How to prevent, recognize and treat eating disorders

By Jennifer Hagman, M.D., Medical Director of the Eating Disorders Program, Children’s Hospital Colorado

Four in 10 Americans have either suffered from or know someone who has suffered from an eating disorder, according to the National Eating Disorders Association. An eating disorder arises when a person develops a distorted relationship with food and weight, but it involves much more than simple dieting, exercise or feeling too full.

Eating disorders like anorexia nervosa and bulimia nervosa are about eight times more common in females than in males, but the incidence of eating disorders is increasing in males. Young people often work hard to keep their struggles with food secret, so it's hard to know just how many people suffer from eating disorders. Between 1 to 13 percent of American high school and college-age women are estimated to suffer from these illnesses.

How It Begins

Eating disorders often begin with dissatisfaction in appearance and efforts to "eat healthier" or exercise more. But for some people, these behaviors can lead to changes in thought patterns and behaviors that develop into an eating disorder. The thoughts and behaviors become difficult to resist, and emotional and physical health begin to deteriorate. The problem often begins with active efforts to lose weight, such as a  weight-loss diet, or increasing exercise, but then something goes wrong. Once 5 pounds have been lost, the weight goal is lowered another 5 or 10 pounds. Or perhaps the original goal is never quite reached, and instead the teenager's weight goes up and down in a seesaw pattern. Eventually, the pursuit of thinness becomes an obsession that assumes more importance than anything else in the person's life.

How to Recognize an Eating Disorder in a Young Person

Young people go to great lengths to deny and conceal their painful struggles with food. Here are some signs that may help you recognize an eating disorder in one of your students, whether in the classroom or related to other school activities:

• Excessive weight loss. Anorexia Nervosa is diagnosed when someone is 15 percent below expected weight (whether because of loss of weight or failure to gain with growth).

• Weight fluctuations. Although people with bulimia nervosa usually maintain near-normal body weight, their roller coaster dieting may show up in erratic weight gains and losses.

• Unusual eating habits, such as taking tiny bites to stretch out eating time or compulsively arranging food on the plate.

• Secretive behavior, especially with respect to eating and bathroom use. A teenager who habitually runs water, plays the radio or flushes the toilet repeatedly while using the bathroom may be masking the sounds of vomiting.

• Use of laxatives or diet pills.

• Food disappearing on a regular basis.

• Excessive and often obsessive exercise.

• Dull hair and hair loss, splitting or softening nails.

• An absence of menstrual periods for females related to malnutrition.

• Dental cavities and gum disease, caused by malnutrition and vomiting.

• Extreme sensitivity to cold, caused by loss of fat and muscle.

• Fine body hair on arms and legs. This is the body's attempt to keep warm.

• Low self-esteem.

• Distorted body image. No matter how thin they get, people with anorexia still believe they are too fat.

• Irritability, depression, or talk of suicide.

• Drug or alcohol abuse. Sometimes, teenagers with eating disorders will turn to substance abuse to relieve feelings of fear, shame and depression.

How to Help as a Teacher:

• Discuss your concerns with the child or adolescent first, and suggest that he or she talks with the parents.

• Expect denial of any problem. You may have to talk with the parents, but always let the adolescent know that you will be doing this and why.