Even Normal-Weight Teens Can Have Dangerous Eating Disorders, Study Finds08/26/14
TUESDAY, Aug. 26, 2014 (HealthDay News) -- Teenagers do not need
to be rail thin to be practicing the dangerous eating behaviors
associated with anorexia, a new study suggests.
Rather, the true measure of trouble may be significant weight
loss, and the Australian researchers noted that a drastic drop in
weight carries the same risk for life-threatening medical problems
even if the patient is a normal weight.
Even more concerning, the scientists saw a nearly sixfold
increase in this type of patient during the six-year study
Anorexia nervosa is a mental illness characterized by excessive
weight loss and psychological symptoms that include a distorted
self-image and fear of weight gain. In some patients, this can also
include depression and anxiety. Those who have these symptoms but
are not underweight enough to qualify for the definition of
anorexia fall under a different diagnosis, known as Eating Disorder
Not Otherwise Specified (EDNOS-Wt).
"Emaciated bodies are the typical image portrayed in the media of patients with restricting eating disorders such as anorexia nervosa," said lead researcher Melissa Whitelaw, a clinical specialist dietitian at The Royal Children's Hospital in Melbourne, Australia. "This paper highlights that it is not so much about the weight but the weight loss that can lead to a serious eating disorder. The complications of malnutrition can occur at any weight."
In her study, which included 99 teens aged 12 to 19, Whitelaw
found only 8 percent of the patients had EDNOS-Wt in 2005, but more
than 47 percent of the patients had it in 2009.
"I was surprised to see how much it increased," Whitelaw said. "I was also surprised at how similar they were not only physically but also psychologically. Everything about them was anorexia except that they don't look really skinny." Both groups had even lost a similar amount of weight: a median 28 pounds for those with anorexia and 29 pounds for those with EDNOS-Wt.
Other experts noted that it can be difficult to spot this less
obvious eating disorder.
"We are conditioned to think that the key feature of anorexia nervosa is low body mass index [BMI]," said Cynthia Bulik, director of the Center of Excellence for Eating Disorders at the University of North Carolina at Chapel Hill. BMI measures whether a person is a healthy weight for their height.
"In fact, we miss a lot of eating disorders when focusing primarily on weight," Bulik added.
Leslie Sim, an assistant professor of psychology at Mayo Clinic
Children's Center in Rochester, Minn., said, "People are calling it
atypical anorexia, but we see it every day. We see people who have
all the psychological, behavioral, cognitive and physical symptoms
of anorexia nervosa, but the only difference is their weight."
In this study, the side effects of having an eating disorder
were also very similar. Dangerously low phosphate levels occurred
in 41 percent of anorexia patients and 39 percent of EDNOS-Wt
patients. The lowest pulse for the teens was 45 beats per minute
(bpm) for those with anorexia and 47 bpm for the other group.
Meanwhile, 38 percent of the EDNOS-Wt patients and 30 percent of
the anorexia patients required tube feeding.
"[Normal-weight patients with anorexia symptoms] were becoming medically unstable, despite the fact that they had what you would call a normal body weight," Whitelaw said.
The reasons for the apparent increase in these patients is less
clear, but both Sim and Whitelaw said it is likely a combination of
increased awareness of the problem and an increased focus on
obesity. One tricky aspect of identifying these patients, Sim said,
is that the weight loss appears at first to be a positive
"These patients just fly under the radar and when they're in that earlier stage, it's harder for people to see it," Sim said. "Parents say to me every day, 'I thought my daughter was doing something good and making healthy choices until it got out of control. We didn't know it was a problem until she couldn't eat the cake at her birthday party.' "
The experts emphasized that eating disorders are not parents'
fault. Instead, parents can play an important role in identifying
the symptoms of an eating disorder, especially in its early stages,
said Jessica Feldman, a licensed social worker and site director of
The Renfrew Center in Radnor, Pa. Symptoms include significant
changes in eating patterns, excessive exercising, a teen's negative
statements about their body image, an increase in depression or
anxiety, and a loss of interest in previously enjoyable
Bulik stressed the importance of recognizing that both
conditions are illnesses.
"No one chooses to have an illness. We would never tell someone with allergies to 'just stop sneezing,'" Bulik said. "Although dieting might be a first step, the illness takes over and develops a life of its own -- sufferers often cannot eat, even if they want to."
National Eating Disorders Associationfor more on
Copyright © 2014
. All rights reserved.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.