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Expert sees growing problem of youngsters with eating disorders

Dr. David Rosen says, 'We should start to be concerned when children express weight concerns … or if their activity level suddenly rises outside of usual recreational or athletic activities.'

January 09, 2011
  • The government published data that showed that kids under 12 were the fastest-growing population of patients hospitalized for eating disorders.
The government published data that showed that kids under 12 were the fastest-growing…

With so much attention focused on rising rates of obesity among children and teens, it can be easy to overlook kids who eat too little or purge after they binge. But government data suggest that eating disorders are actually on the rise among children, for reasons researchers are still working to understand.

Dr. David S. Rosen, professor of adolescent medicine, pediatrics and internal medicine at the University of Michigan Health System, is an expert on eating disorders in kids. He discussed this growing problem in a recent Web chat hosted by Chicago Tribune health reporter Deborah L. Shelton.

How common are eating disorders in children, and why is this a growing problem?

Anorexia nervosa and bulimia nervosa are relatively uncommon, but there are many people with eating disorders whose symptoms fall short of the strict criteria necessary to make one of those diagnoses. We don't have exact numbers for children, but we believe the problem is growing. In 2009, the government published data that showed that kids under 12 were the fastest-growing population of patients hospitalized for eating disorders.

How young are these children?

I've seen eating disorders in kids as young as 7 or 8, and I have colleagues that have seen even younger patients. In very young patients, the disorders often look quite atypical, making the diagnosis (and treatment) more complex.

My most common patients now start at ages 11, 12 and 13.

What are the red flags that indicate a child might have an eating disorder?

Changes in eating, weight loss, growth retardation, and in girls old enough to be menstruating, loss of periods.

But I would argue that we ought to recognize eating disorders before we see these symptoms. We should start to be concerned when children express weight concerns, when they talk about or start diets, or if their activity level suddenly rises outside of usual recreational or athletic activities.

Social pressure to be thin is enormous, especially among girls. Is media the main issue here or is it something else?

Our old belief was that eating disorders were caused by media effects, or psychological issues, often related to family dysfunction. Any effort to explain eating disorders based on a single cause will be overly simplistic.

In our more up-to-date understanding, media effects, psychological issues and family dysfunction sometimes play roles, but we now recognize a strong genetic component to eating disorders. They run in families. Individual psychological characteristics, family dynamics and media influences contribute as well, but usually do so in the context of someone who is already predisposed to the possibility of an eating disorder.

How do you bring up the subject with someone when you suspect they have an eating disorder?

It depends on the age. I would try not to be confrontational. Express your concern. Tell them you are worried. Don't be drawn into an argument about whether there is or isn't a problem. Suggest that they see someone to help figure out if there is a problem or not.

This chat was edited for space and clarity from a longer discussion. For more on this conversation, go to latimes.com/Rosen. For upcoming Web chats with experts on sports medicine, children's health, aging, diseases, insurance and other topics, please visit latimes.com/healthchats.

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