Posted with permission by Jane M. Rees, PhD, RD, CD
Adolescent Nutrition and Eating Disorders
Chapter 1: Eating Disorders During Adolescence
Eating Disorders: Prevalence
The number of adolescents with diagnosed anorexia nervosa or bulimia nervosa is growing and many adolescents with various eating disorders and disordered eating behaviors remain undiagnosed and untreated. Uncounted teenagers preparing to be models, entertainers, dancers, gymnasts, jockeys and other athletes who manipulate their weight also suffer from long-term effects of chronic malnutrition, whether they do or do not meet the criteria for anorexia nervosa or bulimia nervosa. They may be categorized as having an "Eating disorder not otherwise specified" when they have combinations of symptoms that do not fit the exact criteria of the other described eating disorders.
Background: Physical growth and development.
Rapid physical growth and development in adolescence constitute the unique background for development of eating disorders at this stage of life. Self-esteem problems intensify in many normal young women in the process of doubling their body weight, increasing the percent of body fat, gaining about 4 inches in height, developing breasts and acquiring other features of the mature female body, as well as experiencing menarche. Given that this development occurs within a 6-8 year period, the rapidity of change contributes to the difficulty of the task of acceptance.
The intensity of physical growth and development also accounts for the vulnerability of any adolescent to long-term consequences if they experience semi-starvation. All organisms are subject to the greatest harm from food deprivation at periods when they are synthesizing tissue; they need nutrients to build into tissues and food energy to fuel the process. Human teenagers are no exception to this basic biological rule.
Background: Body image and psychosocial development
Adapting a mental image of one's unique body (the body image) is a basic feature of adolescent development. Body image distortion is a core characteristic of anorexia nervosa and bulimia nervosa. Thus, these disorders are commonly seen in adolescence, the period when young people are vulnerable to body image problems. Whether as cause or effects, progress in adopting adult body image is interrupted for the teenager with an eating disorder.
Teenagers with severe eating disorders also fail in varying degrees to accomplish other psychosocial developmental tasks of adolescence. The most striking of the developmental problems first described by Hilde Bruch in 1973 (Eating Disorders. New York, Basic Books) is a struggle to develop autonomy.
Inability to develop and use formal operational thought processes, especially in reference to themselves.
Inability to experience bodily sensations originating within themselves as “normal” and “valid”.
Unrealistic perceptions of body size.
Preoccupation with weight and food, reflecting dependence on social opinion and judgment.
Failure to normalize eating and exercise patterns.
Unrealistic expectations for themselves.
Failure to develop autonomy.
Difficulty in accomplishing the normal psychosocial tasks of adolescence.
Background: Etiology
For many adolescents disturbed eating has developed slowly throughout earlier life, though seeming to appear suddenly in adolescence. The origin of eating disorders is very complex. Individual and familial, biological and psychological characteristics contribute. Cultural values combined with eating habits common in modern societies create a milieu that is said to foster eating problems. To reflect the multiple influencing factors, eating disorders are said to have a multi-factorial etiology.
Website link for chapter 1:
http://faculty.washington.edu/jrees/ch1edado.html
References
American Dietetic Association: Anorexia and Bulimia Nervosa Medical Nutrition Therapy Protocol. Chicago, ADA, 1998.
Brown, S and Bnoifazi, DZ: An overview of anorexia and bulimia nervosa and the impact of eating disorders on the oral cavity. Compend Contin Educ Dent 1993,14:1594-1608.
Center for Disease Control, National Center for Health Statistics. 2000 CDC Growth Charts; United States.
Cromer BA, McClean CS, & Heald FP. A critical review of comprehensive health screening in adolescents. J Adolesc. Health. 1992 Mar;13(2 Suppl):1S-65S. Review.
Fisher, MF, Golden, NH, Katzman, DK et al: Eating disorders in adolescents: A background paper. J Adolesc Health 1995,16:420-437.
Frisancho, RA: Anthropometric Standards for the Assessment of Growth and Nutritional Status. Ann Arbor, U Michigan Press, 1993.
Gurney, JM and Jelliffe, DG: Arm anthropometry in nutritional assessment: nomogram for rapid calculation of muscle circumference and cross-sectional muscle fat areas. Am J Clin Nutri 1973,26:912.
Hazelton, LR and Faine, MP: Diagnosis and dental management of eating disorder patients. Int J Prosthodont 1996,9:65-73.
Katzman, DK & Zipursky, RB: Adolescents with anorexia nervosa: The impact of the disorder on bones and brain. Ann NY Acad Sci. 1997;817:127-137.
Kohn, MR, Golden, NH, and Shenker, IR: Cardiac arrest and delirium: presentations of the refeeding syndrome in severely malnourished adolescents with anorexia nervosa. J Adol Health 1998;22:239-243.
Golden NH, Katzman DK, Kreipe RE, Stevens SL, Sawyer SM, Rees J, Nicholls D, Rome ES. Eating disorders adolescents. A position paper of the Society for Adolescent Medicine. J Adolesc Health. 2003;33:496-503. [ Society of Adolescent Medicine, Position Paper on Adolescent Eating Disorders ]. Accessed January 4, 2009.
Rome ES, Ammerman S, Rosen DS, et al: Children and Adolescents With Eating Disorders: The State of the Art. Pediatrics 2003; 111: e98-e108. [Link to article in ePediatrics (pdf file)]. Accessed January 4, 2009.
Seidel, HM, Ball, JW, Dains, JE and Benedict, GW: Mosby’s Guide to Physical Examination, 2nd Edition. St. Louis, Mosby Year Book, 1991, pg 83.
Shebendach, JE & Reichart-Anderson P.: Eating disorders. In Mahan, LK and Escott-Stump, MA: Krause’s Food Nutrition, and Diet Therapy, 10th Edition, Philadelphia, WB Saunders Co, 2000. Chapter 24.
Shebendach, JE, Golden, NH, Jacobson, MS, et al: Indirect calorimetry in the nutrition management of eating disorders. Int J Eat Disord 1995,17:59-66.
Shebendach, JE, Golden, NH, Jacobson, MS, et al: The metabolic responses to starvation and refeeding in adolescents with anorexia nervosa. Ann NY Acad Sci 1997,817:110-119.
Schebendach, J, Nussbaum, MP: Nutrition management in adolescents with eating disorders. Adolescence Med 1992, 3:541-558.
Striegel-Moore, RH: Risk factors for eating disorders. Ann NY Acad Sci 1997,817:110-119.
