Recognizing an Eating Disorder

This week’s guest columnist is Jacob Clement, MD a family practice resident at Ochsner University Hospital & Clinics.
 
“Why is my child such a picky eater?”, a concerned mom asked me. “She doesn’t eat anything.” The teen was 15 years-old, and she lost 25 lbs since her last visit. She already had blood tests and x-rays because of months of abdominal pain. She was a straight-A student and avid runner. The answer to her pain and weight loss was hiding in plain sight.
 
Many parents have anxiety about picky eaters. No one wants their kid to starve and when children seem to not eat enough, they wonder. When that child is healthy, is gaining weight on the growth chart, it's time for some light-hearted reassurance: I too used to only eat pizza and chicken nuggets, and fussy eating is normal for many kids. Somehow they're getting enough calories to survive and thrive. But my 15-year-old patient wasn't thriving, she was losing weight.
 
Given the teen’s normal tests and her controlling personality, it seemed she had an eating disorder- Anorexia Nervosa. When children lose weight from a medical condition like Crohn's Disease, they've got indications on their tests. When overweight kids go on diets, it's also obvious and parents are typically involved in the weight-loss process, collaborating with meal and exercise planning. But this girl had already been skinny and athletic, was losing further weight and the parents didn’t know she’d purposefully skipped meals and over-exercised. 
 
Eating disorders are complex, with serious physical, mental and psychosocial issues. They're often missed because the signs aren’t always dramatic like my patient's weight loss. Kids hide that they're severely dieting. Parents also buy into kids’ anxiety about weight, given fat-shaming and social media’s “ideal” body image. 

Jennifer Aniston is candid about her weight. Before her TV hit “Friends”, she was a good actor landing guest TV parts and movie roles, but just hadn’t had major success. Then her agent told her Hollywood was tough on actresses and women. Since people look heavier on camera, she should lose weight, even though she was fit. Aniston admitted her diet could improve, having “too many mayonnaise sandwiches” for one. She dropped 30 pounds just in time for her “Friends” audition.
 
Most Americans could eat fewer calories. But there's some kids, like my 15-year-old patient above, who take weight loss to unhealthy extremes. Anorexic teens refuse to stay at a normal weight. They see fat when they look in the mirror, even if they're thin. They skip meals, exercise excessively, sometimes take laxatives or make themselves vomit. Look for physical signs like thinning hair, brittle nails and dry skin. 
 
Bulimia is another eating disorder, with binge eating followed by induced vomiting and laxatives to expel the food. Warning signs include over-eating when stressed, disappearing after meals and strict dieting followed again by high-calorie binging. Bulimia is tougher to spot, since these kids have normal weight. 
 
About 20% of kids with Anorexia, if untreated, will die. They get blood chemistry imbalances that lead to heart arrhythmias, seizures and comas. And only one in ten kids with eating disorders gets treatment. If you spot any of the above signs in teens, talk to them. 
 
If they seem in denial, see their doctor. If losing weight, they need testing. My patient above had a dangerously low potassium level, along with other scary labs and was hospitalized. Fortunately, we “tuned up” her blood chemistry and she then got good mental health treatment.