An Overview: What Youth Leaders Need to Know Today About Deadly Eating Disorders

It’s been said that eating disorders (EDs) are the greatest mental health challenge for youth today. The fact is, troubling reports confirm to a greater extent that teens—girls and guys—are being held captive to this dreadful disorder. In this culture, an obsession with food and dieting often can be mistaken for a healthy lifestyle choice. We’re often praised for working out three hours a day or having the willpower to eat teeny-tiny meals. We can download forms to help us count each calorie we ingest.

These are deceptive traps disguised as a potentially deadly eating disorder—and they are ready to take over a teen’s life. Most disturbing is that in 2009, the government published data showing that children under 12 years old were the fastest-growing population of patients hospitalized for eating disorders. For the adolescent with a propensity toward an eating disorder, food eats a hole in their lives.

Eating disorders are often taken too lightly. The symptoms are brushed off as attention-seeking devices or fads that the person eventually will outgrow. This is usually not the case. Let me tell you personally, no one chooses to have an eating disorder; it’s not a lifestyle choice or case of vanity. EDs are serious with severe medical, nutritional and psychological consequences. EDs that begin in a person’s youth can carry over to adulthood. I developed an ED my senior year of high school and was not set free until I was 37 years old. It is a myth that an adolescent simply outgrows an ED. We need to be concerned when teens express weight concerns, when they talk about or start diets, or if their activity level suddenly rises outside of usual recreational or athletic activities.

Eating disorders, including anorexia nervosa, bulimia nervosa, binge eating disorder and eating disorders not otherwise specified (EDNOS) are the unspoken secrets that permeate many families. This is a growing problem in a nation that places undue value on thinness—even as overeating and obesity are epidemic. A growing body of evidence indicates men are as concerned about body image as women and that it’s not unusual for a male to have an eating disorder. About 10 percent of teens with an eating disorder are boys, and the number is growing.

Anorexia nervosa is a serious, potentially life-threatening disorder characterized by self-starvation and excessive weight loss. Individuals with anorexia have a relentless preoccupation with dieting and an irrational fear of weight gain even when emaciated, as well as a distorted self-image of body weight and shape. At 16, Terrie embarked on a harmless post-Christmas diet to shed a few pounds, but was soon caught in the grip of anorexia. Months later, her major organs failed and she died of a heart attack. Successful treatment is challenging because anorexia is brutal! One teen admitted, “I started to just eat less and less, then I started to feel fat for eating an apple a day. I wanted to be beautiful and I wanted people to notice how thin I was and I wanted to be somebody, but in the end I ended up wrecking my future.” One aspiring model’s body is so starved that she physically smells because her body literally is eating itself alive.

One teen blogged, “I’m at 150 calories today. I’m exercising as soon as I get home. I plan to skip dinner. I need to reach my next goal weight by Monday, or else. Today my heart rate was 53 before lunch, about 56 now. My fingernail beds are not blue, exactly, but they’re not pink any more. And the sad thing is these symptoms thrill me. Like many of us, I have romantic ideals. I want to be the Poetic Waif, the starving artist, a princess, a fairy, something ethereal. I want to be Shakespeare’s Ophelia, a nostalgic, tragic figure, living in a world of air and dreams. Instead, I have always felt the opposite. I am logical, earthy, contained, responsible, boring. Ana [anorexia] is how I deal with my failures, Ana is how I achieve my dreams. I am choosing to live in a dream world, because I cannot live in the real one. I’m slipping slowly away.”

Bulimia nervosa is also serious and potentially life-threatening. It is characterized by a cycle of bingeing and purging. Purging may be self-induced vomiting or ingesting large amounts of laxatives designed to eliminate the effects of binge eating. Exercise bulimics, instead of vomiting, purge on exercise after eating in a desperate attempt to burn off calories and lose weight. According to the National Eating Disorders Association, about 80 percent of patients who are diagnosed with bulimia use excessive exercise to control their weight. The majority are women, aged between 15 and 35.

Studies note higher than normal rates of bulimia in families of substance abuse, especially alcohol abuse. Rates of obesity, depression and mood disorders are also higher. Bulimia is used as a distraction from pain, to control emotions, to ease the stress of major life transitions or to reduce image pressure, including the pressure to succeed.

Increasingly, teens are experiencing anxiety and depressive disorders, key indicators of stress. Many teens think they will just outgrow bulimia; they don’t. I had no idea this monster would consume and destroy my life for 17 years. For others, the torment of this bondage is severe, and many truly desire to die.

Binge Eating Disorder (BED) is the most widely occurring eating disorder. It is characterized by eating an unusually large amount of food at one sitting, even when the person is not hungry, but without the counteracting use of purging. BED is more than just occasionally overeating. Many eat in secret due to shame. This disorder appears to be linked to very specific histories of childhood sexual or emotional abuse, which in turn lead to self-criticism.

EDNOS: Approximately 70 percent of patients diagnosed with eating disorders do not have bulimia or anorexia or BED, according to criteria from the current DSM-IV. Instead, they suffer from what are known as eating disorders not otherwise specified—illnesses defined by what they aren’t.

The term disordered eating falls into the EDNOS category. It is a term used by some to describe a wide variety of irregularities in a person’s eating behavior. A person’s focus is on his or her body and diet, but he or she does not meet the medical criteria for bulimia, anorexia or binge eating. They eat, or don’t eat, for emotional reasons.

EDNOS includes diet addiction, which describes people who jump from one fad diet to another without ever stabilizing their weight or learning healthy eating habits. Another category is exercise addiction. It is not unusual for a girl to get up at 3 or 4 a.m. to exercise for three hours before school. They feel extremely guilty for missing a workout. Injuries, anxiety, amenorrhea (loss of menstrual cycle), bone loss or a drop in protein levels are common due to the intensity and frequency of exercise and refusal to allow the body time to rest and recover.

One nutritionist said, “Many of my patients began their eating disorder after initially losing weight on purpose. When they realize their new weight has not protected them from their problems or negative feelings, they have the mistaken belief that more weight loss was needed. This will continue until they seek help and address the underlining issues that need to be resolved.”

Drunkorexia: The previously mentioned EDs are the most commonly discussed eating disorders, but there’s another unhealthy habit that’s becoming more prevalent among teenagers and college students. Drunkorexia is a term used to describe the combination of disordered eating with heavy alcohol consumption. It is becoming a danger to long-term health. It puts individuals at risk not just for more serious eating disorders, but also addiction problems.

A growing body of evidence indicates men are as concerned about body image as women and that it’s not unusual for a male to have an eating disorder. This is the key—the ED, the disordered eating behavior, is only a symptom to cover and mask inner feelings—a hole in the soul. Think about this: If food really did make you better, then you’d be better. The underlying cause must be addressed and resolved. Showing unconditional love and forgiveness is significant. Typical triggers are social pressures, low self-esteem, depression, loneliness, abuse, troubled relationships and family life.

It’s important for not only parents to be well-educated, but also for youth leaders (and teachers and coaches) to be aware and knowledgeable of the nature of EDs, as well as to recognize potentially troubling behavior and to know what to do and what resources are available. I will be exploring this in a forthcoming four-part series:

1. Learn the warning signs of an eating disorder—be prepared to respond.
2. Debunk the myths—learn the different causes of eating disorders.
3. The risk and prevalence of eating disorders in athletics is huge—help save a life.
4. The adolescent with an eating disorder is attempting to fill a huge soul hole—lead them to the Soul Hole Filler.

According to statistics compiled by The Renfrew Center, a network of residential facilities for the treatment of women with eating disorders:
• Approximately half (40 to 60 percent) of high school girls are on a diet.
• 13 percent of high school girls binge and purge (bulimia).
• 30 to 40 percent of junior high girls worry about their weight.
• Otherwise healthy teenage girls who diet regularly show worrying signs of malnutrition, researchers have found. Dieting can cause teenagers serious harm, potentially preventing them from developing properly. Calcium deficiency is a large concern.

Data compiled by other organizations indicate:
• Estimates suggest one out of every four young males will struggle with an eating disorder.
• Males account for an estimated 10 to 15 percent of people diagnosed with anorexia or bulimia.
•  Experts estimate that more than 1 million American boys and men suffer from anorexia alone. The actual rates may be higher. To combat high levels of anxiety about body image many males resort to compulsive exercise, steroids, strict diets, laxatives or making themselves vomit in an attempt to lose weight or achieve a more toned physique.
• 90 percent of people with anorexia or bulimia are females between the ages of 12 and 25.
• It is estimated that 11 percent of high school students have been diagnosed with an eating disorder.
• The 2009-2010 Child and Adolescent Mental Health Service Report states that adolescent girls accounted for 90 percent of all admissions with eating disorders.

Eating disorder resources are available. Across the country, treatment centers offer a variety of programs for students in school who are struggling with eating disorders or body-image issues. Many treatment centers also offer eating disorder resources for friends, family members and loved ones to help them understand these diseases. The key is that the community as a whole must be part of the solution so each child repeatedly gets the same message that he or she is not his or her body.

Most importantly, as C.S. Lewis said, “Until you have given up yourself to Him [Jesus Christ], you will not have a real self. Sameness is to be found most among the most ‘natural’ men [women], not among those who surrender to Christ…You will never make a good impression on other people until you stop thinking about what sort of impression you are making…The more we get what we now call ‘ourselves’ out of the way and let Him take us over, the more truly ourselves we become.”

More information and a list of resources at

Next issue: Learn the warning signs of an eating disorder—be prepared to respond.
[Excerpted from Torn Between Two Masters: Encouraging Teens to Live Authentically in a Celebrity-Obsessed World.]

Kimberly received her M.A. in specialized ministry from Western Seminary, Portland, Oregon. She is a board certified biblical counselor, personal life coach, speaker, and founder of Olive Branch Outreach, a ministry dedicated to bringing hope and restoration to those struggling with eating disorders and body image. Kimberly volunteers in student ministries and youth education outreach. She is the author of four books, including Torn Between Two Masters: Encouraging Teens to Live Authentically in a Celebrity-Obsessed World.

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