With so much focus on childhood obesity, are we missing another big problem? Kids and teens who are significantly underweight are usually targeted for appropriate eating disorder treatment, but overweight and obese kids are slipping through the cracks. Because their weight is in the “normal” or overweight range for their height, kids that have lost a large amount of weight, lost weight rapidly, or are experiencing other symptoms of eating disorders are being overlooked by doctors, yet they are in just as much danger as someone who is underweight.
The eating disorder most associated with kids of normal weight is bulimia nervosa, an eating disorder characterized by binging and purging. Anorexia nervosa on the other hand is an eating disorder that is characterized by abnormally low weight. However, as evidenced in a recent Pediatrics paper, anorexia is not defined by weight and is not limited to kids that are underweight.
Warning signs of anorexia include a dramatic weight loss, preoccupation with food, fat, and calories, restricting certain foods, denying hunger, engaging in food rituals, and withdrawal from friends or activities. All of these behaviors and symptoms can occur in individuals that aren’t noticeably thin.
Two cases of such were recently described in Pediatrics, one of a 14 year old girl who rapidly lost weight and one of a 14 year old boy who had restricted his intake to 600 calories per day. Both of these teens were taken to the doctor numerous times out of concern from their parents, and the symptoms of their eating disorders were continuously overlooked due to their weight. At 14, Kristin ate only 1,500 calories while running seven miles a day. She dropped 80 pounds in three years, suffered from multiple stress fractures, and stopped getting her period. Daniel, also 14, ran cross country and only ate 600 calories per day. He lost weight rapidly, experience cold intolerance and fatigue, withdrew socially, and had trouble concentrating —all hallmarks of anorexic behaviors.
Leslie Sim of the Mayo Clinic Children’s center shares, “Thirty-five percent of kids who are coming in with anorexia nervosa — with restricted eating and significant weight loss — started out in the ‘obese’ or ‘overweight’ weight range. And it takes them about a year longer to be identified.” That’s too long, especially when early intervention is a big key to recovery.
What this means for healthcare providers (and parents) is that the actual number on the scale or on a chart may not be adequate information for determining health. Instead, a weight history or look at specific behaviors would be more enlightening. Even if an individual is classified as “overweight” based on BMI, if they have recently lost a lot of weight, it’s important that doctors and parents ask the most important questions: “Why?” and “How?” In cases like the two teens mentioned earlier, as well as many others, the problem lay not in their weight, but in their behaviors. Dramatic restriction of calories and rapid weight loss are dangerous both physically and mentally. For girls, loss of their period is a pretty good indicator that something isn’t right and should be looked into further.
As someone who is thin by nature and a dietitian by profession, I often find it disturbing how little attention doctors pay to my weight. I gained more than the recommended amount of weight during pregnancy (as is so common) and dramatically lost weight while breastfeeding my newborn. Despite asking pointed questions, my doctors ignored it. When my son’s weight jumped from below the third percentile on the growth chart to the 72nd percentile in just a matter of months, his doctor brushed it off, disregarding other concerns I had for his health based on symptoms and behaviors. In a world where we’re so preoccupied with weight, being thin, and fighting obesity, we sure do ignore weight a whole lot when it comes right down to it.
Overlooking kids that are showing signs of eating disorders can be extremely risky and damaging. Anorexia and the behaviors associated with anorexia can lead to serious health consequences like low heart rate, low blood pressure, bone and muscle loss, dehydration, fatigue, and more. Even kids that are overweight can experience these same health issues. It’s more important than ever to be looking at the bigger picture: the behavior, the history, and the child’s health as a whole, not just a number on a scale.