Question:

My 14 year old daughter used to be a little overweight. She never seemed to mind before, but now she is obsessed with losing weight. In the last two months she's lost a significant amount of weight (I don't know how much exactly because she won't tell me) and she looks great. However, I think she has lost enough and should just maintain her new, healthy body. I can see, however, that she has become fanatical about weight loss; she isn't showing any signs of letting up on her diet. How can I be sure that she has not developed anorexia nervosa? My friend's daughter used to be very heavy and when this young lady lost weight she went way too far, becoming so thin that she had to be hospitalized. I don't want this to happen to my child. How do I know if she is in danger of doing the same thing?

Answer:

You are asking an excellent question. Sometimes teenagers do overcompensate for a previous weight problem by becoming anorexic. Their original intent, of course, was to lose a few pounds. However, the weight loss can occasionally take on a life of its own and the youngster becomes obsessed with her body image (the way she looks) and with being thin. There are also many girls, and some boys as well, who become anorexic as a response to stresses other than being overweight.

As a parent, you may not be able to fully distinguish between normal dieting and the disease of anorexia nervosa. However, if you see the following symptoms in your child, you should definitely talk to her. Let her know that you are worried about what is happening and that you want to set up a meeting with a professional (mental health provider, dietician or doctor) in order to ascertain that all is well or to treat a condition if one is assessed. Here is what to look out for:

· Child has lost a significant amount of weight. The official criteria is 15% of normal weight. However anorexics often wear layers of clothing to help hide excessive weight loss (as well as to maintain their body heat). The unusual amount of baggy clothing can, in itself, be a warning sign.

· Skipping meals (as a new behavior).

· Showing excessive concern about weight loss by constantly weighing herself, examining herself in the mirror, talking about how fat she is (when she isn't), talking about how many calories foods have – beyond what normal dieters do.

· Lying about having eaten or how much she has eaten.

· Restricting her diet to low fat foods and empty calorie foods (i.e. removing all grains, meats, dairy products even though she used to enjoy these).

· Cutting her food into tiny little pieces, pushing them around the plate and barely eating them.

· Shows disgust toward calorie-laden foods such as meat, pastries, cakes and cookies (anorexics may still eat candy).

· Exercises excessively (i.e. for 2 hours a day).

· Leaves "evidence" of purging such as wrappers and packaging from diet pills or laxatives.

· Leaves "evidence" of lack of menstruation by failing to request a new supply of menstrual products (if she used to give you that shopping list previously) or by failing to show whatever other signs of menstruation she used to show.

· Fainting or complaining of dizziness.

· Developing a layer of soft hair on her skin (called lanugo); developing dry or yellowish skin.

· Developing uncharacteristic fatigue and moodiness.

If you do notice one or more of the possible symptoms of anorexia nervosa, don't panic. It is more important to be effective now, than dramatic. Gently let your daughter know that you want to have a little chat with her later in the day. When you have that chat, tell her that you have been concerned. Let her know that you know the symptoms of anorexia and that even though she probably doesn't have it, you are feeling anxious (people with anorexia, like alcoholics, are generally in denial about their condition). Let her know that you want someone knowledgeable to put your mind at rest. Be gentle but firm. The assessment, if you feel you need one, is not an option. Your daughter's health is still your responsibility. If you have reason to be concerned, then definitely carry through until the matter is satisfactorily put to rest.