Four Risk Factors for Eating Disorders in Children

The process of helping people recover from an eating disorder at some point returns to the inception of the illness. Many stages in personal and emotional maturing stop when an eating disorder takes over, and recovering means restarting that maturing process where it left off. 

There are many reasons why the trajectory of growing up goes off course into an eating disorder. Among parents aware of these illnesses and concerned about their children becoming ill, the fear of contributing to this transition is a common yet somewhat mystifying concern. Worried but misguided parents often focus on the wrong things while inadvertently contributing to the risk.  

Many important elements of raising children are in large part determined by the zeitgeist of the time. The trends of parenting that lead to what is considered properly raised children change from generation to generation. However, recent decades have shown that something in the culture is a part of the increased incidence in eating disorders. 

The rise of helicopter parents, intense competition between children for success and perfection at all costs has brought pressure on children at younger and younger ages and appear to contribute to the increase in eating disorders. These changes have largely wrought a childhood devoid of freedom and independence. Children follow strictly determined guidelines and struggle to find the space or time to figure out who they are while spending every waking hour trying to reach unattainable goals. 

A common thread for people with eating disorders is that the illness itself becomes the core of identity. The successes of manipulating food and weight followed by the increased attention, positive or negative, transform a child's self-image.

People often relate that the start of the eating disorder was a liberating and formative moment in their lives. The rules and structure of the eating disorder begin to feel like not just a triumph but a sign of true superiority. The guidelines of the eating disorder align with the expectations of the world around them. 

It was the first moment they felt as if they mattered in the world. Sadly, they had no idea where that moment would go.

On the other side of the timeline of the illness, the emotional struggle with recovery later in life reveals what kind of support and guidance may have been missing when the eating disorder first took hold, a treasure trove of advice for worried parents of younger children.

My implication is not that eating disorders are caused by parents. That is the exception rather than the rule. However, parents don't know the fairly common risk factors for an eating disorder and when it's important to step in.

The four central risk factors reflect four components of personal growth and self-determination in these formative years.

The first is the freedom of self-determination. The process of learning about oneself and feeling able to search for an identity without the undue pressure to prematurely be what other people want you to be. 

The second is a level of compassion towards oneself. The presence of a harsh, critical thought process in one's head can drown out any kindness towards oneself and serves as fuel for the start of an eating disorder. 

The world presents children this age with a sense that acquiring the perfect body is the most important life goal. Accordingly, children who become lost in the desire for that body conflate body image with self-determination and can easily find an eating disorder as a viable solution. 

The last and most important risk factor is dieting. The most common story for the inception of an eating disorder is a diet. The combination of dieting as normal behavior and the accolades that come after successfully losing weight is a deadly one. Eating disorder symptoms almost always start with the body and mind's natural response to a diet, and no one can predict how a child is programmed to respond to starvation. Being sure a child does not diet is the most important decision a concerned parent can make. 

Parents who focus on helping their child in these four areas will go a long way towards preventing eating disorders.  These suggestions directly contradict many of the norms of child rearing today. It's time the culture looks at the risks of current behavior and the rise of eating disorders.


Why Most Doctors Don't Help People with Eating Disorders

I had an unusual conversation with a gastroenterologist last week. She explained the situation with a mutual patient including the results of several tests, the likely diagnosis and treatment plan. That was all par for the course. She then asked my opinion, as someone who treats people with eating disorders, both for the best psychological approach to treatment and also for any other thoughts about possible diagnoses. 

This last question, one of collaboration and respect, is very rare in the medical treatment of people with eating disorders. What was just as surprising is that the doctor was not writing in the chart, taking to a staff member in the office or hailing a taxi while on the phone, all common occurrences during doctor to doctor calls. 

It is unusual to find doctors who have the time to talk, listen and collaborate. Patients with eating disorders need that medical approach to get help. Sadly, they tend to give up and ignore the issue rather than face the frustration of seeing doctors who are unable to find any reasonable cause for their symptoms. 

Medical problems associated with eating disorders are complex and out of the norm for a general doctor or specialist to see. One fundamental complication is that malnutrition both in terms of underfeeding and low levels of vitamins and minerals are central to the problem, something doctors learn next to nothing about.

The malnutrition is often different from general starvation due to lack of food. This malnutrition is specific to a world packed with food with no nutritional value. People will often eat some food but will have very inadequate nutrition.

Since doctors in the first world know little about the possible causes, they search for causes of illness as if the person does not have an eating disorder and ignore possibilities likely only to be seen in these patients. 

Any useful medical work-up has to include the expertise of a primary doctor or specialist and a doctor well versed in the medical problems associated with eating disorders to be effective. 

Many diagnoses are common for patients with eating disorders but otherwise would not come up on a doctor's radar: gastroparesis (delayed stomach emptying) that can be treated with food, kidney damage from malnutrition, odd mineral deficiencies such as low blood copper levels, high cholesterol from chronic anorexia and neurological swallowing difficulties from years of purging. 

The truth is that textbooks about eating disorders focus on the medical effects which occur in the first few months of starvation but not those that come after years of eating disorder symptoms. Accurate diagnosis relies on persistent doctors willing to collaborate and think outside the box to find an answer. 

The current state of medicine encourages short visits, minimal time spent on history and physical exam and no attention to detail. This situation leaves the patient with an eating disorder out in the cold. However, doctors like the one I spoke to last week can help create an environment that gives hope for better care.

For the patient with an eating disorder, it's worth looking into finding the right doctors and not settling for the most convenient ones. A doctor with time to think and collaborate will help maintain health through the process of recovery. A doctor who simply sends for a few blood tests will not help at all.