It is estimated that in the United States, up to 24 million people of all ages and genders suffer from one of the three most common types of eating disorders (anorexia, bulimia and binge eating disorder).  The term “eating disorder” refers to a variety of psychiatric illnesses common in our society today. Each disorder involves unrealistic, distorted thinking about appearance, body weight, and food. Obsessive behaviors in eating and exercise result which can significantly affect health by causing nutritional deficiencies and impaired body function. In fact, eating disorders are known to have the highest death rate of any mental illness. Having any type of eating disorder is serious and requires treatment.

Low self-esteem appears to be the most common trait seen in people suffering from all eating disorders. In addition, the following key characteristics for the individual types are observed:

• Anorexia nervosa: People starve themselves by refusing to maintain a minimally normal body weight.
• Bulimia nervosa: People go on repeated, secretive, uncontrolled eating binges, then, they attempt to rid themselves of the food to avoid gaining weight by fasting, self-induced vomiting, laxative abuse, and/or excessive exercise.
• Binge eating disorder: People “binge eat” [eat a large amount of food in a set time period that is more than most people would do under similar conditions and circumstances] and feel out of control over eating but do not purge.

In this article, you will find information on:

• Who’s at risk
• Symptoms
• Other risk factors
• Treatment
• Athletics and eating disorders
• The best time to seek help
• Talking to your child or teen
• Poor body image

Who is at risk?

Anorexia and bulimia nervosa are most common in females and usually starts between the ages of 12 and 25. However, people of all ages may develop these disorders. For every 1 male with anorexia or bulimia nervosa there are 9 females. However, binge eating disorder is as common among males as females. Eating disorders occur among all ethnic groups and income levels.

What are the symptoms?

Anorexia Nervosa: weight loss and refusal to maintain normal body weight, intense fear of gaining weight, a negative body image, menstrual changes or the absence of menstruation, fatigue and depression. There are 2 types of anorexia nervosa: restricting subtype where individuals significantly reduce their intake, fast, or skip meals; and binge eating/purging subtype, where individuals regularly binge eat or purge (e.g., self-induced vomiting).

Bulimia Nervosa: recurrent episodes of binge eating (eating much more food than what most people would eat during a similar period of time and feeling a lack of control), recurrent purging in order to prevent weight gain (e.g., self-induced vomiting, using laxatives or other medications, fasting or excessive exercise), unhealthy attitude toward body shape and weight, dehydration, fatigue, depression.

Binge eating disorder: recurrent episodes of binge eating (eating much more food than what most people would eat during a similar period of time and feeling a lack of control) that are not followed by purging, eating beyond the point of feeling very full, eating more rapidly than normal, feelings of shame or guilt.

What are the risk factors?

A number of factors predispose some people toward eating disorders. Eating disorders run in families and may have a genetic component. Gender is a risk factor. Teenage girls and young women are more likely than teenage boys and young men to develop eating disorders (possibly as the result of how our society defines beauty and the importance places on body image). However, with increasing pressure in society for males to also meet a specific body image, the number of male’s suffering from eating disorders appears to be rising.

Other common risk factors include individuals of any age, gender, race or ethnicity who have:

• Significant body image dissatisfaction
• Perfectionistic attitudes
• Low self-esteem
• Depression
• Anxiety
• Obsessive-compulsive disorder

How is it treated?

Treatments vary but generally include a multidisciplinary approach that includes psychotherapy, family counseling, nutrition counseling by a registered dietitian nutritionist (RD/RDN), medications and medical care. Depending on the severity of the eating disorder, individuals may need intensive outpatient treatments or require hospitalization.

Athletics and eating disorders

Individuals who participate in highly competitive athletic activities (usually with body image and weight requirements) are at greater risk of developing an eating disorder. At particular risk of anorexia nervosa are females in sports such as gymnastics, figure skating, track, swimming, and dance

Males who participate in wrestling, bodybuilding, running, swimming, cycling, and even football are also at higher risk for an eating disorder.

When is the best time to seek help?

The earlier an eating disorder is identified and treated, the better the long-term outcome. Unfortunately, individuals with eating disorders, especially anorexia nervosa, deny that they have a problem so seeking medical advice may come only at the insistence of a family member or friend.

If you or someone you care about loses a great deal of weight, feels worse-not better-about their body after losing weight or alternates between binge eating and strict dieting, see your doctor to find out whether you or your loved one has an eating disorder. Purging by vomiting is never part of a normal diet and can have serious health consequences.

How do you talk to a child or a teenager about a suspected eating disorder?

Parents shouldn’t feel shy about sharing their concerns with their child even though many children will initially deny that there is a problem. Involve your pediatrician in monitoring your child’s weight, assessing their health status and referring you to nutritional and mental health resources. Parents should also institute family meal times, close supervision after meals and set strict limits around unhealthy dieting behavior.

Poor body image

Unfortunately, concerns about body image are the norm among girls and women in our society. Only about a quarter of females feel satisfied with their weight and appearance. Body image disturbance occurs on a continuum with only those on the extreme end developing eating disorders. However, even those who do not have eating disorders may have their sense of self diminished by negative thoughts about their weight and shape.

Many children will complain occasionally about some aspect of their appearance or weight. However, preoccupation with such thoughts, extreme dieting or avoidance of regular activities due to body image concerns may require further intervention.

For more information:

Go to the Eating Disorders health topic.