I see a lot of girls who are preoccupied with their weight. It seems that more and more girls, at younger and younger ages begin to ask, "am I fat?" or "does this dress make me look fat?" or even "why do I have a fat on my stomach that I can pinch?".
The world we live bombards young girls with images of being thin and of the "perfect body". We all know that a Barbie doll is not a realistic image of a woman's body, just as the cover of People magazine or the cover of Teen Vogue is also not always "real". Many models are 10-20% below their ideal weight, and movie stars often have their pictures "photo-shopped" to appear thinner. The obsession with being thin has only continued to contribute to the increasing incidence of eating disorders, in girls as young as 10 and 11.
Anorexia and bulimia are both examples of eating disorders. Anorexia is a syndrome in which there is insufficient caloric intake to maintain normal weight and growth, which is associated with a disturbed body perception, an intense fear of weight gain, and obsession of being thinner. Girls (who are more commonly affected) truly believe that they are fat, even when they are emaciated and they fail to be able to distinguish a healthy weight.
Anorexia occurs in about 1% of the adolescent population, and is most commonly seen in females (90%), who are Caucasian (95%). It is also seen more commonly in middle to upper middle class families.
Bulimia is defined as binge eating followed by compensatory behavior in order to prevent weight gain. These behaviors may include vomiting (purging), laxative abuse, diuretic usage, stimulant abuse, and enemas.
Girls who develop eating disorders often have many common personality characteristics. They are typically pretty, over achieving, perfectionistic, anxious, sensitive, self critical, and have a desire to please others. They often will say that their eating disorder "gave them a sense of control in a world out of control".
I see many young girls (and I have treated 2 anorexic teen age boys) who have what I call, "disordered eating". In other words, they are the picky eater who has gotten even more picky. They are suddenly obsessive about food, count calories, weigh their food or talk about being fat. They talk about diets and may have mother's who are very self conscious about their weight as well who may also have "eating issues". There is often discussion at meals about who will eat what, how much and when. Mealtime is often an anxiety provoking, stressful "event". In other words, food has become a preoccupation. These symptoms coupled with a preoccupation about appearance and body image are warning signs of developing a full blown eating disorder.
If your child is showing any of these symptoms, and you see abnormal weight loss or unusual behaviors surrounding eating and mealtime the most important thing you can do is to talk to your doctor. Do not wait until your child has a full blown eating disorder. You do not have to see your daughter have weight loss, missed periods, secretive behaviors surrounding mealtimes, evidence of binge eating, or ritualized eating behaviors to be concerned about a possible eating disorder. The earlier the problem is recognized and addressed the easier it is to treat.
Both anorexia and bulimia treatments are intensive and involve an interdisciplinary approach. Treatment teams should include your primary care physician (who is comfortable treating eating disorders), a psychiatrist and/or psychologist, and a nutritionist. It takes a team to treat these issues. It also takes a great deal of family involvement, including both individual and family therapy.
The best advice I have is to begin family mealtimes at young ages where the focus is on eating a healthy meal together. Less focus on food and more focus on family values, attitudes and behaviors will help to instill healthy eating habits. A little family exercise is a good thing too.
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