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Dangerous Eating Disorder Behaviors Are Not Exclusive to Rail-Thin Teens

The study showed that eating disorders are not diagnosed early enough when specialists focus exclusively on weight.

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By Victoria Kim

08/27/14

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A new study has emphasized that serious eating disorders like anorexia nervosa can occur at any weight. Significant weight loss, rather than the appearance of being “rail thin,” is the true measure of dangerous eating behaviors associated with anorexia, the researchers said.

“We are conditioned to think that the key feature of anorexia nervosa is a low body mass index,” said Cynthia Bulik, director of the Center of Excellence for Eating Disorders at the University of North Carolina at Chapel Hill. “In fact, we miss a lot of eating disorders when focusing primarily on weight.”

The study, which was conducted in Australia, examined 99 teenagers ages 12 to 19 within a six-year period. Only eight percent of the teens had EDNOS-Wt (Eating Disorder Not Otherwise Specified) in 2005, but more than 47% had it in 2009. Both groups lost a similar amount of weight—a median of 28 pounds for those with anorexia and 29 pounds for those with EDNOS-Wt.

“I was surprised to see how much [the percentage of patients with EDNOS-Wt in the study] increased,” said lead researcher Melissa Whitelaw, a clinical specialist dietitian at The Royal Children’s Hospital in Melbourne, Australia. “I was also surprised at how similar they were not only physically but also psychologically. Everything about them was anorexia except that they don’t look really skinny.”

EDNOS-Wt is the “less obvious eating disorder,” similar to anorexia but those with EDNOS-Wt are not underweight enough to fit the definition of anorexia. However, they exhibit the same symptoms such as distorted self-image, fear of weight gain, and physical symptoms such as excessive weight loss, critically low phosphate levels, and low pulse.

“Emaciated bodies are the typical image portrayed in the media of patients with restricting eating disorders such as anorexia nervosa,” said Whitelaw. “This paper highlights that it is not so much about the weight but the weight loss that can lead to a serious eating disorder.”

Individuals in the earlier stage of anorexia tend to go unnoticed until it is too late. “These patients just fly under the radar and when they’re in that earlier stage, it’s harder for people to see it,” said Leslie Sim, an assistant professor of psychology at Mayo Clinic Children’s Center in Rochester, Minn.

“Parents say to me everyday, ‘I thought my daughter was doing something good and making healthy choices until it got out of control. We didn’t know it was a problem until she couldn’t eat the cake at her birthday party.’”

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