By Molly Freeman
A case study published in October’s Pediatrics found that teenagers who have overcome obesity are at a higher risk of disordered eating habits, but less likely to be diagnosed with an eating disorder. In our society where “thin is in” and there are constantly news stories about teenagers being bullied over their weight, does this come as any surprise?
Leslie Sim, clinical director of the eating disorders program at the Mayo Clinic in Minnesota, co-authored the report, “Eating Disorders in Adolescents With a History of Obesity” with two colleagues: Jocelyn Lebow and Marcie Billings.
“For some reason we are just not thinking that these kids are at risk. We say, ‘Oh boy, you need to lose weight, and that’s hard for you because you’re obese,'” Leslie Sim told USA Today.
The report describes two cases of teenagers with a history of obesity that developed restricted eating patterns while losing weight. According to the review both teens, Daniel, a 14-year-old boy, and Kristin, an 18-year-old girl, presented signs of an eating disorder that were attributed to other disorders.
Photo by FBellon.
The boy suffered from concentration problems, irritability, bloating, and chest pains but he was diagnosed with gastrointestinal conditions; the girl in the study had stress fractures, menstrual problems, hair loss, and dizziness that were attributed to polycystic ovary syndrome. These two teenagers’ eating disorders went unidentified and untreated for nearly two years.
According to Sim, both teens lost weight through exercise and eating minimal calories. They “set out to diet, and were both very diligent, eating fewer than 1,500 calories a day, running and doing other intense activities to lose weight in a very driven way.”
Yoni Freedhoff, assistant professor of family medicine at the University of Ottawa and founder and medical director of the Bariatric Medical Institute, responded to the report on his blog. Freedhoff said the “traumatic diets” of these teenagers should have been red flags for their doctors from the get go.
“Had their family physicians or pediatricians explored their losses when they began, the severity and disordered nature of the efforts might have been uncovered long before these two teens developed their traumatic-diet-induced psychological and physiological signs and symptoms,” Freedhoff said.
What Freedhoff doesn’t address in his post, however, is that losing weight in the efforts of being healthy might take precedence over proper nutrition when a teenager deals with obesity. He also does not mention how society’s standards of beauty might be a driving factor, rather than health, in the desire to lose weight.
Jennifer Hagman, medical director of the eating disorders program at Children’s Hospital Colorado, has noticed the same trend in teenagers battling obesity then developing eating disorders. She told USA Today that it has become more prevalent over the past five years.
“They come in with the same fear of fat, drive for thinness, and excessive exercise drive as kids who would typically have met an anorexia nervosa diagnosis,” Hagman said. “But because they are at or even a little bit above their normal body weight, no one thinks about that.”
About three percent of teenagers suffer from eating disorders in the US, according to a 2011 study funded by the National Institute of Mental Health. Another three percent of teenagers who participated had troubling symptoms that did not meet the full criteria of an eating disorder.
Lynn Grefe, president of the National Eating Disorders Association, told USA Today that these cases come as no surprise.
“Our field has been saying that the more we’re pushing the anti-obesity message, the more we’re pushing kids into eating disorders,” Grefe said.
Sim said eating disorders have the highest mortality rate of any mental health illness and require medical, psychiatric, and nutritional intervention for successful treatment.
With this study, Sim, Lebow and Billings have brought the trend of obese teenagers developing undiagnosed eating disorders into the public discourse, but what will it take to make the necessary changes to prevent such disorders from occurring? Is it even possible to do one without the other?
It’s possible that medical providers should pay closer attention to patient diets, as suggested by Freedhoff, though a little more discussion of the “anti-obesity message” and its effects on teenagers should be what the doctor orders.