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It’s a sad paradox: in a nation that has a plenitude of easily-available, safely-stored, nutritious food some young people are starving themselves.

Anorexia means loss of appetite and can occur in many disorders from flu to food poisoning. Anorexia nervosa is the term used to mean pathological denial of appetite for food. It is estimated that 1% of white females are anorectic or one out of every 100-150 white, middle- or upper-class young women. There is a higher incidence in certain groups such as ballet dancers and models. The age of onset has two peaks: 13-14 and 17-18.The mortality rate is as high as 5%.

Girls–anorexia is rare but not unheard of in boys–with this disorder have an abnormal fear of fatness; self-starvation and weight loss; physical concomitants of starvation such as amenorrhea, bone mineral loss, metabolic disturbances, and cardiac weakness; and mental problems including distorted body image, obsession with losing weight, low self-esteem, depression, and a need to control.

The first signs may be bizarre eating habits such as cutting food into tiny pieces or only playing with food and pretending to eat. Some girls hoard food but never eat it. Next comes the abnormal weight loss which they often camouflage with bulky clothes and hide by not undressing in front of anyone. Although hunger pangs disappear as starvation progresses these girls remain obsessed with food and may spend hours preparing huge, rich meals which they feed to others but never eat.

How can parents tell if their child might be anorectic? Usually these are great girls! They are bright and dutiful and high-achieving. Everything is fine until they decide they are too fat. All prepubertal girls experience widening of the hips and some deposit of fatty tissue and many girls who go off to college gain weight. These are normal benign occurrences but they happen in a culture that values thinness. The girls feel fat so they go on an ordinary teenage diet or embrace vegetarianism or hyper-exercise to lose weight. But they don’t stop dieting

Some clues:

o Weight loss often concealed by clothing; never let parents see them in a fitting room or naked.

o Worry to the point of obsession about being too fat even in the face of weight loss.

o Preoccupation with food.

o The signs and symptoms of starvation: scrawny limbs and swollen belly, cold skin, constipation, cessation of menstruation, muscle weakness, lethargy or irritability, dry hair or loss of hair.

Nobody knows what causes anorexia but it seems to occur in countries where there is both an abundance of food and a preoccupation with thinness. Today our society as a whole seems obsessed with both thinness and fitness. Currently many of us are compulsive label-readers and consider certain foods like those containing fat to be evil.

Obsession with food is not healthy. Both compulsive eaters and anorectics are obsessed with food, the one constantly thinking about food that will be eaten, the other constantly thinking about food that will not be eaten.

I warn parents to be careful about the messages they give their children. Fitness is a good goal, as is a low-fat diet. But don’t overdo it. Parents must be careful that in their own zeal for fitness and leanness they not harm their children either nutritionally or emotionally. Kids need fat to meet their nutritional requirements for growth. Kids should not grow up thinking that foods can be bad. There are no bad foods, just bad eating habits.

As a society we may have to rethink our ideas about food and thinness. Food is not love, food is not approval, food is not control. Food is the fuel we need to run our bodies. Eating food is a pleasurable way of satisfying hunger and providing proper nutrition. It is not the only pleasure in life.

Anorexia does respond to treatment but it is a chronic disease and families cannot expect instant cures. Today’s nutritional rehabilitation programs use positive reinforcement and behavioral modification along with individual, group, and family therapy. Most girls need hospitalization initially in order to stabilize weight and begin the behavioral treatment. Close follow-up is needed because some girls will suffer relapses.