To prevent eating disorders, parents must know signs

Parents -- not doctors and therapists -- are in the best position to help prevent eating disorders and to spot the early warning signs of anorexia or bulimia.

Researchers, doctors and battle-tested parents have begun to understand not only which environments encourage healthy eating and body image but also how to spot a seemingly ordinary teenage diet spinning out of control. The key, they say, is to help kids as soon as possible, before their eating habits threaten their health.

“We’re becoming more focused on the message of ‘Let’s catch it even before it becomes an eating disorder,’ ” says Lynn Grefe, chief executive of the National Eating Disorders Assn. “If you know what to look for and can catch it early, you’ve saved a lifetime of misery.”

Most experts say that the sooner an eating disorder is diagnosed and treated, the better the chances for long-term recovery. Patients who have struggled with anorexia or bulimia for many years are the hardest to treat and the most in danger of death or disability.

But distinguishing troubled eating from a normal adolescent’s unpredictable eating habits can be difficult. Surveys show 55% of teenage girls in the U.S. diet at some point. And a recent study by the Canadian Medical Assn. found that 27% of girls ages 12 to 18 had disordered eating attitudes and behaviors. Most do not develop eating disorders.

Researchers have identified some key behaviors and personality traits that can help identify kids -- and adults -- at risk. A study published last month in the online version of the American Journal of Medical Genetics found that people with eating disorders tend to be obsessional (a form of perfectionism), anxious, easily upset by their mistakes and have food-related obsessions. Anecdotally, doctors and therapists say that eating disorders often arise in kids who are high-achieving and people-pleasing.

This pressure can arise from the family, the media or from within the child, says Michael Strober, director of the eating disorders program at the Lynda and Stewart Resnick UCLA Neuropsychiatric Hospital. It often emerges in families where expectations are high and where family members have a tendency toward anxiety. Manipulating food intake can give a child the feeling of success and being in charge.

In addition to personality traits, certain behaviors can serve as a tip-off, says Strober.

“A serious condition like anorexia nervosa begins with dieting behavior. It’s very innocent at that point, and there is no basis for the parents to think this is ominous,” he says. “But what happens is it accelerates very rapidly and, essentially, one cannot stop dieting.”

Strober outlines the early stages of an eating disorder in his new book, “Just a Little Too Thin,” one of several new books about eating disorders. In the first phase, the child selects a diet and sticks to it faithfully. She monitors her progress closely and begins to exercise.

In the second phase, which he calls “the exhilarated dieter,” the child begins receiving compliments on her appearance. But she thinks she can do better and becomes preoccupied with her diet. She feels powerful and is anxious to exercise off what she has just eaten.

In the third phase, “the obsessed and preoccupied dieter,” the child begins to try to keep her diet hidden, even avoiding meals and eating in her room. Exercise intensifies. She still feels fat and hates her appearance. She doesn’t feel hungry much.

“Children are in the throes of a lapse of control. And, at some point, they become aware that they are not able to control their behavior,” Strober says. “The parent has to step in and be more vigilant and take a supervisory role.”

Researchers now believe that once dieting progresses and weight loss occurs, changes take place in the brain that perpetuate the behavior and symptoms.

The changes can include a temporary imbalance in neurochemicals, such as serotonin, that contributes to depression, anxiety and poor appetite. For that reason, some experts believe that weight needs to be restored before meaningful counseling can begin.

Parents should seek help as soon as they become concerned. “Don’t take too much of a laissez-faire attitude,” Strober says. “Hanging in the background and hoping for the best may result in the continued progression of the behavior.”

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Encouraging healthy attitudes

Prevention of eating disorders starts in the home, with a healthy attitude toward both food and physical appearance. Experts offer these tips:

* Make family dinners a priority.

* Watch your own values about the importance of physical appearance. Be aware of the comments you make about yourself and others.

* Encourage diversity (acceptance of people of all races, ethnicities and physical appearances).

* Teach your children about healthy eating: flexibility, variety, moderation and joy.

* Listen to your body to determine hunger and satiety, so you can model that for your children.

* Appreciate your own appearance.

* Serve healthy, balanced meals. Make one meal for the entire family (not separate meals catering to individual preferences) and have everyone serve themselves from what is offered.

* Communicate with your child and listen. Studies show teens who report good family communication are less likely to engage in extreme weight-control measures.

* Be a role model in your own balance between work and play.

* If you notice any warning signs, get more information and advice. It’s not your job to diagnose your child’s possible disorder.

Source: National Eating Disorders Assn.