Anorexia, bulimia becoming "equal opportunity" eating disorders

With eating disorders on the rise among boys, minorities and younger children, doctors need to keep an eye out for unexpected cases, according to the author of a new report.

The stereotype that eating disorders affect only affluent, white teenage girls no longer applies, said David S. Rosen, MD, MPH, who wrote a clinical report on the topic that was published in the December issue of Pediatrics.

"It's also happening to boys, young children, people of color and middle-aged women. It's more of an equal opportunity disorder," said Dr. Rosen, a professor of pediatrics, internal medicine and psychiatry at the University of Michigan.

Males, for example, now represent up to 10% of all cases of eating disorders. The number of children younger than 12 who are hospitalized for eating disorders increased 119% from 1999 to 2006, according to an analysis by the Agency for Healthcare Research and Quality cited in the report (link).

Young children who develop eating disorders are more susceptible to serious medical consequences such as stunted growth and organ damage, Dr. Rosen said.

Early intervention recommended

He urges physicians, nurses, parents, school social workers and others to intervene early. Health care professionals should take note when patients, particularly young ones, make derogatory comments about their appearance or talk about going on a diet.

The report said screening questions about eating patterns and body image should be asked of all preteens and adolescents.

Fewer than 1% of adolescent girls in the U.S. have anorexia, and 1% to 2% percent have bulimia. Experts estimate that between 1% and 14% of Americans exhibit some physical and psychological symptoms of an eating disorder. Male and female athletes, including gymnasts, runners and wrestlers, and performers, such as dancers and models, may be more at risk.

The report said eating disorders may have more of a genetic link, similar to alcoholism and depression, than previously thought. The discovery that some children may be genetically predisposed to the condition may "help to take away some of the blame or stigma," Dr. Rosen said.

With more children obese, physicians should choose their words carefully when counseling a child about his or her weight, Dr. Rosen said. He sees young patients with eating disorders who claim their problems with food began when their doctor told them to lose weight.

Dr. Rosen recommends that physicians discuss healthy eating practices, not dieting, with patients and focus on a healthy lifestyle, not losing weight.

"There's a perception that, like alcoholism, [an eating disorder] never goes away and that the best you can do is keep it under control," he said. But if caught early, "most children and teens can expect to recover completely."