eating disorder?
• Who can get it?
• What causes it?
• What are signs that my child has an eating disorder?
• How can an eating disorder affect my child's health?
• What can I do to help?
• How is it treated?
• How long does it last?
• Can it be prevented?
• When should I call the doctor?

What is an eating disorder?

• Eating disorders involve negative thoughts and feelings about food.
• A person with an eating disorder has negative thoughts about her appearance.
• Her eating behavior harms her health.

Anorexia Nervosa

• A person with anorexia denies herself food, even when she is hungry.
• She starves herself to be thin.
• She loses a lot of weight.
• Even as she loses weight, she continues to think she is fat.

Bulimia Nervosa

• A person with bulimia binges (eats a large amount) and then purges (tries to get rid of the calories).
• Bulimics purge by vomiting, strict dieting, fasting (not eating), exercising, or by taking laxatives.
• During a binge, people have an uncontrollable urge to eat.
• Bulimics' weight may go up and down, but they usually do not lose a large amount of weight.

Eating Disorders Not Otherwise Specified (ED-NOS)

• Binge eating.
• Feeling guilty, embarrassed, and disgusted with self after eating, but not purging.
• Having a very low weight, may often diet even though thin, but still gets menstrual period.
• Weight may not change but person has other symptoms of an eating disorder.

Who can get it?

• Anyone can develop an eating disorder: men, women, boys and girls. It is most common in girls.
• Many teenage girls and college girls in the United States have eating disorders.
• Young children may even worry about food and calories.
• People with anorexia tend to be shy, high achievers, who put a lot of pressure on themselves to be perfect. They often are not sexually active because they are embarrassed about their bodies.
• People with bulimia are often outgoing and sometimes make quick, unwise decisions. They are more likely than anorexics to abuse drugs and alcohol or have problems with the law.
• Children in sports or activities that focus on weight, such as dance, running, gymnastics, or wrestling, are more likely to develop an eating disorder.
• People with a family history of depression, eating disorders, or substance abuse are more likely to have an eating disorder.
• Adolescents are at risk for developing eating disorders.

What causes it?

• Doctors do not always know why someone has an eating disorder.
• It may be caused by the way a person's brain or body works.
• Different types of stress can lead to an eating disorder.
• People often develop the disorder as a way to cope with other problems.
• Depression, problems with family or friends, or pressure from school or sports are examples of stress.
• Sometimes, people put pressure on themselves, or the pressure might come from teachers, coaches, or parents.
• Media images are part of the problem. Women and men in movies are usually very thin, sending the message that only skinny people are beautiful.

What are signs that my child has an eating disorder?

• People who have eating disorders are often very good at hiding them.
• People with an eating disorder may seem overly interested in food or worried about food.
• They may not enjoy food.
• They may have strange rituals and routines about food.
• They may make excuses for losing weight or not eating.
• They often convince themselves and others that they aren't hungry and don't need to eat.
• They may hide weight loss by wearing baggy clothes.

Anorexia

• extreme weight loss
• dieting (even if thin)
• feeling fat, even after losing weight
• extreme fear of gaining weight
• menstrual periods stop
• spends a lot of time worrying and talking about food and calories
• preferring to eat alone, embarrassed to eat in front of others
• feels that she needs to exercise
• binge eating and purging
• sleep problems
• brittle, dry hair or nails
• depression, avoids family and friends
• eating in many very small bites but never eating very much
• often seems weak and tired
• is often cold
• drinks large amounts of caffeine for energy
• loss of hair
• dry skin
• furry, soft hair on the face, back, and arms

Bulimia

• binge eating, even if not hungry
• purging
• using laxatives to lose weight
• uses the bathroom often after meals
• red finger(s) from making herself vomit
• swollen cheeks or glands
• worries an unusual amount about her weight
• depression, mood swings
• periods are not regular
• tooth decay
• heartburn, bloating
• drug abuse
• impulsive sexual activity
• problems with the law
• eats in private
• hides what she eats from others

How can an eating disorder affect my child's health?

• Eating disorders can lead to dehydration.
• They can cause dizziness, fainting, irritability, and confusion.
• They can make it hard to concentrate or remember things.
• Anorexia can stunt growth, delay puberty, and lead to bone problems. It also can cause problems with the heart, stomach, and intestines.
• Bulimia can cause tears and irritation in the esophagus, stomach, and intestines. It also can lead to blood pressure problems and tooth decay. It can damage metabolism.
• If eating disorders are left untreated, they can lead to death.

What can I do to help?

• If you are concerned your child has an eating disorder, talk to her about why she needs to see the doctor.
• Talking about the disorder may be difficult. If your child knows she has an eating disorder, she may deny it. Or, your child may not understand that she has a disorder. People who lose weight are often praised for being thin, making it hard for a person with an eating disorder to see that she has a problem.
• After it is clear she has an eating disorder, avoid talking about her appearance or food. Any comment you make may be taken the wrong way and can slow down her recovery.
• Give your child love, support, and affection.
• Be patient. It may take your child a long time to get better.
• Do not force her to eat. Avoid power struggles over food.
• Talk to your doctor if you are concerned your child has not eaten enough lately.

How is it treated?

• Talk to your doctor if you think your child has an eating disorder.
• The earlier you can start treating the problem, the quicker treatment usually is.
• The doctor will help your child think about food differently so that she can have normal eating habits. She may need to talk to a therapist.
• If your child has lost a lot of weight, doctors or nutritionists will encourage her to gain weight. They will teach her how to do it safely.
• If your child has lost an extreme amount of weight, she may need to stay in the hospital.
• Sometimes, medication can help control abnormal eating behaviors.

How long does it last?

• A person can have an eating disorder her whole life if it goes unnoticed.
• If left untreated, the disorder can lead to death.
• With treatment, recovering from an eating disorder takes different amounts of time for different people.
• Some people describe feeling completely free from the disorder after treatment.
• Others may still have negative thoughts about their appearance or food even after treatment, but may have learned how to maintain a healthy weight.

Can it be prevented?

• Do not let children tease or use nicknames related to weight.
• Focus on your child's strengths and encourage her to get involved with things she is good at. Having high self-esteem will make your child want to take care of her body.
• Parents should avoid focusing too much on weight, calories, or food. Never put a child on a diet without talking to the doctor first. Instead, replace unhealthy food with healthy food.
• Children should be allowed to eat when they are hungry and allowed to stop eating when they are full. Do not make children "clean their plate." (That is to say, do not make them eat until every bite is gone.)
• Parents should not complain about their own weight in front of their children.
• Encourage a healthy body image. Focus on helping your children feel strong and energetic instead of on losing weight or being thin.
• Exercise together as a family. Be active. Eat healthy together.
• Encourage your child to help you cook nutritious meals.

When should I call the doctor?

• Call the doctor if you think your child has an eating disorder.
• Call the doctor if you think your child has lost too much weight or is not eating enough.
• Call the doctor if you have questions or concerns about your child's condition.

Quick Answers

• A person with an eating disorder has negative thoughts about her appearance and food. Her eating behaviors hurt her health.
• Anyone can have an eating disorder: men, boys, women, and girls.
• People with eating disorders are often trying to cope with other problems in their lives.
• People with eating disorders may lose weight, complain that they feel fat, prefer to eat in private, or worry about food and talk about food a lot.
• Eating disorders can cause problems with the heart, stomach, intestines, metabolism, and hurt memory and concentration.
• Talk to your doctor if you think your child has lost too much weight lately, is not eating enough, or has other symptoms of an eating disorder.
• Doctors will help your child think about food differently so that she can have healthy eating habits and maintain a healthy weight.
• With treatment, recovering from an eating disorder takes different people different amounts of time.
• Help your children lead a healthy lifestyle. Eat nutritious food and exercise. Focus on feeling strong and healthy instead of on being thin and losing weight.
• Call the doctor if you have questions or concerns.

References

• Goodman RF, Gurian A. About Eating Disorders. AboutOurKids. (cited 2002 April 1). URL: http://www.aboutourkids.org/articles/about_eating.html
• Jacobs C, Chase L, Frates S. Information About Eating Disorders. Children's Hospital Boston: Center For Young Women's Health. 2001 (cited 2002 April 1). URL: http://www.youngwomenshealth.org/eating_disorders.html
• Rutherford K. Eating Disorders. KidsHealth. 2001 September (cited 2002 April 1). URL: http://kidshealth.org/parent/emotions/feelings/eating_disorders.html

See related Patient Topics Child and Teen Health, Eating Disorders, Food, Nutrition and Metabolism, Mental Health and Behavior or Teen Health.

See related Provider Topics Child and Teen Health, Food, Nutrition and Metabolism, Mental Health and Behavior or Teen Health.

All contents copyright © 1992-2004 the Author(s) and The University of Iowa. All rights reserved.

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