With up to half of all adolescent girls engaging in some form of disordered eating - crash dieting, fasting, binge eating and vomiting - experts now urge that young people with anorexia or bulimia be treated differently from adults.
Sweeping new guidelines just published in the Journal of Adolescent Health say it’s vital that young people with eating disorders get medical as well as the traditional psychological care, because of possible irreversible damage to their reproductive systems, bones and growth.
Eating disorders are the third most common chronic illness among adolescent girls - behind obesity and asthma. As many as one of every 20 teenage girls is severely affected - and the problem is on the rise. Many more teen-age girls engage in what experts call disordered eating, meaning they have exhibited strange eating behavior at some time in the past. More than 10 percent of teenagers with anorexia nervosa die because of chemical imbalances or heart problems that occur when girls stop eating.
“What we’re trying to point out is that you can’t treat adolescents with eating disorders like adults with eating disorders because the potential complications are different - and may be long term and irreversible,” said Dr. Seth Ammerman, assistant clinical professor of adolescent medicine at Stanford University’s school of medicine, and a member of the panel that wrote the new guidelines.
“We’re suggesting that the criteria for diagnosing an adolescent with an eating disorder be broadened because by the time a teen is diagnosed using the traditional criteria, they are already in poor health.”
Ellen Kendrick could not agree more.
She was 16 when her doctor first noticed she was losing too much weight. Four months went by and Ellen’s 5-foot-3-inch frame kept getting thinner and thinner. When Ellen finally showed up for an informational meeting at the Eating Disorders Clinic at Lucille Packard Children’s Hospital at Stanford, she was hospitalized immediately and diagnosed with anorexia nervosa.
She weighed 75 pounds.
“I just remember that first night, they had me hooked up to heart monitors, you don’t really know what’s going on, you’re in this strange place,” said Ellen, now 21 and still in treatment at the clinic. “It terrified me.”
Five years later and 20 pounds heavier, Ellen is still fighting her way back from a disease she describes as a “destructive force that’s taken a lot of things away from me.” She credits her success to the clinic’s multidisciplinary approach: Every patient works closely with a doctor, psychiatrist or psychologist and nutritionist.
Anorexia nervosa is a disorder in which the person has a fear of fat and a distorted body image which leads to abnormal or restrictive eating patterns leading to weight loss and malnutrition. Bulimia is a severe concern with body size and shape that causes the person to purge to lose weight and is accompanied by bingeing.
These disorders primarily afflict females and some people theorize that societal pressures are the cause. But specialists say that if that were the case, all young girls would have eating disorders because they are inundated with pictures of bone-thin models every day in the media.
Doctors say that often one or both parents are controlling or overbearing and the affected children reacts by grasping control of the one thing they can - their bodies and what goes into them. Oddly enough, it is usually teachers, pediatricians or school nurses who notice the problem and suggest medical help and counseling.
Among the suggested guidelines in the report:
Adolescents with eating disorders should be treated by an interdisciplinary team consisting of medical, nursing, nutritional and mental health professionals. Those doctors should have an expertise in working with adolescent patients.
Early intervention is especially critical in adolescents because of the potentially irreversible damage, and even death, that could result.
Teens with eating disorders should not be denied access to care because of absent or inadequate health insurance. The labeling of the disorder as a purely psychiatric illness by some insurance companies limits hospitalization, restricts outpatient visits and puts lifetime caps on coverage.
Ammerman said that 50 percent of final adult weight is put on in adolescence and that young people with eating disorders don’t develop appropriately during puberty, which could lead to long-term problems including infertility.
The Eating Disorders Clinic at Stanford - founded in 1981 - drew 1,233 visits from new and established patients in the past year - up from 578 visits in the 1990-‘91 fiscal year and 823 visits in 1992-‘93. The average age group of patients at the clinic is 12 to 15, but some patients have been as young as seven years old.
Because eating disorders are so prevalent among teen-age girls, the suggestion that treatment of young people with those diseases must change is groundbreaking.
Hans Steiner, co-director of the clinic and professor of psychiatry at Stanford Medical School, said that too often people - including psychologists - treat anorexia and bulimia as psychiatric problems.
“There are a lot of people in the psychiatric field who are totally oblivious to the medical side of eating disorders and that can be very dangerous,” Steiner said. “They don’t understand the intricacies of malnutrition and sometimes they don’t even think about it.”
Another problem the report focuses on is the difficulty of getting health care insurance providers to pay for necessary hospital stays, long-term outpatient medical visits and psychiatric care.