Eating Disorders: What Teens Need to Know
What should I know about eating disorders?
Most importantly, you should know that Eating disorders require medical attention!
- The National Institute of Mental Health has an online brochure on eating disorders.
- Read Eating Disorders: Anorexia and Bulimia for general information.
- Also in Spanish: Trastornos de la alimentación: Anorexia y Bulimia.
The two best-known types of eating disorders are anorexia nervosa and bulimia nervosa. They can occur separately or together in the same person. A person who has an eating disorder is not necessarily skinny. Some people with eating disorders are even overweight. Binge eating disorder is another kind of eating disorder.
Can men and boys have eating disorders?
Eating disorders most often affect girls and women, but boys and men can also have an eating disorder. One out of every four pre-adolescent kids with anorexia is a boy. Binge eating disorder affects about the same number of females and males1.
- Read a story about Stephen’s problem.
What is anorexia nervosa?
To be diagnosed with anorexia, a person must:
- Be 15% below their ideal weight
- Have an intense fear of being fat, even though they are underweight
- Have a distorted image of their body and denial of the problem of their being underweight
- Have amenorrhea (missing at least 3 periods in a row)
- May also binge and purge
Anorexia usually affects teens, and mostly girls. An estimated 1% of white females have anorexia nervosa. It is more common among people in higher income groups, and in groups that value thinness (like athletes, ballet dancers and models). It usually starts around ages 13-14 or ages 17-18.
What is bulimia?
To receive a diagnosis of bulimia nervosa, a person must:
- Binge eat (eat larger amounts of food in a given period of time than most people would normally eat in similar situation)
- Feel a lack of control during binge eating
- Purge the excess food by making themselves vomit, fasting (not eating for 24 hours), exercising excessively (for more than an hour), or abusing diet pills, laxatives, enemas, or diuretics (water pills)
- Binge and purge regularly over a period of time
- Have a self-image based mostly on their body shape and weight instead of other qualities
People with bulimia may be anywhere from underweight, to normal weight, to overweight. It is estimated that as much as 3% of college-aged women have bulimia.
What is binge eating disorder?
Binge eating disorder is diagnosed when a person:
- Continues to binge eat over time (eating larger amounts of food in a given period of time than most people would normally eat in similar situation)
- Feels a lack of control during binge eating
- Eats fast during binges
- Overeats until uncomfortable
- Eats a lot when not hungry
- Eats alone out of embarrassment
- Feels disgusted with themselves, depressed or very guilty after overeating
- Is worried about their binge eating
Binge eating disorder does not include the purging consistent with anorexia and bulimia. About 40% of obese people may have this problem.
- See the National Institutes of Health guide to binge eating disorders for more information.
What are the signs of an eating disorder?
Look for these warning signs and symptoms:
- Eating tiny portions or refusing to eat
- Intense fear of being fat
- Distorted body image
- Strenuous exercising (for more than an hour)
- Hoarding and hiding food
- Eating in secret
- Disappearing after eating—often to the bathroom
- Large changes in weight, both up and down
- Social withdrawal
- Depression
- Irritability
- Hiding weight loss by wearing bulky clothes
- Little concern over extreme weight loss
- Stomach cramps
- Menstrual irregularities—missing periods
- Dizziness
- Feeling cold all the time
- Sleep problems
- Cuts and calluses across the top of finger joints (from sticking finger down throat to cause vomiting)
- Dry skin
- Puffy face
- Fine hair on body
- Thinning of hair on head, dry and brittle hair
- Cavities, or discoloration of teeth, from vomiting
- Muscle weakness
- Yellow skin
- Cold, mottled hands and feet or swelling of feet
If your or your friend has some of these signs, it’s time to see the doctor right away. There are some diseases that can appear to be an eating disorder that would need to be ruled out. If the eating disorder is not treated, it can become life threatening.
What causes eating disorders?
The exact causes of eating disorders are not known for sure. Many different factors working together probably cause a person to develop an eating disorder. Dieting can lead to eating disorders, with the greatest risk to severe dieters. Around two-thirds of new cases of eating disorder are in girls and women who have dieted moderately.2
Are eating disorders dangerous?
Many dangerous medical and psychological problems can result from eating disorders. Eating disorders can be deadly. They require medical attention!
What if I think my friend may have an eating disorder?
- Learn the warning signs and how to help your friend.
- Answer these questions to see if you or someone you care about may have disordered eating.
- In a calm and caring way, tell your friend what you saw or heard. Use "I” statements and let him or her know you are concerned. For example, "I'm worried about you because you haven't eaten lunch this week.”
- Listen carefully to what your friend says. Teens with eating disorders might feel ashamed or afraid. They may think that life doesn't matter. Feeling out of control is also common.
- What if they get mad or deny it? It is very common for kids with problems to say that there is nothing wrong. Tell them you want to help.
- If your friend won’t get help, you should talk to your parents, your school counselor, or your friend’s parents. It may feel weird to “go behind their back” like this, but it could save their life.
- Find out more about what to do if you think your friend has an eating disorder.
- It’s my life: How to get help for yourself or a friend
Is it dangerous to use medications to lose weight?
The products a person might use to lose weight can be very dangerous. The regular use of diuretics (water pills), laxatives, and weight loss pills can cause a variety of life threatening problems, even if they don’t cause very much weight loss. Using syrup of ipecac to cause vomiting can also lead to life threatening complications.
How can I tell what's a sensible diet?
Generally speaking, most kids and teens should not be on a restrictive diet. In fact, restricting eating to control weight is not only doesn’t work, but dieting actually promotes weight gain in tweens and teens3 4.
Read up on dieting vs. sensible eating habits:
- Fad Diets vs. Healthy Weight management
- The Deal With Diets—includes dieting danger signs
- Should I Go on a Diet?—talks about the constant focus on dieting and weight, and is also available in Spanish.
- Diet-Plan Diagnosis: Is Yours Healthy and Safe?—also in Spanish
- How Can I Lose Weight Safely?—also in Spanish
- Is Dieting OK for Kids?
- Meal Times Matter!—eat dinner with your family
How can I tell if my weight is healthy for me?
If you are concerned about your weight, you should talk to your parents, your doctor, your gym teacher or another trusted adult. Your doctor or nurse can tell you whether your weight is healthy for you. They have checked your weight and height over time and will know if you are growing normally. They can plot your weight and height on a growth chart. Your health care provider can also check your body mass index (BMI).
How do you get started in treatment for an eating disorder?
The first goal in treating severe anorexia is to improve your nutrition and eating habits. Then, the goals will focus on learning about nutrition and normal eating patterns, improving self-esteem, relating to others, interacting with family, and treating medical and other psychological problems.
- To get started, call the National Eating Disorders Association’s Toll-Free Information and Referral HelpLine at 1-800-931-2237.
- Seeking treatment—this page includes links to more resources, such as questions to ask when choosing a treatment provider and treatment options, getting insurance coverage, and suggested medical tests.
- Find a Registered Dietician in your area through the American Dietetic Association’s website.
What is body Dysmorphic disorder (BDD)?
Body Dysmorphic Disorder (BDD) means thinking about what you look like much more than normal. It also involves thinking too much about real or imagined defects in how you look. It is a kind of distorted thinking. It affects males and females about equally.
Find out more about BDD here:
- List of clues to BDD's presence
- Books and articles about the disorder
If you think you have BDD or body image problems, you should talk to your parents, doctor, school counselor or other trusted adult. They can assist you in getting help to feel better about yourself.
How can these problems be prevented?
Our society is pretty confusing. On the one hand, we see idealized (and often air-brushed!) pictures of “perfect,” skinny stars and models all over. On the other hand, we get bombarded with ads for unhealthy foods. Our families might talk about “good foods” and “bad foods,” and our parents and friends might often be on restrictive diets, and talk about what’s “wrong” with their bodies.
There are things you can do to feel good about yourself and your body, like these ten steps to positive body image (diez pasos hacia una imagen positive.You can also learn to be media literate, which will help protect you from harmful messages about food, eating, and body size from TV, music videos, magazines, and ads. Avoid women’s fashion magazines, which one study found linked to trying to lose weight.
What are some good books about eating disorders, healthy eating and body image?
Here is a list of books on a range of eating and body image topics, many aimed at teens.
What are some other resources?
- YourChild: Feeding Your Child and Teen
- YourChild: Media and Media Literacy
- YourChild: Obesity and Overweight
- For students, staff and faculty at the University of Michigan, find out about UM resources and services that can help with eating and body image problems.
- Children and Adolescents With Eating Disorders: The State of the Art is an article from the journal Pediatrics. It is a scholarly review of the research and outlines issues relevant to the care of the adolescent patient with an eating disorder.
- The National Eating Disorders Association is the largest not-for-profit organization in the United States working to prevent eating disorders, eliminate body dissatisfaction, and provide treatment referrals to those suffering from anorexia, bulimia and binge eating disorder and those concerned with body image, eating and weight issues. Their Web site offers information about eating disorders and body image; referrals to treatment centers, doctors, therapists, and support groups; opportunities to get involved in prevention efforts; prevention programs for all ages; and educational materials. Call 1-206 382-3587 for more information. Call the Toll-Free Information and Referral HelpLine at 1-800-931-2237.
- The National Association of Anorexia Nervosa and Associated Disorders (ANAD) has an international network of support groups, offers referrals to health care professionals, publishes a newsletter, and will mail information packets customized to individual needs upon request. They work to educate the public, promote research projects, and fight insurance discrimination and dangerous advertising. Their national hotline (847-831-3438) can give you a listing of support groups and referrals in your area.
- The Something Fishy Website on Eating Disorders has lots of resources of all kinds, including information and online support. (Scales are for Fish!)
- The Academy of Eating Disorders is an organization for professionals from all fields who deal with eating disorders. Phone 703-556-9222.
- Overeaters Anonymous is a twelve-step program offering support for recovering from compulsive overeating. Phone 505-891-2664.
- About-Face focuses on the impact mass media have on the physical, mental and emotional well being of women and girls. They challenge our culture's overemphasis on physical appearance and encourage critical thinking about the media. Phone 1-415-436-0212.
- The Vegetarian Resource Group (VRG) educates the public on vegetarianism, health, nutrition, and more.
- The American Dietetic Association has information on good nutrition, sensible eating habits. Phone: 1-800-877-1600, ext. 5000 (for publications).
- The Weight-control Information Network provides the general public, health professionals, the media, and Congress with up-to-date, science-based information on weight control, obesity, physical activity, and related nutritional issues. Phone: (202) 828-1025 or 1-877-946-4627.
- The EatRight Nutrition Information Service (NIS) at the University of Alabama-Birmingham provides up-to-date, accurate and useful nutrition, health, and food information to the community and to health care professionals. Through community workshops, information fact sheets, and the hotline, the NIS answers questions and helps people reach their health goals. The national hotline can be reached at 1-800-231-DIET. Hours are 8:00 am to 4:00 pm Monday through Friday.
- The Council on Size and Weight Discrimination, Inc. provides information on eating disorders, "sizism," the non-dieting movement, and size discrimination. Phone: (914) 679-1209.
- The National Association to Advance Fat Acceptance provides support and attempts to eliminate discrimination against fat people. Provides information to health professionals on how to treat very large patients (e.g., weighing). Phone: (916) 558-6880.
- Gurze Books sells books on eating disorders and related topics.
2 Patton GC, Selzer R, Coffey C, Carlin JB, Wolfe R. Onset of eating disorders: population based cohort over 3 years. BMJ.1999; 318:765 –768
3. Field AE, Austin SB, Taylor CB, Malspeis S, Rosner B, Rockett HR, Gillman MW, and Colditz GA. Relation Between Dieting and Weight Change Among Preadolescents and Adolescents. Pediatrics, Oct 2003; 112: 900-906.
4. Neumark-Sztainer D, Wall M, Guo J, Story M, Haines J, Eisenberg M. Obesity, disordered eating, and eating disorders in a longitudinal study of adolescents: how do dieters fare 5 years later? J Am Diet Assoc. 2006 Apr;106(4):559-68.
Written and compiled by Kyla Boyse, RN. Reviewed by David Rosen, MD, MPH.
May 2008
