Eating Disorders: What to Watch For

February 28, 2017 • By Dr. Alan E. Simon, M.D., Medical Officer, Office on Women's Health

When I was a teenager, during the long winter month of February, I would often look forward to the warm weather and getting back to summer camp. Being a summer camp counselor was the best part of the year. But now that I am a pediatrician, I often think back on summer camp and remember one thing that I wish I had done differently.

Dr. Alan E. Simon

When I was a counselor-in-training, Molly1, one of my close friends at summer camp, was the person that all the other campers and counselors wanted to be around. She had endless patience with the campers and shared at least one inside joke with every counselor. She smiled almost all of the time, and, although she was a little overweight, Molly was a talented athlete who was often tasked to teach basketball, volleyball, and swimming.

One year when Molly and I were both junior counselors, she looked different. She retained her ever-present smile, and she had also dropped a lot of weight. She looked healthy and happy, and everyone told her so.

But by the next summer, Molly had lost more weight. A lot more weight. Only, she didn’t look healthy or happy this year. Even as teenagers in the 80’s, we’d heard of eating disorders and suspected that she had one, but none of us really knew what to do or what to say to her... so we said nothing. If I could go back, I would have intervened, armed with the knowledge I have now.

Eating disorders or disordered eating includes anorexia nervosa, bulimia nervosa, and other disorders. While most people struggling with an eating disorder show behaviors that don’t fit cleanly into any one disease definition, here are the basic definitions:

Anorexia nervosa is when a person restricts how much they eat, leading to low body weight as well as a fear of gaining weight or becoming fat. People with anorexia also judge themselves largely on their weight or body shape and don’t recognize the seriousness of their own low body weight.
Bulimia nervosa, in general, is defined as recurrent episodes of binge eating followed by some inappropriate behavior to compensate for these episodes, such as vomiting or taking laxatives. People with bulimia also judge themselves largely on their weight or body shape.
Binge eating is eating more food at one time than most people would, because a person feels a loss of control of his or her ability to stop eating.

Eating disorders are common. While estimates vary widely, one study suggested that approximately 1 in every 4 high school girls has symptoms of an eating disorder. The same study suggested that about 1 in 10 boys has symptoms, too. Genetics play a role, and there are other factors that put girls at risk for eating disorders. Participation in activities where being thin is considered helpful, such as dancing, gymnastics, modeling, and running, puts people at higher risk for developing eating disorders. People who diet are also at higher risk.

What can you do to help identify an eating disorder in yourself or others? First, look out for these signs:

Having a lot of concern or an obsession about weight and food
Being very defensive about eating or weight loss habits
Having a fear of food, or changing plans to avoid eating
Exercising excessively
Losing weight or not gaining weight when still growing taller (ask your doctor about how your weight should be changing, if at all)
Going on extremely restrictive diets
Eating large amounts of food at once (binge eating)
Vomiting or using diuretics, laxatives, diet pills, stimulants, steroids, or ipecac
Involvement or interest with pro-anorexia or pro-bulimia websites (yes, they exist)
Not having regular periods
Feeling weak, faint, or dizzy, bruising easily, looking pale, complaining of being cold a lot, losing your hair, or having abdominal pain
Not hanging out with friends during mealtimes
Experiencing mood changes or depression
Growing thin, soft hair on your body’s midsection and extremities
Having cavities or erosion of the enamel on your teeth

If you notice any of these symptoms in yourself, make sure that you tell an adult you trust (if you are a teen) and see a doctor or nurse as soon as possible. Make sure that the doctor screens you for eating disorders by telling them that you are concerned about an eating disorder. If you see these symptoms in a friend or family member, please talk to them (link is external) privately and express concern for them. Offer your support and offer to go to a doctor with them. Don’t blame them for their behavior. If you are still concerned after speaking with them, speak to a trusted medical professional, adult, school counselor, or parent for help. You won’t be able to fix this problem by yourself. Your friend will need to get the help of a doctor or counselor. Also, follow up with your friend or family member and make sure they are getting help.

I still see Molly every now and again, and I think about how lucky she was. One in 20 people with anorexia nervosa and about 1 in 25 people with bulimia nervosa die from the disease. As a pediatrician, I have seen teenagers who are dangerously sick from their eating disorders. Eating disorders can cause problems with any body system, including heart problems and kidney problems. Fortunately, after that summer, Molly did seek treatment, and she has been at a healthy weight for a very long time. When I see her now, she reminds me of the happy Molly I met that first summer.

1Name changed to preserve confidentiality.