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Bright Futures in Practice: Physical Activity

EATING DISORDERS

BFPAIC_ILP40

Unhealthy eating behaviors and preoccupation with body size can lead to life-threatening eating disorders (e.g., anorexia nervosa, bulimia nervosa) described in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR).1,2 (DSM-IV criteria for anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified follow on pages 119 and 120.) Many children and adolescents with eating disorders participate in excessive physical activity to control their weight.3 Some become anxious or depressed if they are unable to participate in physical activity.4

Significance

Eating disorders have been observed in both sexes and across socioeconomic and racial/ethnic groups. The prevalence of anorexia nervosa and bulimia nervosa is thought to be 1 to 2 percent among female adolescents. Estimates of mortality resulting from anorexia nervosa vary considerably. The average estimate is 5 to 8 percent, but some estimates are as high as 20 percent.5,6 Death may be due to cardiac arrhythmia (irregular heartbeat), acute cardiovascular failure, gastric hemorrhaging, or suicide. The major medical complications observed in children and adolescents with anorexia nervosa include the following:7

  • Cardiac arrhythmia

  • Dehydration and electrolyte imbalances

  • Delayed growth and development

  • Endocrinological disturbances (e.g., menstrual dysfunction, hypothermia)

  • Gastrointestinal problems

  • Oral health problems (e.g., enamel demineralization, salivary dysfunction)

  • Osteopenia, osteoporosis

     

  • Protein/calorie malnutrition and its consequences

Bulimia nervosa can damage teeth. Purging exposes the teeth to acidic vomitus, which demineralizes tooth enamel and slowly dissolves the teeth. Health professionals should refer children and adolescents to a dentist if tooth damage is apparent. With bulimia nervosa, enlargement of the parotid glands may also be present.

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