Boys and Eating Disorders

Expert Q&A

Teens running track at school.
If your child is overly interested in exercise and weight loss, then he could have an eating disorder. Photo by Getty Images

Q. My son is 13 1/2 years old. He was always very overweight and ate mostly junk food like McDonald's or pizza most of his life. As he started going through puberty, he grew 4 inches and lost 25 pounds. The problem is he has become obsessed with his weight and continues to lose more and more weight. His highest weight was 169 and now he is down to 117 pounds. He has also changed his diet completely. He has become a health nut and exercises all the time. I have no problem with that part. I am very worried since he is all skin and bones and seems to be very happy about the weight loss. He says he can't get skinny enough. What can I do? All of his relatives keep telling him that he is now "too skinny" including his pediatrician. He only eats healthy foods, but maybe not enough. How can I get him to gain some weight back? Isn't 117 pounds too thin? Meryl, Brooklyn, NY

A. At his age, 117 pounds is actually just above average. That doesn't mean it is a healthy weight for him though. Instead of just looking at a child's weight, it is more important to know about their body mass index.

Eating disorders are common though and many people believe that they have reached epidemic levels. By some estimates, about 5% of women and 1% of men suffer from an eating disorder, such as anorexia nervosa or bulimia. And since most of these eating disorders began in the teen years (76% between age 11-20 and 10% in children less than 10 years of age), parents and pediatricians should learn how to recognize, prevent and treat children with eating disorders.

Eating disorders can cause serious and life-threatening medical (malnutrition, dehydration, kidney, heart and liver damage) and psychological problems (depression, poor self-esteem, anxiety), so early identification is important.

Could your child have an eating disorder?

Is Your Child Underweight?

Children with a BMI that is below the 5th percentile for their age are usually thought to be underweight.

For his weight, he would already have to be over 6 feet tall to have a BMI below the 5th percentile though, so his weight may be okay.

Is he that tall? Since you describe him as being so skinny, he may very well be...

It is important to keep in mind that you can have a normal weight and normal BMI and still have an eating disorder.

Signs of an Eating Disorder

You actually mentioned may of the common signs and symptoms that would raise some concern that your son has or is developing an eating disorder, including that he:

  • has continued to lose weight, even though he is now 'too skinny'
  • has an obsession with his weight
  • exercises all of the time
  • may not be eating enough food and getting enough calories

Although some of what you mention might be normal, especially that he wants to exercise, eat healthy foods, and be a 'health nut,' the fact that he feels that 'he can't get skinny enough' should probably be considered to be a big warning sign.

In general, you might suspect that a child has an eating disorder if they have any of the following classic symptoms, such as:

  • being underweight, losing weight, or not gaining weight normally. Keep in mind that even children who appear to be at a healthy weight can have an eating disorder depending on what they are doing to maintain their weight.
  • having an intense fear of gaining weight or becoming fat, especially if your child is underweight
  • having a disturbed body image, meaning that your child thinks that he or she is overweight, even though they are really underweight or at a healthy weight.
  • in girls that have begun having regular periods, having amenorrhea, or the absence of at least three consecutive menstrual cycles.
  • episodes of binge eating
  • trying to prevent weight gain by performing self-induced vomiting, misuse of laxatives, diuretics, enemas, or other medications, fasting, or excessive exercise.
  • refusing to eat and continuous dieting

Children with more subtle signs can be more difficult to diagnose or discover.

These less obvious signs of an eating disorder might include hair loss, dramatic weight fluctuations, sensitivity to cold, excessive facial hair, swollen salivary glands, broken blood vessels in the eyes, taking OTC or natural weight loss medications, exercising compulsively, development of food rituals, refusing to eat certain foods, skipping meals, disappearing after meals (perhaps to vomit), withdrawn behavior, mood swings, not wanting to eat around other people, tooth decay, and wearing loose clothing to hide weight loss. And be aware that a teen with anorexia usually has a perfectionist type personality and is a high achiever in school.

Screening for an Eating Disorder

If you spot some of the early warning signs of an eating disorder in your child, you might ask some screening questions to get more information. According to the National Eating Disorders Screening Program, these include:

  • Are you terrified about being overweight?
  • Have you gone on eating binges where you feel you may not be able to stop?
  • Do you feel extremely guilty after eating?
  • Do you vomit or have the impulse to vomit after meals?
  • Do you feel that food controls your life?

The American Academy of Pediatrics also suggests asking your child:

  • What do you think you ought to weigh?
  • What is the most you ever weighed? How tall were you then? When was that?
  • What is the least you ever weighed in the past year? How tall were you then? When was that?
  • Exercise: how much, how often, level of intensity? How stressed are you if you miss a workout?

Your child's answers to these questions might help you to discover whether or not he or she has any of the more classic symptoms of anorexia or bulimia. You might also ask if any of your kids' friends have an eating disorder. And don't ignore the warning signs in younger children. Keep in mind that 10% of people with eating disorders begin before age 10. So even if your 8 or 9 year old is concerned about getting fat or talks about dieting, look for other red flags that he or she may have an eating disorder.

At this point, your child likely needs a further evaluation from a health professional that has experience treating teens with eating disorders. A registered dietician might be a good place to start. If he really wants to be healthy and not just thin, they might be able to help him plan a healthy diet and make sure he is getting enough calories, vitamins, and other nutrients, to be healthy and continue to grow normally.

A counselor, psychologist, or psychiatrist might also be helpful, as can your pediatrician, especially if they have developed a good relationship together.

If you are not sure where to take your child, the National Eating Disorder Association offers a referral service and can provide you with 'a list of doctors, nutritionists, counselors, and inpatient and/or outpatient facilities in your area.'

Pro Anorexia and Pro Bulimia Information

Surprisingly to most doctors and parents, there are a number of organizations and websites that actually advocate or encourage teens to have eating disorders and become anorexic. These include pro anorexia (pro ana) and pro bulimia (pro mia) websites which include galleries of pictures of models and celebrities that appear very thin (Super Thin Celebs), tips on losing weight and hiding their eating disorder, lists of 'safe foods' that don't have many calories and foods that increase your metabolism (like celery and green tea), forums and chat rooms to talk with other 'pro-rexies'.

They also support messages, such as 'Nothing Tastes As Good As Thin Feels,' 'Nothing is so bad that losing weight won't cure,' have articles about the 'Joys of Anorexia', 'The beauty of Bulimia', how to 'teach one another how to play the dangerous game', and how to figure out the minimum number of calories you need each day to stay alive. They also have their own ana food pyramid, which consists mostly of water, diet pills, diet soda, coffee, and cigarettes and advises to use food 'sparingly'.

And they have rules, such as 'The THIN-commandments' and 'Thinspirations'.

Does your teen know what a pro ana or mia is?

Does she know who the 'dragonflies' are (a large community of pro anas)?

Is she trying to be an ana or mia?

Has he or she visited one of these pro eating disorder (pro ed) websites?

Does he or she have an ana journal or diary?

Has he or she started wearing a red bracelet as 'a kind of "solidarity" thing' with other anas?

Does your child understand that anorexia is not a choice and is instead an addiction?

If you think your child is trying to become an ana or mia or has other signs of an eating disorder, further evaluation is important.

Boys and Eating Disorders

Although eating disorders are more common in teen girls and young women, males can also develop an eating disorder. The incidence of eating disorders in males also seems to be rising, so it is important to also think about eating disorders in teen boys and young men.

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