Several factors contributed to a 12-year-old Massachusetts girl developing what Alyse Beekman, Psy.D., program director at the Center for Discovery in Southport, Conn., called “severe, severe anorexia.” But Beekman believes the problems of the girl referred to her for treatment largely stemmed from one event in the previous year: “She got a notice from her school that said that her BMI was borderline overweight,” Beekman says. “That really kind of set her off.”
The term BMI has no place in a school health curriculum, says Beekman. Instead of measuring ideal body fat for a person’s weight and height, teachers should focus on how food supports the body, Beekman explains. That’s especially important advice as clinicians see patients with eating disorders getting ever younger. The Center for Discovery’s Southport location, which has a six-bed residential facility, treats patients ages 10-18.
The Cambridge Eating Disorder Center in Cambridge, Mass., treats patients 12 and older. But its director, Seda Ebrahimi, Ph.D., says, “We do get calls from parents who are looking for services for their 7 to 11-year-olds.”
Inquiries tend to be about a child who has lost significant weight from restrictive eating out of a concern about feeling fat or a child avoiding eating based on food’s sensory characteristics, leading to significant weight loss or nutritional deficiency. If a child needs inpatient care, Ebrahimi refers to Boston Children’s Hospital or Hasbro Children’s Hospital in Providence. A therapist with an anxiety disorder specialty can also be helpful for younger children with restrictive food intake disorder she said.
While children represent three percent of overall hospitalizations for eating disorders, hospitalizations for patients under age 12 diagnosed with an eating disorder increased 72 percent between 1999 and 2009,and patients aged 12-19 had a six percent increase, according to data from the federal Agency for Healthcare Research and Quality.
Eating disorders, defined broadly as anorexia nervosa, bulimia nervosa, and/or binge eating disorder, account for 2.7 percent of 13-17-year-olds, with girls more than two and a half times likely as boys to be affected, according to the National Comorbidity Survey – Adolescent Supplement. The Centers for Disease Control and Prevention’s National Health and Nutrition Examination Survey estimates prevalence among 8 to 15-year-olds to be at one tenth of one percent.
“The youngest child I have seen for an eating disorder was a 9-year-old boy,” says Camden, Maine, psychologist Vicky L. Willey, Ph.D. “I think eating problems can be overlooked in boys because they haven’t been associated with them previously. I can’t think of major differences between gender because we don’t differentiate diagnostically – same symptoms are used for both genders.”
Children are experiencing far more stress than ever before and have less support, Willey says. They are susceptible to media images supporting distorted body images that glamorize thinness, from retailer J.Crew’s introduction of a new triple zero size for someone with a 23-inch waist to former “Real Housewives of New York” star Bethenny Frankel Instagramming a photo of herself wearing her 4-year-old daughter’s Hello Kitty pajamas.
When a child makes negative comments about their body, pushes food around their plate, skips meals or over-exercises, these are all red flags indicating the child should see a pediatrician for screening or a therapist who can diagnose the issue, Willey says.
Mood disturbances are another warning sign, Beekman says. “You may have this outgoing kid that’s starting to withdraw socially, they’re not as engaged in relationships, they’re concerned about going to parties and social events where there’s eating. ‘Oh, do I really have to go to a party?’ She knows that there’s going to be pizza and cupcakes there,” she adds.
Both younger and older girls are similar in their presentation of symptoms, which tend to involve feelings of not fitting in and being bullied, Beekman says. For the very youngest boys with eating disorders, the problem is typically one of communicating needs by acting out through restricting their meals. Older boys are more concerned with body image.
Maudsley Method, which requires participation from parents in the treatment of adolescents with eating disorders, is a well-researched successful treatment approach, Willey says. And the earlier the intervention the better the outcome when it comes to addressing a child’s symptoms.
Beekman says more schools are recognizing the need for appropriate health conversations about food and nutrition. The parents of the 12-year-old girl whose anorexia was linked to that BMI notice given to her to bring home contacted the school to tell them what was happening with their daughter to get them to stop doing such evaluations.
“Now they’re not doing it anymore,” Beekman says.
By Janine Weisman