TEEN HEALTH: Eating Disorders in our Midst

by Dr. Ann L. Engelland

Ask Dr. Engelland a question

(February 22, 2004) Eating disorders are creating major medical problems across the country –and right here in Larchmont. Though we’re relatively savvy and sophisticated in Westchester, kids and their parents can get caught up in unhealthy eating patterns that lead to anorexia, bulimia, binge eating and obesity.

In my own practice of adolescent medicine, I see all types of disorders at all stages from the “picky eater” to the full-blown anorexic. If we intervene early and effectively, many patients can be “turned around” before they head towards a lifetime struggle with potentially serious and life-threatening consequences, including bone disease, infertility, and hormone disorder.

It may start like this...

You notice your 12 year-old daughter, until now a typical Hommocks seventh grader, is unhappy with her stomach. She has begun to eat a lot of salad, push the pasta around her plate and walk the dog twice a day –without you even asking.

What should you do?

• Talk to your child about your observations and concerns.
  
  
• Don’t be afraid to say: “You know, I’m concerned that if you keep eating this way (picking at food, restricting calories, eating in secret, skipping meals) or thinking this way (expressing excessive concern about weight, exercising too much) you may develop an eating disorder.”

What if you get stonewalled?

“Mom, you’re exaggerating, as usual. I’m fine. Do you think I have anorexia or something?”

Remember, it is not uncommon for kids with eating disorders to persuasively deny that there is any problem. Keep your antennae up.

What if things don't improve?

Her dinner behavior continues. Her usual packed lunch comes home from school uneaten. She still has not had her first period, even though the doctor told her last year she would probably get it before now.

• Schedule a checkup for your child. Notify her doctor ahead of time about your concerns. Arrange for another visit in 4-6 weeks if you are still worried.
  
  
• If you are still worried, consider contacting a pediatrician with known interest and expertise in the field, or a specialist in eating disorders or adolescent medicine. Eating disorders are tricky for patients, parents, and medical providers. Even doctors may hesitate to “call a patient’s bluff” or alarm a family, particularly if they are unfamiliar with handling eating disorders.
  
  
• Most people with a confirmed eating disorder need a medical provider, a psychologist (or psychiatrist) and a dietician to manage their care.
  
  
• Try not to be hobbled by guilt. Eating disorders develop insidiously and often remain undiscovered and undiagnosed for many months before families realize what is happening. When I first see a patient in my office, much of what we do at first is to de-mystify and educate about eating disorder and figure out how we will work together. Taking action may take courage, but help is out there.

Local Resources

• Your local pediatrician or internist
  
  
• Local therapists-ask specifically if they have managed eating disorder cases
  
  
• Adolescent Medicine Providers are specially trained in managing and coordinating care for patients with eating disorders.
  
  
• Center for Eating Disorders and Recovery, located in Mt Kisco and Scarsdale
  
  
• New York Hospital/Cornell Westchester
  
  
• North Shore/LIJ Hospital, Division of Adolescent Medicine
  

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