Sarah appears to have an eating disorder. which of the following best describes her behavior?

Sarah had always been a healthy child. She got along well with her siblings, was an excellent student, and excelled as an athlete.  She had really pushed herself to become the captain of her cross-country team.

However, it took an annual physical exam to reveal that Sarah was not doing well.  Her pediatrician discovered that she had lost 15 pounds from the previous year and her periods, which had been regular, had stopped nine months earlier. Sarah’s mother had noticed that Sarah’s clothes now seemed to fit loosely, but she hadn’t noticed that anything else was different about her daughter.

Sarah’s pediatrician asked if Sarah had been eating OK. “Now that you mention it,” her mom said, “Sarah doesn’t eat dinner with us anymore.   She always says she eats after practice or isn’t hungry.”

This is a typical story for a young woman with a developing eating disorder, says Susan Brill, M.D., Chief, Division of Adolescent Medicine, The Children’s Hospital at Saint Peter’s University Hospital.

“Eating disorders are a complex group of conditions that often result in weight loss or failure to gain weight. But some individuals with eating disorders have a normal weight or are even overweight,” Dr. Brill says “When these children start losing weight they are often praised, delaying treatment for the problem. The root of the problem often isn’t about food. Rather, the eating issues are a way of coping with negative emotions or feelings.”

Here is  a closer look at eating disorders that can afflict kids and adults.

People who have anorexia nervosa have a distorted body image and do not see themselves as thin. They fear gaining weight and becoming fat. They will limit or restrict their intake of food and will lose or fail to gain weight as a result.  . When they are told to gain weight they become uncomfortable and upset, and sometimes refuse to eat altogether. They usually end up very underweight, which can produce severe health effects. Many young women will stop menstruating while suffering from this condition.  If they are younger than 12 when they develop it, they may not even get their first period.

Bulimia nervosa patients also fear gaining weight. However, they will eat too much at one time or binge. They then will compensate for their overeating by exercising excessively or forcing themselves to vomit, a behavior known as purging. The bulimic person can be thin, of normal weight, or overweight.

Children with eating issues sometimes don’t fit into those categories, but they still have odd eating habits, are frightened of eating certain foods, or they refuse to eat select food groups. There is a new category of eating disorder known as ARFID – Avoidant Restrictive Food Intake Disorder – which may best describe these individuals. This is a condition in which there is significant weight loss (or failure to achieve expected weight gain) that interferes with functioning at work or school. These youngsters aren’t concerned about body shape or weight but are focused more on the particular foods they want to avoid.  There is often anxiety when they have to try new foods or eat in front of family or friends.

Treatment

All eating disorders can affect a growing child’s health and need to be addressed. The sooner the eating disorders are recognized the better the treatment outcomes. Anyone suspected of having an eating disorder should have a comprehensive history and physical examination by a clinician experienced with these conditions.  Adolescent medicine specialists are often called upon to treat these conditions because they most commonly start during the teenage years.

In addition to a medical evaluation, there should be an assessment by a mental health professional and a nutritionist to assess the person’s emotional and nutritional needs. If the condition is severe, patients are best treated in a facility such as a hospital or an inpatient program in order to provide immediate and more intensive services and treatment.  Particular blood tests, cardiac testing and nutritional testing will be needed as patients begin medical and psychological treatment.

“Eating disorders can be modified and patients can do well with the proper treatment and mindset,” says Dr. Brill. “True, it may take years of intensive work to claim success, but the result will be a happier, healthier individual.”

Take our Saint Peter’s Better Health Library quiz to see how much you know about eating disorders.