Bulimia is an eating disorder that has been described by the ancient Romans as a means of relieving excessive food indulgences by way of the vomitorium. The word vomitorium is a historical term describing the place, in which, the purging of stomach contents occurred. Unfortunately, many a non history major in college is acquainted with this term for the wrong reasons. It is estimated that 2 to 5 percent of college students are Bulimic. The ratio of females to males is 10:1.
Bulimia is an eating disorder that is characterized as rapidly eating large volumes of food with excessive calories followed by vomiting. Diuretics and laxatives may also accompany this purging of GI contents. The binge and purge cycle best describes the process. Bulimia is usually preceded by previous attempts to diet. The majority of Bulimics are females of normal weight. Up to 40 percent of these patients may actually be overweight.
A Bulimic youth tends to be overly concerned with body shape and weight. Depression is often coupled with the disorder but not in anorexia (another eating disorder, in which, anorexia sufferers derive happiness from weight loss.) Unfortunately, along with depression associated with bulimia, one sees higher incidences of suicide attempts, suicide and obsession problems. Most often, a child with Bulimia may have tried to loose weight and got caught up in a cyclical and obsessive inappropriate way to loose weight. Children at risk may be inclined to engage in the following: socially motivated activities where thinness is valued, gymnastics, running, modeling, dancing and wrestling. The wrestlers tend to be the boys concerned about their weight class competition. Boys are usually worked up in the primary care providers (PCP) office for other problems associated with weight loss before being diagnosed with Bulimia.
This brings us to early detection. It is imperative that when parents, siblings, teachers, friends or coaches suspect an eating disorder, they must address the question. Here are some behaviors to look for:
1. A decrease of 10 lbs. or more in a short amount of time.
2. Dental carries- stomach acid when vomiting will erode tooth enamel.
3. Irregular menstrual cycles (periods) or cessation of menstruation.
4. Over concern for body shape, size or weight.
5. Binge eating at least twice/week for about 3 months or more.
6. Purchasing diuretics and laxatives.
7. Depression and/or negative self thoughts about themselves.
8. Family history.
9. Impulsiveness such as drug/alcohol use or sexual behaviors.
Health care providers are asking more and better questions these days because there has been an increase in the number of children with eating disorders. The rates have increased in minorities, boys and children of lower socioeconomic level. Well child checks are important in screening for eating disorders. Your PCP should be using height/weight charts and BMI charts as part of their health screening as well as food/intake history. Prevention is the best medicine.
If an eating disorder is detected, rapid response and treatment is the best answer. A “let’s wait and see approach” is a recipe for failure. Many PCP’s don’t feel comfortable treating eating disorders because treatment is multidisciplinary in design and this disorder requires frequent monitoring. You will most likely be referred to the proper channels for care. Depending on where you are located, eating disorder specialty care may not be readily available. Here in metro Atlanta, care is accessible.
The long term effects of Bulimia are the following:
1. Growth retardation- bones will eventually stop growing after adolescence. If your child has malnutrition, the window of opportunity for healthy bone growth can be missed.
2. Fractures of bones throughout life can occur.
3. Psychological problems related to depression, guilt and self esteem.
4. Heart problems due to metabolic and electrolyte issues. Laxatives and emetics (medications that can cause one to vomit) can have some very serious side effects.
Family Therapy is fairly new in the US. In order for this type of therapy to be effective, parents must assume more responsibility for the child’s intake. This type of therapy does not work as well in older children or in families with communication problems. The good news with eating disorders is that children can be cured. The rates of survival and cure have increased considerably over the last 25 years. Of course, there will always be the patients, who may suffer from eating disorders and fight the urge to purge. The secret to success is early detection and aggressive treatment of the disorder. Studies show that children ages 10-12 who were treated aggressively had better patient outcomes.
I would like to encourage families and schools to talk about eating healthy. Emphasizing and developing healthy eating habits and attitudes can prevent eating disorders. Discussing body image and Madison Avenue marketing strategies opens up communication and allows parents the ability to positively affect children. Schools and health classes need to openly address issues regarding body image, self esteem and bullying. Physical activities and organized sports need clear and precise goals for athletes engaging in activities where weight can be a factor. Too much pressure may be involved in these physical activities to compete and win. The loss of a child’s health is too great. Coaches need to be aware of risky behaviors.
If you detect a problem, seek professional help immediately. The PCP can determine the extent of the problem. Professionals can refer parents to the proper channels. Some parents who choose to place the child in a once a week group discussion and minimize the problem may be a deterrent to their child’s recovery. Studies show that the longer a child remains entrenched in eating disorder behaviors, the harder it will be for the chil