As doctors are starting to see eating disorders manifest at increasingly younger age, pediatricians across the country are being asked to report binging and purging in children as young as five.
In the absence of reliable data on the incidence of bulimic symptoms in children in Canada, the Canadian Pediatric Surveillance Program is attempting to collect information on bulimia nervosa in five to 18-year-olds.
An initial study uncovered surprising findings, so a second one is now under way to gather more information, says Dr. Leora Pinhas, psychiatric director of the eating disorders program at Toronto’s Hospital for Sick Children.
“The original study was looking specifically at restrictors and we weren’t expecting to see purging because most of the literature suggests that doesn’t start until late adolescence,” says Dr. Pinhas, one of the principal investigators of the study.
“A parent may not spot it, and we’ve had patients whose doctor said it can’t be an eating disorder, so it’s really important to identify that this can happen to anyone. Otherwise kids are going to be missed.”
Early detection is also important, as the longer eating disorders persist, the harder they are to treat. Bulimia is characterized by eating, in a two-hour period or less, an amount that is much larger than what most people would eat under similar circumstances.
There is a feeling of loss of control over eating, and “compensatory behaviours” to prevent weight gain include self-induced vomiting, misuse of laxatives, diuretics, other medications, fasting, or excessive exercise.
Anorexia nervosa is defined as a deliberate and sustained weight loss, often driven by a wish to be perfect and a distorted body image. It is estimated that anorexia, which has been described as “a slow suicide,” has a higher death rate than any other psychological disorder.
According to U.S. eating disorders specialist Dr. Barton J. Blinder, anorexia nervosa has been observed in children as young as four.
Dr. Blinder found that children with the disease, most of whom are girls, have less body fat than their adolescent counterparts so they become skeletal more quickly. Childhood-onset anorexia can delay puberty, breast development, and growth.
“It is sad to recognize that food and eating become so laden with emotion at such a young age, and that societal prejudices around weight have already been internalized,” says Merryl Bear, director of the National Eating Disorder Information Centre.
While new research indicates that anorexia and bulimia are inherited conditions, they can also be triggered by things such as puberty, dieting, exercising, going away to college, or a traumatic personal or world event.
“Eating disorder symptoms are attempts by the individual to regulate their emotions and to take some control over themselves in a world that may seem chaotic and out of control,” says Bear.
“Where a child doesn’t feel sufficiently supported or protected or valued by the primary caregivers in her life, she may turn to manipulating food to provide comfort or to have a sense of control over something.”
Eating disorder specialists say society’s obsession with thinness plays a big part, with even young children picking up on messages that being overweight is a no-no.
“The problem is that little kids are social sponges but they don’t have the ability to see through social messages and most of the schools are doing nutrition classes and I think kids do get the sense that being overweight is wrong. We live in a culture where being fat is always frowned upon,” Dr. Pinhas says.
With images of super-thin stars saturating the media, girls are bombarded with the message that to be thin is glamourous and desirable.
The fashion industry has drawn fire for perpetuating the ultra-skinny look, and concerns about anorexia escalated after the deaths of two South American models from anorexia-related complications in 2006. Brazilian Ana Carolina Reston weighed just 40 kilograms when she died at age 21.
The negative effects of an eating disorder on the body are myriad, and include complications associated with cardiac arrythmias, muscle weakness, gastrointestinal problems, and dehydration resulting in dizziness, weakness and confusion.
While little is known about eating disorders in young people, bulimia, the most common eating disorder, is thought to occur in 1 per cent of the adolescent population with partial symptoms occurring in 3 to 6 percent, according to Pinhas’ study, which runs until 2010.
