Teens: Eating Disorders Require Medical Attention

by Food and Drug Administration (FDA)

For reasons that are unclear, some people — mainly young women — develop potentially life-threatening eating disorders called bulimia nervosa and anorexia nervosa. People with bulimia, known as bulimics, indulge in bingeing (episodes of eating large amounts of food) and purging (getting rid of the food by vomiting or using laxatives). People with anorexia, whom doctors sometimes call anorectics, severely limit their food intake. About half of them also have bulimia symptoms.

The National Center for Health Statistics estimates that about 9,000 people admitted to hospitals were diagnosed with bulimia in 1994, the latest year for which statistics are available, and about 8,000 were diagnosed with anorexia. Studies indicate that by their first year of college, 4.5 to 18 percent of women and 0.4 percent of men have a history of bulimia and that as many as 1 in 100 females between the ages of 12 and 18 have anorexia.

Males account for only 5 to 10 percent of bulimia and anorexia cases. While people of all races develop the disorders, the vast majority of those diagnosed are white.

Most people find it difficult to stop their bulimic or anorectic behavior without professional help. If untreated, the disorders may become chronic and lead to severe health problems, even death. Antidepressants are sometimes prescribed for people with these eating disorders, and, in November 1996, FDA added the treatment of bulimia to the indications for the antidepressant Prozac (fluoxetine).

About 1,000 women die of anorexia each year, according to the American Anorexia/Bulimia Association. More specific statistics from the National Center for Health Statistics show that "anorexia" or "anorexia nervosa" was the underlying cause of death noted on 101 death certificates in 1994, and was mentioned as one of multiple causes of death on another 2,657 death certificates. In the same year, bulimia was the underlying cause of death on two death certificates and mentioned as one of several causes on 64 others.

As to the causes of bulimia and anorexia, there are many theories. One is that some young women feel abnormally pressured to be as thin as the "ideal" portrayed by magazines, movies and television. Another is that defects in key chemical messengers in the brain may contribute to the disorders' development or persistence.

The Bulimia Secret

Once people begin bingeing and purging, usually in conjunction with a diet, the cycle easily gets out of control. While cases tend to develop during the teens or early 20s, many bulimics successfully hide their symptoms, thereby delaying help until they reach their 30s or 40s. Several years ago, actress Jane Fonda revealed she had been a secret bulimic from age 12 until her recovery at 35. She told of bingeing and purging up to 20 times a day.

Many people with bulimia maintain a nearly normal weight. Though they appear healthy and successful — "perfectionists" at whatever they do — in reality, they have low self-esteem and are often depressed. They may exhibit other compulsive behaviors. For example, one physician reports that a third of his bulimia patients regularly engage in shoplifting and that a quarter of the patients have suffered from alcohol abuse or addiction at some point in their lives.

While normal food intake for women and teenagers is 2,000 to 3,000 calories in a day, bulimic binges average about 3,400 calories in 1 1/4 hours, according to one study. Some bulimics consume up to 20,000 calories in binges lasting as long as eight hours. Some spend $50 or more a day on food and may resort to stealing food or money to support their obsession.

To lose the weight gained during a binge, bulimics begin purging by vomiting (by self-induced gagging or with an emetic, a substance that causes vomiting) or by using laxatives (50 to 100 tablets at a time), diuretics (drugs that increase urination), or enemas. Between binges, they may fast or exercise excessively.

Extreme purging rapidly upsets the body's balance of sodium, potassium, and other chemicals. This can cause fatigue, seizures, irregular heartbeat, and thinner bones. Repeated vomiting can damage the stomach and esophagus (the tube that carries food to the stomach), make the gums recede, and erode tooth enamel. (Some patients need all their teeth pulled prematurely). Other effects include various skin rashes, broken blood vessels in the face, and irregular menstrual cycles.

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