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Join us at noon CT on Tuesday, Jan. 4, to chat about children's eating disorders.

In the past decade, a growing number of children and adolescents have been diagnosed with eating disorders. In a new clinical report from the American Academy of Pediatrics, "Identification and Management of Eating Disorders in Children and Adolescents," published in the December 2010 issue of Pediatrics (published online Nov. 29), it is estimated that 0.5 percent of adolescent girls in the United States have anorexia nervosa, and 1 percent to 2 percent meet criteria for bulimia nervosa. There is an increasing recognition of eating disorders in males, which now represent up to 10 percent of all cases of eating disorders, as well as in children of younger ages. A recent analysis by the Agency for Healthcare Research and Quality revealed that from 1999 to 2006, hospitalizations for eating disorders in children under 12 years of age increased by 119 percent. The clinical report suggests pediatricians be familiar with early detection and proper evaluation of patients suspected of having a disorder. Because medical complications of eating disorders can affect any organ system, pediatricians should monitor patients for medical or nutritional problems, and ensure appropriate treatment options including medical care, mental health treatment and nutritional intervention.

Joining us on the chat are Chicago Tribune health reporter Deborah Shelton and guest expert Dr. David S. Rosen from the Department of Adolescent Medicine, Pediatrics, and Internal Medicine at University of Michigan Health System.

If you are unable to make the chat, or would like to send your question in advance, e-mail Deborah Shelton at dshelton@tribune.com.

Health Chat: Children's Eating Disorders

(01/04/2011)

  

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11:54

Deborah L. Shelton:  Hello everyone! Happy New Year, and welcome to the Chicago Tribune health chat on eating disorders in children. We will be starting at noon. Please stand by. Tuesday January 4, 2011 11:54 Deborah L. Shelton

12:00

Deborah L. Shelton:  Hi all. We are ready to get started. Thank you again for joining us. A growing number of children and adolescents have been diagnosed with eating disorders over the last decade, and a new clinical report from the American Academy of Pediatrics is giving new estimates of the extent of the problem. Joining us live to talk about the new report and answer your questions is the report's lead author Dr. David S. Rosen, professor of adolescent medicine, pediatrics and internal medicine at the University of Michigan Health System. Thank you Dr. Rosen for taking time out of your busy day to be our guest expert. Tuesday January 4, 2011 12:00 Deborah L. Shelton

12:00

Dr. David S. Rosen:  Thanks for having me. Tuesday January 4, 2011 12:00 Dr. David S. Rosen

12:00

Deborah L. Shelton:  For those who are not familiar with this topic, how common are eating disorders in children? And why is this a growing problem? Tuesday January 4, 2011 12:00 Deborah L. Shelton

12:01

Dr. David S. Rosen:  Anorexia nervosa and bulimia nervosa are relatively uncommon, but there are many people with eating disorders whose symptoms fall short of the strict criteria necessary to make a diagnosis of anorexia nervosa or bulimia nervosa. They share many of the same risks as those with AN or BN, and they are also at risk of progressing to more severe eating disorders. We call these "partial-syndrome" eating disorders. Or they are sometimes called EDNOS ("Eating Disorder- Not Otherwise Specified") Tuesday January 4, 2011 12:01 Dr. David S. Rosen

12:01

Dr. David S. Rosen:  We don't have exact numbers for children, but we believe the problem is growing. In 2009, the government published data that showed that kids under 12 were the fastest growing population of patient HOSPITALIZED for eating disorders. Tuesday January 4, 2011 12:01 Dr. David S. Rosen

12:02

Deborah L. Shelton:  Is it true that children are ever younger ages are developing eating disorders? How young are we talking about? Tuesday January 4, 2011 12:02 Deborah L. Shelton

12:02

Dr. David S. Rosen:  I've seen eating disorders in kids as young as 7 or 8, and I have colleagues that have seen even younger patients. In very young patients, the disorders often look quite atypical, making the diagnosis (and treatment) more complex. Tuesday January 4, 2011 12:02 Dr. David S. Rosen

12:03

Dr. David S. Rosen:  My most common patients now start at ages 11, 12, and 13 Tuesday January 4, 2011 12:03 Dr. David S. Rosen

12:03

Deborah L. Shelton:  That's really young. What are the red flags that indicate a child might have an eating disorder? Tuesday January 4, 2011 12:03 Deborah L. Shelton

12:04

Dr. David S. Rosen:  Changes in eating, weight loss, growth retardation, and in girls old enough to be menstruating, loss of periods. But I would argue that we ought to recognize eating disorders BEFORE we see these symptoms. We should start to be concerned when children express weight concerns, when they talk about or start diets, of if their activity level suddenly rises outside of usual recreational or athletic activities. Tuesday January 4, 2011 12:04 Dr. David S. Rosen

12:04

Deborah L. Shelton:  Chatters: Please start sending your questions, if you haven't already. We'll be taking them momentarily. Tuesday January 4, 2011 12:04 Deborah L. Shelton

12:05

Deborah L. Shelton:  Do boys have eating disorders? Is this just a problem for girls? Tuesday January 4, 2011 12:05 Deborah L. Shelton

12:06

Dr. David S. Rosen:  Yes. Boys get eating disorders too, though less frequently than girls. However, the younger the age, the more even the distribution between girls and boys. Tuesday January 4, 2011 12:06 Dr. David S. Rosen

12:06

Dr. David S. Rosen:  Whereas girls often express concerns about overweight and wanting to lose weight, boys often express concerns about being strong or muscular and about eating "healthy". Behaviorally, however, eating disorders in boys look very much like eating disorders in girls. Tuesday January 4, 2011 12:06 Dr. David S. Rosen

12:07

Deborah L. Shelton:  We see a comment from Lynn Grefe, CEO of the National Eating Disorders Association. Tuesday January 4, 2011 12:07 Deborah L. Shelton

12:07

[Comment From Lynn GrefeLynn Grefe: ]  Just a reminder that we also have millions of people and children with Binge Eating Disorder... and they are getting lumped into the childhood obesity column, but they really need mental health counseling. Tuesday January 4, 2011 12:07 Lynn Grefe

12:08

Dr. David S. Rosen:  I agree! Binge eating disorder is a significant (and poorly studied) problem for many adolescents! Tuesday January 4, 2011 12:08 Dr. David S. Rosen

12:09

[Comment From AmyAmy: ]  How can a family be supportive at mealtime for a recovering anorexic? Tuesday January 4, 2011 12:09 Amy

12:09

Deborah L. Shelton:  We are seeing several questions about difficulties at meal time, Amy. This seems to be a problem for a number of parents. Tuesday January 4, 2011 12:09 Deborah L. Shelton

12:10

Dr. David S. Rosen:  Every family will be different, but having firm and consistent expectations, based on the advice of your treatment team, is important. People recovering from anorexia need help both to eat enough, but also to feel safe they are not eating too much Tuesday January 4, 2011 12:10 Dr. David S. Rosen

12:11

[Comment From Liang LuLiang Lu: ]  Hi Dr. I have a 16 year old daughter who is 5'2 and 100 lbs. She said her goal weight is 97 lbs. She would skip meals and do self-induced vomiting. She said this is normal for her friends. What should we do about it? Tuesday January 4, 2011 12:11 Liang Lu

12:12

Dr. David S. Rosen:  The fact that she is so rigid in her weight goals, and the fact that she is vomiting intentionally, tell me that there is alsready a problem here. This is not normal behavior (though your daughter might honestly believe that it is). Time to get help! Tuesday January 4, 2011 12:12 Dr. David S. Rosen

12:12

Deborah L. Shelton:  Social pressure to be thin is enormous, especially among girls. Tuesday January 4, 2011 12:12 Deborah L. Shelton

12:13

Deborah L. Shelton:  Is media the main issue here or is it something else? Tuesday January 4, 2011 12:13 Deborah L. Shelton

12:14

Dr. David S. Rosen:  Our old belief was that ED were caused by media effects, or psychological issues, often related to family dysfunction. Any effort to explain ED based on a single cause will be overly simplistic. In our more up-to-date understanding, media effects, psychological issues and family dysfunction sometime plays roles, but we now recognize a strong GENETIC component to eating disorders. They run in families. Individual psychological characteristics, family dynamics, and media influences contribute as well, but usually do so in the context of someone who is already PREDISPOSED to the possibility of an eating disorder. Tuesday January 4, 2011 12:14 Dr. David S. Rosen

12:15

[Comment From Lynn GrefeLynn Grefe: ]  Dr. Rosen is correct......all the signs are there that the daughter needs help. These are illnesses, not choices and everyone concerned should be aware of that. and, the media did not cause eating disorders, simply triggers the behaviors and poor self esteem. Tuesday January 4, 2011 12:15 Lynn Grefe

12:15

[Comment From AmyAmy: ]  How do you think Anorexia affects minority communities and Hispanics in particular? Tuesday January 4, 2011 12:15 Amy

12:16

Deborah L. Shelton:  We don't hear much about eating disorders and minorities. Good question. Tuesday January 4, 2011 12:16 Deborah L. Shelton

12:17

Dr. David S. Rosen:  Our old stereotypes about eating disorders have not help up over time. Eating disorders are equal opportunity illnesses. They can affect anyone. I see many African American, Hispanic, and other minority teens with eating disorders Tuesday January 4, 2011 12:17 Dr. David S. Rosen

12:18

[Comment From GuestGuest: ]  My mother found out about this web chat earlier today. I'm struggling with anorexia right now and have a question. How is body distortion (BDD) cured ? Tuesday January 4, 2011 12:18 Guest

12:19

Dr. David S. Rosen:  It will take hard work with a counselor or therapist to work on the issues of body distortion. But the brain suffers when nutrition is poor. Feeding your brain is an important start to helping it work better and distort less. Tuesday January 4, 2011 12:19 Dr. David S. Rosen

12:21

[Comment From HannahHannah: ]  I want to attest to the merits of Family Based Therapy. My 11-year-old daughter is just coming out of a battle with anorexia. She was in serious condition this summer-- extremely thin, a heart rate of 42 and dangerously low blood pressure. I was amazed at the quick progression of the disease from the time we suspected something to the time she was noticeably sick. I so thankful that we were directed to Dr. Rosen and to Judy Banker at the Center for Eating Disorders in Ann Arbor, which guided us through Family Based Therapy. In a matter of six months, my daughter has gone from a total repulsion of food to eating on her own and with pleasure. We proceed with caution but we are amazed at how well this treatment has worked for my daughter and for me, her major caregiver through this illness. For younger anorexics, I think the form of treatment can work wonders. Tuesday January 4, 2011 12:21 Hannah

12:22

Deborah L. Shelton:  For more information about eating disorders and children, go to: http://www.healthychildren.org/English/news/Pages/AAP-Clinical-Report-Childrens-Eating-Disorders-on-the-Rise.aspx Tuesday January 4, 2011 12:22 Deborah L. Shelton

12:22

Deborah L. Shelton:  That report is from the American Academy of Pediatrics and has links to more information. Tuesday January 4, 2011 12:22 Deborah L. Shelton

12:22

Dr. David S. Rosen:  Family-based therapy has received a lot of recent attention--deservedly so--because the outcomes reported have been generally positive. This was a wonderful result! But family-based therapy is not appropriate for all patients, and is not available in all communities. It also places a tremendous burden on families. Family-based treatment is often considered as the first or best choice for children or adolescents with eating disorders, but it is not always effective and may not be available. There are no one-size-fits-all solutions. Here, it was the right one! Tuesday January 4, 2011 12:22 Dr. David S. Rosen

12:23

Deborah L. Shelton:  We have lots of question in queue. Please be patient as we shift through them. Thanks for sending them, and send more! Tuesday January 4, 2011 12:23 Deborah L. Shelton

12:23

[Comment From GuestGuest: ]  I've tried being the "nice" dad with a soft touch and gentle encouragement, as well as the tough dad and being more involved and strict in monitoring my daughter's food and calorie intake. Which is better for long term success? I've had very little success with either approach actually. Tuesday January 4, 2011 12:23 Guest

12:25

Deborah L. Shelton:  Great question. You are not alone, I'm sure. Tuesday January 4, 2011 12:25 Deborah L. Shelton

12:25

Dr. David S. Rosen:  No right or wrong answer here. Depends on so many things. But remember that an ED is an illness, and the treatment is HARD. The approach to take will depend on the age of your child, their nutrition level and where they are starting from, their cognitive status, your relationship, and the approach of your treatment team. But whatever the approach, consistency is important! Tuesday January 4, 2011 12:25 Dr. David S. Rosen

12:26

[Comment From GuestGuest: ]  How can families and individuals work to cure or manage eating disorders if they do not have the funds, insurance, or financial means to do so? Tuesday January 4, 2011 12:26 Guest

12:27

Deborah L. Shelton:  We're getting a lot of questions about insurance and getting treatment covered. We're going to take that as one big question. Lynn, did you want to weigh in as well. Tuesday January 4, 2011 12:27 Deborah L. Shelton

12:28

Deborah L. Shelton:  This doesn't help with the insurance question, but to find providers,go to: For Treatment Referrals, Visit www.NationalEatingDisorders.org Or Contact NEDA's Live Helpline: 800-931-2237 Monday ? Friday: 8:30 a.m. ? 4:30 p.m. (PST) Tuesday January 4, 2011 12:28 Deborah L. Shelton

12:28

[Comment From Lynn GrefeLynn Grefe: ]  Thanks for the toughest question Deborah!! There are research programs, if the person qualifies. Tuesday January 4, 2011 12:28 Lynn Grefe

12:28

Deborah L. Shelton:  Payment is always tough! Tuesday January 4, 2011 12:28 Deborah L. Shelton

12:29

Dr. David S. Rosen:  Resources for treatment is a significant issue. You can work with your medical doctor to receive some treatment under medical benefits. you can negotiate with your insurance company for a waiver. There are research and free services in some communities. There are advocacy organizations that will help. Tuesday January 4, 2011 12:29 Dr. David S. Rosen

12:29

[Comment From Lynn GrefeLynn Grefe: ]  We have information on our website about working with insurance companies. You may have to appeal and fight, but over and over we find families can win, it takes patience. Sadly people have to go throughh all this to get the help they need. Tuesday January 4, 2011 12:29 Lynn Grefe

12:30

Dr. David S. Rosen:  We created a website specifically to help with reimbursement and payment at www.eatingdisorderhelp.org Tuesday January 4, 2011 12:30 Dr. David S. Rosen

12:30

[Comment From Edward ReyesEdward Reyes: ]  Hello, is there a support group for children with eating disorder, most for the parents, since we have a hard time dealing with our 17 years old daughter, she's bulimic, her weight is not at risk according to the doctors but her behavior and the issues attached because of the induced vomits what worries us Tuesday January 4, 2011 12:30 Edward Reyes

12:31

Deborah L. Shelton:  Thanks for the question Edward. Tuesday January 4, 2011 12:31 Deborah L. Shelton

12:32

Dr. David S. Rosen:  There are support groups for kids and also support groups for parents. Obviously, availability will vary from community to community. I would be very cautious about ONLINE support groups. Even the best intentioned online sites can have unintended consequences, especially for kids who are still a ways away from recovery. Tuesday January 4, 2011 12:32 Dr. David S. Rosen

12:33

[Comment From Lynn GrefeLynn Grefe: ]  There are also a few scholarship programs, such as the FREED Foundation, Manna SCholarship Fund and others.. Tuesday January 4, 2011 12:33 Lynn Grefe

12:34

[Comment From MargaritaMargarita: ]  How do you bring up the subject with someone (to get help) when you suspect they have an eating disorder? Tuesday January 4, 2011 12:34 Margarita

12:34

Deborah L. Shelton:  Another great question. Often people want to help but don't know how. Tuesday January 4, 2011 12:34 Deborah L. Shelton

12:35

Dr. David S. Rosen:  It depends on the age. I would try not to be confrontational. Express your concern. Tell them you are worried. Don't be drawn into an arguement about whether there is or isn't aproblem. Suggest that they see someone to help figure out if there is a problem or not (you might KNOW there is a problem, but better not to assume in this conversation). Tuesday January 4, 2011 12:35 Dr. David S. Rosen

12:36

Dr. David S. Rosen:  If it is an adult peer or older child, offer to go with them to the appt. Tuesday January 4, 2011 12:36 Dr. David S. Rosen

12:37

[Comment From CassieCassie: ]  I'm struggling with anorexia. I'm told I have to gain atleast 30lbs to be at a "healthy weight" When I look in the mirror I see myself as normal. I'm told it's body distortion. But I dont know what to believe any more. I cant even bare to think of gaining any more. My mom is threatening to get me a feeding tube if I keep losing weight. I'm scared. I dont want to gain weight. I cant Tuesday January 4, 2011 12:37 Cassie

12:38

Deborah L. Shelton:  We're seeing a number of questions from young people. Thank you for joining us to talk about this. We can't take every single question, but we can address some of your concerns. Tuesday January 4, 2011 12:38 Deborah L. Shelton

12:40

Dr. David S. Rosen:  I know how hard this is. It is hard not to believe what your eyes are telling you, and harder still when people don't seem to realize that this is really what you see. You need to try to focus on day-to-day eating, meeting your needs, improving your nutrition level so that YOU start to feel better, and trust that it will get easier as you get better (it will!). Tuesday January 4, 2011 12:40 Dr. David S. Rosen

12:40

[Comment From JaneJane: ]  I just want to say THANK YOU to Dr. Rosen and the AAP for bringing attention to eating disorders in young people. (My daughter had anorexia at 14 and is doing great now, years later.) I was especially glad to see optimism about recovery in some of the press reports. EDs are serious, but treatable and beatable! Tuesday January 4, 2011 12:40 Jane

12:41

[Comment From GuestGuest: ]  I'm 5'6 and 88lbs. I was diagnosed with anorexia. When I look in the mirror I see myself as normal and not needing to gain weight. My doctor's said that I'm seeing myself in a wrong way. How is this possible? Tuesday January 4, 2011 12:41 Guest

12:43

Dr. David S. Rosen:  Body image disotrtion is very real for people with anorexia, and nearly incomprehensible to people who don't have it. The distortion seems to be related to the effects of malnutrition on the brain. As your nutrition improves, you will see that some of the distrotion will start to clear.... almost like you are removing a pair of distorting glasses. That makes the rest of the recovery process WAY easier. It's taking the first steps and getting a little better thatis the hardest step. Tuesday January 4, 2011 12:43 Dr. David S. Rosen

12:43

[Comment From GuestGuest: ]  Do you have to live with your eating disorder the rest of your life? Is it curable? Tuesday January 4, 2011 12:43 Guest

12:44

Dr. David S. Rosen:  It is not inevitable that sufferers must learn to live with their eating disorder. Most patients with eating disorders, especially younger patients, recover completely. Tuesday January 4, 2011 12:44 Dr. David S. Rosen

12:45

[Comment From Lynn GrefeLynn Grefe: ]  The earlier the treatment, the better. . Tuesday January 4, 2011 12:45 Lynn Grefe

12:46

Dr. David S. Rosen:  By completely, i mean physically healthy, mentally healthy, and no longer having any of the distortions or ED thoughts. In my practice, complete recovery is the most common outcome. This is partly because younger patients tend to recover more readily than patients who have had eating disorders for many years. But it is still hard work! Tuesday January 4, 2011 12:46 Dr. David S. Rosen

12:47

Dr. David S. Rosen:  I agree with Lynn.... The earlier the better. We should start to be concerned when children express weight concerns, when they talk about or start diets, of if their activity level suddenly rises outside of usual recreational or athletic activities. Waiting until there are symptoms and significant weight loss is almost too late! Tuesday January 4, 2011 12:47 Dr. David S. Rosen

12:48

[Comment From GuestGuest: ]  There is a great family support group called F.E.A.S.T. Their website has lots of information and a forum where parents can ask questions of other parents and get support. Tuesday January 4, 2011 12:48 Guest

12:49

[Comment From EmilyEmily: ]  What is your sense on the impact of obesity prevention programs and the increase in eating disorders in younger children. Is that message missing it's target? Tuesday January 4, 2011 12:49 Emily

12:50

Deborah L. Shelton:  Interesting question. Tuesday January 4, 2011 12:50 Deborah L. Shelton

12:52

Dr. David S. Rosen:  Many of us believe that the focus on obesity prevention, especially with young children, has had the unintended consequence of increasing eating disorders in susceptible individuals. Some younger kids handle the nutrition messages in ways that are too rigid, inflexible, and that get them into trouble. Tuesday January 4, 2011 12:52 Dr. David S. Rosen

12:53

[Comment From Lynn GrefeLynn Grefe: ]  I believe that we all need to get a grip on how we discuss all of this, focus on health not size. there are many mixed messages out there. Re childhood obesity, the culprit is not one cupcake. Tuesday January 4, 2011 12:53 Lynn Grefe

12:53

[Comment From Charlotte UKCharlotte UK: ]  With regard to the obesity prevention programme, another area which does seem to impact on adolescents is the "healthy eating" part of the curriculum, which is presented to the children at a very vulnerable age. Tuesday January 4, 2011 12:53 Charlotte UK

12:54

Dr. David S. Rosen:  I agree. Most kids can handle the messages, but some have thinking that is too black and white... That gets them into trouble Tuesday January 4, 2011 12:54 Dr. David S. Rosen

12:55

[Comment From JaneJane: ]  What should parents first step be if they are worried about their child? Tuesday January 4, 2011 12:55 Jane

12:55

Dr. David S. Rosen:  Get help! The sooner the better! Do not settle for "wait and see" approaches, especially if you are worried. Tuesday January 4, 2011 12:55 Dr. David S. Rosen

12:57

Deborah L. Shelton:  Several people have asked about strategies for prevention of eating disorders. What can people do? Tuesday January 4, 2011 12:57 Deborah L. Shelton

12:57

Dr. David S. Rosen:  The single best strategy I can suggest is to help your child to avoid dieting! Dieting is recognized as a potent risk factor for eating disorders. Instead of dieting, better to focus on healthy eating, healthy physical activity, and healthy lifestyle, discussed in a way that does not threaten self-esteem. Tuesday January 4, 2011 12:57 Dr. David S. Rosen

12:58

Dr. David S. Rosen:  We know that early eating disorders, before they become full-blown illnesses, can be reversed more easily that established disorders. And we are starting to recognize strategies that can reduce the rates of eating disorders in groups--simple things like family meals, eating breakfast, and being active. It remains to be seen if we can prevent eating disorders in individuals, especially individuals who are genetically predisposed. Tuesday January 4, 2011 12:58 Dr. David S. Rosen

12:58

[Comment From Celia -- RD from SeattleCelia -- RD from Seattle: ]  I agree that parents/families need to get help as soon as any of the symptoms Dr. Rosen has described present. But families can also begin to consider their own eating/dieting habits and can promote an eating environment where ALL foods are ok and are included/promoted as part of an overall health-supporting intake. Tuesday January 4, 2011 12:58 Celia -- RD from Seattle

12:59

[Comment From Celia -- RD from SeattleCelia -- RD from Seattle: ]  And parents need to model that behavior which can be very difficult in our current eating culture! Tuesday January 4, 2011 12:59 Celia -- RD from Seattle

12:59

Deborah L. Shelton:  Our hour is up already. Thanks to all who tuned in for our first live health chat of 2011. Sorry we couldn't answer all the questions. There were a lot of them! Thank you again Dr. Rosen. Tuesday January 4, 2011 12:59 Deborah L. Shelton

1:00	Dr. David S. Rosen:  Thanks for letting me particiapte, and thanks to everyone who posted questions! I wish I could have answered all of them! Tuesday January 4, 2011 1:00 Dr. David S. Rosen

1:00	Deborah L. Shelton:  Check us out at noon CT next Tuesday, Jan. 11 to chat about tips for caring for an elderly loved one. Tribune health reporter Judy Graham will be chatting with panelists Margaret Mintz and Jody Winer. Have a great day! Tuesday January 4, 2011 1:00 Deborah L. Shelton

1:01