Kids Love Dr. Barton


by Dr. Douglas Barton, M.D., Pediatrician 11/17/2008

            The, other day in the office, I met with a family who was concerned about their daughter’s chest pain.  She was about 14 years old and I’ve always thought she was quite pretty.  Her chest pain, however, turned out to be quite secondary to what was really going on.  She had spent some time with an aunt over the summer and on returning home, was noticed to weigh quite a bit less than before.  No biggie.  Maybe she was just enjoying summer so much that she didn’t eat as much as she could have.  Except that, lately, her mother had noticed that every time she approached a certain weight, all of a sudden, her diet would change, her appetite would change and she would increase her exercise.  Unfortunately, as I evaluated her, it turns out that that certain weight is still considerable under-weight for her height, and she had been much lighter at the end of summer.
            Anorexia and bulimia are scary illnesses that have largely come about as the fashion trends and medical advice have encouraged us to be lean, thin and sexy.  Clearly affecting women and girls more often than boys and men, they can occur in any one.  The key defining element is an inappropriate obsession with body weight combined with a distorted body image and an inappropriate weight management technique.  A person that is severely overweight might have to become obsessed with body weight, but be able to have an appropriate body image and weight loss techniques.  This person does not have a problem.  An extremely overweight person who eats large meals, then purges them and goes to the gym and attempts to “sweat of the pounds,” does have a problem.
            Anorexia is the intentional, and often extreme, reduction of caloric intake in an attempt to meet some distorted body weight.  As the patient reaches that weight, there is often a sense that that weight is not low enough, so they often set a lower goal. This process continues to weights that are terribly unhealthy. 
            Bulimia also begins with a distorted body image and a goal weight, but the method of reaching it includes eating a lot of food, then using inappropriate methods to try to eliminate the calories just eaten, such as vomiting or excessive exercise. 
            Both diseases are dangerous.  Both types can create medical problems that are difficult for physicians to treat.  Both are also dangerous because they tend to persist.  Even if we are able to treat the underlying abnormalities of dehydration and abnormal chemistry values, the patients often go right back to the disordered eating and distorted body image. 
            Often, early recognition and brief counseling help.  You may, however, need to take advantage of one of the outpatient, or even inpatient programs specifically designed for eating disorders.  If you have any reason to think your child might be going through this, get help sooner rather than later.  Talk to your pediatrician.  



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