Opposite of Obesity

This week's guest columnists are Dr. Jacob Sellers and Dr. Anna Malesky, Family Practice Residents at the University Hospital and Clinics here in Lafayette. Imagine this.  Your teen has been experiencing months of headaches, dizziness and fatigue.  You've been to countless doctors, had blood tests and EKGs, and finally she has a diagnosis.  "We don't know exactly how it happens," this last doctor explains, "but untreated, there's a 1 in 10 chance it could be fatal."  Your heart sinks.  Bad news continues: "It will take many months, even years, for your daughter to fully recover. She should be admitted to the hospital now to start treatment."  The diagnosis: Anorexia, a psychological illness that's more common than you'd think. Anorexia is an "eating disorder," wherein the teenager sees themselves as overweight, and goes to extremes to lose weight.  Even when skinny, anorexic teenagers still think they need to shed more pounds.  Their intense fear of weight gain leads to severe dieting, purging through vomiting or laxative use, and calorie burning through vigorous exercise.  Anorexia has the highest death rate of any psychiatric disorder, about 10%. Bulimia is the other common eating disorder, consisting of uncontrollable overeating, followed by distress and guilt.  This leads the teen to purge by vomiting, laxative use, and extreme exercise.  Eating disorders affect girls ten times more than boys, and these girls tend to be intelligent and capable, enabling them to achieve life-threatening feats of weight loss. These kids rarely seek help- they want to lose that weight.  Parents can miss the early warning signs too, being so busy with their jobs and other kids.  Teens often have vague complaints that mimic other common illnesses- headaches, fatigue, dizziness, abdominal pain.  They also have behavior changes that are passed off as normal teen "phases"- moodiness, wanting to be alone, body image concerns, frequent trips to the bathroom.  More obvious changes are noticeable weight loss, wanting to eat alone, and only eating at certain times.  Affected kids will refuse to eat favorite foods, not eat at restaurants, and not eat at holiday gatherings where the rest of the family is stuffing themselves.  If you notice these signs, get your child to their doctor for a weight check and evaluation. Teen girls are more susceptible to eating disorders, because mass media has always shown the ideal girl to be skinny.  TV, movies, and even Barbie dolls depict girls with unrealistic proportions, leading kids to have unrealistic expectations for their own body image.  Thus one facet of eating disorders, where even skinny girls still perceive themselves as overweight. Social media has complicated the issue with the rise of blogs and websites that encourage eating disorders.  These websites, often called "Pro-Ana" for anorexia promotion and "Pro-Mia" for bulimia, aim to support kids with this behavior by putting a positive spin on it, providing "thinspiration."  They post tips on how to vomit, how to dose laxatives most effectively, how to think about food to make it less appetizing, and most darkly, how to hide this behavior from parents. Like we mentioned above, teens rarely seek help for eating disorders.  Often they hide it so that no one interferes with their weight-loss efforts.  However, these behaviors can be life-threatening: 10% of anorexics will die if untreated.  Anorexia became a much better known illness after the famous singer Karen Carpenter died of heart failure at age 32 as a result of her weight loss.  Eating disorders can cause dehydration, heart arrhythmias, low blood pressure, slow heart rate, and low temperature. Thus it's important to be vigilant for the signs of eating disorders.  If your teen seems to be getting skinnier and skinnier, get her seen.  But some signs are often passed off as healthy activities, like dieting and exercise. Other signs can be attributed to teen "phases," like moodiness and wanting to be alone.  Physical symptoms include always being cold, dizziness and fatigue, and headaches.  Starvation also leads to thinning hair, brittle nails, dry and discolored skin, and loss of menstrual cycles.  Like we mentioned above, red flags are peculiar eating habits, like only eating at certain times, wanting to eat alone, or not eating with everyone else at restaurants or holiday gatherings. These are difficult illnesses to treat.  The sooner you recognize your teen's eating disorder and get her evaluated, the more successful the treatment, and the likelier you'll be to save her life.