It's common for kids - particularly teens - to be concerned about how they look and to feel self-conscious about their weight. During puberty, kids' bodies are changing dramatically and they are facing new social pressures, like attraction to the opposite sex.

Unfortunately, for a growing proportion of kids and teens, that concern grows into an obsession that causes dramatic weight fluctuation, interferes with normal daily life, and damages vital body functions.

Up to 10 million teens develop eating disorders, abnormal attitudes and behaviors with foods, which include anorexia nervosa or bulimia nervosa. For most kids, eating disorders begin when they are 11 to 13 years old. While they are more common among girls, boys can experience eating disorders too. Unfortunately, many kids and teens successfully hide these disorders from their families for months or years.

You can help prevent an eating disorder by nurturing your child's self-esteem, and healthy attitudes about nutrition and appearance. If you fear that your child has an eating disorder - because he or she has rapid weight fluctuation, and his or her concern about weight interferes with normal daily activities, it's important to approach your child about getting the proper medical care.

What Are Eating Disorders?

Generally, eating disorders involve self-critical, negative thoughts and feelings about body weight and food, and eating habits that disrupts normal body function, and daily life activities. A person with anorexia nervosa typically starves himself or herself to be thin and experiences excessive weight loss, typically 15% below the weight that doctors consider ideal for his or her height and age. In some cases of anorexia, in addition to restricting their food intake kids use purging - by vomiting or taking laxatives - to control their weight.

Bulimia is characterized by habitual binge eating and purging. A child with bulimia may experience weight fluctuations, but rarely experiences the low weight associated with anorexia. Both disorders tend to involve compulsive exercise.

For kids with eating disorders, there is a large gap between the way they see themselves, and the way that they actually look. Once a person is starved to a certain degree, body image distortions tend to become more severe and extreme. As he or she gets thinner and thinner, he or she keeps feeling "fat."

It's important to remember that an eating disorder is not just a behavior that a child can control. It is a medical condition that requires professional medical attention and treatment.

What Causes Eating Disorders?

What causes eating disorders is not entirely clear, though a combination of psychological, genetic, social and family factors are thought to contribute to the disorder.

Certain sports, such as ballet, gymnastics and wrestling are thought to potentially contribute to developing eating disorders because of the emphasis on leanness. There is also a role for genetics. Individuals who have a close relative with an eating disorder have an increased risk for also developing an eating disorder. There is also an increased incidence of psychiatric disorders, such as anxiety disorder and obsessive-compulsive disorder, amongst kids and teens with eating disorders. Sometimes, problems at home, such as drug or alcohol abuse, can put a child at higher risk to develop disordered eating behaviors.

Some research suggests that media images contribute to the rise in the incidence of eating disorders. Most women in advertising, movies, TV, and sports programs are very thin, and this may lead girls to think that the ideal of beauty is thinness. Boys, too, may try to emulate a media ideal by drastically restricting their eating and compulsively exercising.

And this concern can begin at an alarmingly young age. Research shows that 42% of first to third-grade girls want to be thinner, and 81% of 10-year-olds are afraid of being fat.

Frequently a child who develops an eating disorder has a low self-esteem and often the focus on weight is an attempt to regain a sense of control.

The Effects of Eating Disorders

While eating disorders result from a serious mental and behavioral health condition, they can lead to other serious physical health problems.

A child with anorexia or bulimia may experience dehydration as well as other medical complications. In advanced stages, it can affect the brain and cause symptoms such as dizziness, fainting, agitation, confusion, inability to concentrate, and loss of memory.

Anorexia may affect a child's growth, bone mass, cause puberty delays, an irregular heartbeat and blood pressure problems, and gastrointestinal problems. The continuous vomiting involved in bulimia can cause tears and severe inflammation of the esophagus, in addition to gastric disturbances, blood pressure problems, and erosion of tooth enamel.

Behavioral problems, such as sexual promiscuity, crime (often shoplifting), and drug and alcohol abuse are more common in teens with bulimia. When kids with bulimia are caught up in a binge eating and purging cycle, they tend to become very impulsive. They feel like they're invisible, or just feel really impulsive and embarrassed to buy some of the things that they want.

Warning Signs of Eating Disorders

It can be a challenge for parents to tell the difference between a child's normal self-image concerns, and warning signs that a child may be developing an eating disorder.

While kids and teens - girls in particular - are going to be self-conscious, compare themselves to others, and want to diet. But those concerns don't necessarily mean that they have eating disorders. In kids with eating disorders, there are glaring abnormal behaviors and physical signs.

In anorexia, these signs include:

• significant weight loss (15% below the normal weight for height)
• continual dieting (although thin)
• feelings of fatness, even after weight loss
• fear of weight gain
• lack of menstrual periods
• preoccupation with food, calories, nutrition, and/or cooking
• preference to eat in isolation
• compulsive exercise
• binge eating and purging
• insomnia
• brittle hair or nails
• depression with social withdrawal

The warning signs of bulimia include:

• uncontrollable eating (binge eating)
• purging by strict dieting, fasting, vigorous exercise, and/or vomiting
• abuse of laxatives or diuretics ("water pills") to lose weight
• frequent use of the bathroom after meals
• reddened finger(s) (from inducing vomiting)
• swollen cheeks or glands (from induced vomiting)
• preoccupation with body weight
• depression or mood swings
• irregular menstrual periods
• dental problems, such as tooth decay
• heartburn and/or bloating
• problems with drugs, alcohol, sexual activity, or crime

If you suspect your child has an eating disorder, it's important to talk to your child, and approach him or her about seeing a doctor about his or her eating habits.

When You Suspect an Eating Disorder

It's common for kids with eating disorders to act defensive and angry when confronted for the first time. They often have trouble admitting, even to themselves, that they have a problem.

Trying to help a child who doesn't think he or she needs help can be hard. Remember that it's not your job to diagnose your child - only a doctor can do that.

Your job is to express your concerns and explain why you are concerned, and get your child to a medical professional for an objective and accurate assessment of your child's condition.

It's important to approach your child about your concerns in a loving, supportive and non-threatening way. It's a good idea to bring up your concerns at a time and in a setting where your child feels comfortable and relaxed, and where there are no other distractions.

Your child may be more receptive to a conversation if you focus on your own concerns, and use "I" statements, rather than "you" statements. For example, you may want to steer clear of statements like "you have an eating disorder" or "you're obsessed with food," which may sound accusatory to your child, and only illicit anger and denial. Instead, you may want to say "I imagine that it's very stressful to count calories of everything you eat" or "I'm worried that you have lost so much weight so quickly." It's also a good idea to explain specific things your child has said or done that have made you worry. You may want to say that you want your child to see a doctor just to put your own mind at ease.

If your child still resists help, or the suggestion that he or she has a problem, you may want to talk with your child's doctor, or a mental health care professional about other approaches.

Treating Eating Disorders

The focus of treatment for eating disorders is helping kids cope with their disordered eating behaviors and thinking and establish new patterns of thinking about and approaching food.

Treatment can include medical supervision, nutritional counseling, and therapy. The professionals try to address a child's perception about his or her body size, shape, eating, and foods. Kids who are severely malnourished may require hospitalization and ongoing care after their medical condition is stabilized.

Generally, the earlier the intervention, the shorter the treatment that's required. If a parent can discover an eating disorder before malnutrition or continual binge-purge cycles occur, the duration of treatment is shorter.

Preventing Eating Disorders

Your approach to food and nutrition can play a powerful role in your child's development of healthy attitudes about food and nutrition.

Your own body image may influence your child. If you constantly say "I'm fat," complain about exercise, and practice "yo-yo" dieting, your son or daughter may feel that it is normal and acceptable to have a distorted body image.

It is important to make sure that your child knows that you love him or her for who she is and what she does, not how she looks.

At a time when there is a lot of societal concern about obesity, it can be particularly tricky for parents to feel comfortable talking to their kids about their eating habits. Many parents worry about how to get their kids a healthy diet, and prevent them from becoming obese or overweight without giving them anxiety about food that might lead to an eating disorder. The best thing to do is to emphasis health, rather than their weight.

Finally, take an active role in creating a healthy lifestyle for your child. Involve your child in the preparation of healthy, nutritious meals on a regular basis. Let your child know that it's OK to eat when you're hungry, and refuse food when you're not. Also, make exercise a fun and rewarding family activity, as well as a regular one. If you have healthy attitudes about food and exercise, your child will have a good example from which to learn.

Updated and reviewed by: Barbara P. Homeier, MD
Date reviewed: June 2005
Originally reviewed by: Steve Dowshen, MD, and Edward Versteeg, MD