It's estimated that up to 24 million people suffer from eating
disorders, including at least 10 percent of late-adolescent girls and
adult women. While the disease is also known to affect boys, parents
need to keep a particular eye on their girls, especially if they are
athletes or people pleasers. Early traces of the illness can be seen
around age 7, when kids often start referring to themselves as "fat."
Today, 95 percent of people with eating dis-orders are between the ages
of 12 and 25.
What causes eating disorders? Sharon Fried Buchalter, PhD, a clinical
psycholo-gist with advanced training in child and adolescent
psychology, points to a variety of factors, ranging from psychological
(low self-esteem) to genetic (depression, chemical imbalances) to
social (super-thin celebrities on magazine covers). What parents say
matters, too. "Talking about feeling fat, your own dieting or your
kids' weight can have a negative impact on how children look at
themselves," says Jane Shure, PhD, a Philadelphia-based psychotherapist
who has specialized in treating eating disorders for more than 20 years.
The consequences of an eating disorder can range from very serious (low
blood pressure, rotted teeth, stunted growth, loss of menstruation,
liver damage, osteoporosis, ulcers) to fatal (heart attacks). In fact,
eating disorders are the deadliest of all mental illnesses, according
to the Renfrew Center, an eating disorder education and advocacy group
with several treatment facilities. The mortality rate for anorexia is
12 times higher than that of all other causes of death in females 15 to
24 years old.
Warning signs
What begins as seemingly normal behavior (a child says she ate at a
friend's house or exercises more frequently) can quickly become a
serious problem. Alarm bells should go off when children:
  • Regularly refuse family meals or skip lunch at school.
  • Stick to a few "safe" foods, including vegan or low-fat, low-carb options.
  • Talk about (and fear) being fat even when they are slim.
  • Become obsessed with exercise.
  • Attempt to create a "perfect" image in every area of their lives.
  • Consistently exaggerate the size of their body or body parts.
  • Have an overriding sense of shame about themselves and their body.
  • Experience rapid weight loss.
If you notice any of these signs, consider making a trip to your
family doctor or pediatrician. "He or she will listen to your concerns,
interview your teen alone and do a physical exam," says Laurie Mitan,
MD, head of the eating disorders program at Cincinnati Children's
Hospital Medical Center. If there is a problem, the doctor will know
where to turn next. "Having a mental health therapist, a medical doctor
and a registered dietitian is best," says Dr. Mitan, "though patients
with more severe
diseases will need a psychiatrist." Anti-depressants are an effective
part of the treatment for bulimia and binge-eating disorder, she adds.
Many patients with anorexia may appear depressed, but this often
results from malnutrition and will improve with weight gain.
Anorexia and bulimia are the most well-publicized eating disorders,
but they are not the only ones. Here, a brief primer on these complex
Anorexia nervosa
Present in about 1 percent of the general population, anorexia is the
third most com-mon chronic illness among adolescents. Sufferers are
very underweight, sometimes to the point of emaciation. Terrified of
being fat, they severely restrict calories. "Ironically, their fear
only tends to heighten as the weight drops off," says Trisha Gura, PhD,
author of Lying in Weight: The Hidden Epidemic of Eating Disorders in Adult Women.
What to look for: A child who
skips meals, eats tiny portions or eats in strange ways (chewing food
for half an hour, spitting food out before swallowing). Children with
anorexia may avoid food-related events (such as a family barbecue or a
pizza party with friends) or make excuses to avoid eating ("I'm not
hungry"; "I have a stomachache").
Bulimia nervosa 
Most bulimics are of normal weight and display few outward signs of
their problem, making it difficult for parents to catch on. Affecting
about 4 percent of the population, bulimia consists of cycles of binge
eating (usually sweets and junk food) followed by unhealthy behavior
that rids the body of the calories. About 80 percent of bulimics vomit
to purge, but other methods include laxatives, diuretics, fasting,
compulsive exercise, enemas or other medications. Kids can lose major
nutrients, especially potassium, which helps to regulate the heart. In
chronic cases, the body has so little potassium that physical function
suffers and hospitalization is needed.
What to look for: Empty food
packages around the house, bathroom smells or running water (the sound
covers the vomiting). Children with bulimia may have scratched or
black-and-blue knuckles (from scraping their fingers against their
teeth); they may also use the bathroom at unusual times or make
frequent bathroom trips, especially right after meals. Note the
excessive use of mouthwash and breath mints.
Binge-eating disorder (BED)
BED consists of bingeing—like bulimia—but there's no purging. Those
with BED tend to be obese and racked by low self-esteem. They may also
be frequent dieters who binge with the sense that they can't stop
themselves. Research shows that between 15 and 50 percent of people
enrolled in dieting programs suffer from BED. The consequences mirror
those of obesity: high blood pressure, heart disease, diabetes and
gallbladder disease.
What to look for: A child who
eats a lot of food quickly, exhibits a pattern of emotional eating or
feels ashamed or disgusted by the amount that he or she eats. Note any
irregular eating patterns, especially skipping meals and eating at
unusual times (such as late at night).
Why is it so important to catch eating disorders early? 
About 76 percent of people treated for anorexia either recover
completely or make significant progress. But the earlier treatment
begins, the better the outcome. "Getting into treatment in the first
six months can make all the difference in a child's life," says Dr.
As the disorder takes hold, the physical and psychological damage
becomes much harder to reverse. "Initially, there's a lot of excitement
for kids at being able to meet the goals they set," notes Dr. Shure.
Later, however, they realize that even if they want to eat more or
exercise less, they can no longer control their behavior. "In the first
months it is much easier to help somebody out of it. After a year, the
system is patterned, making it much more difficult—and leading to years
of treatment."
What should you do as a concerned parent? If you notice even one thing
that seems off, listen to your gut. And if your child's friend, her
friend's parent, her coach or her school nurse comes to you with things
they've noticed, hear them out, urges Dr. Mitan: Your child's life
could depend on it.
Rachel Silver's did. She's now a thriving 21-year-old junior at the
University of Miami. "She is happy, healthy, engaged, and has a good
attitude toward food and exercise. She wants to move on with her life,"
her mother says. "We credit Rachel's recovery to her will not to be a
sufferer for her entire life—and especially to early diagnosis and