Skinny and unhealthy: Striving to be thin can put your life at risk

Even though anorexia nervosa can be life-threatening, adolescents with the eating disorder often feel being skinny makes them healthy

Even though anorexia nervosa can be life-threatening, adolescents with an eating disorder often feel being skinny makes them healthy, according to Brittany K. Badal, M.D., an adolescent medicine physician with Norton Children’s Medical Group – Novak Center.

We live in a society where there is social stigma around weight, with teasing and bullying, and social media only adds to that pressure, according to Dr. Badal. The estimated prevalence of anorexia nervosa at any given time is 0.9% to 2% among adolescent females and 0.1% to 0.3% among adolescent males. The prevalence for bulimia nervosa is between 1.1% and 4.6% of females and 0.1% to 0.5% of males in adolescence. 

“There’s fear of becoming fat or a fear of gaining weight,” Dr. Badal said. “Many teens are spending more time looking in the mirror, thinking about the clothing they’re wearing and how they appear to their peers.”

Anorexia nervosa is restricting food intake to the point where it leads to significant weight loss. Sports where adolescent athletes are burning more calories than they are taking in can lead to anorexia. So can dieting. 

“For the majority of adolescents, dieting is inappropriate,” Dr. Badal said, adding that the adolescent years are a time of growth and development, when the body needs more calories, not fewer.

Psychological risk factors for anorexia nervosa include perfectionism, body image dissatisfaction, a personal history of an anxiety disorder and behavioral inflexibility. 

More males with anorexia nervosa

The stereotypical anorexia nervosa patient has been a white female from a higher socioeconomic class, but that is changing, according to Dr. Badal. 

Males now represent 25% of patients with anorexia nervosa. Disordered eating is also increasing among those in lower socioeconomic groups and among older patients. 

Unlike girls and young women, who typically want to be skinny, young men with anorexia nervosa focus on gaining muscle mass while getting rid of fat tissue, according to Dr. Badal.

Signs of anorexia nervosa

Significant weight loss is the most obvious sign of anorexia nervosa. Other signs of anorexia nervosa:

  • Fainting or dizziness
  • Bony appearance
  • Lanugo hair — the fine hair typically found on newborns — covering the body
  • Scalp hair that is thinning or dull
  • Fingers feeling cold easily due to delayed blood flow; or appearing bluish in light-skinned individuals
  • In young women, menstruation stopping after significant weight loss

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Bulimia and binge eating

Other common eating disorders among adolescents are bulimia nervosa and binge eating. 

Signs of binge eating disorder are eating much more rapidly than normal, eating until uncomfortably full, eating large amounts even when not feeling physically hungry, eating alone because of embarrassment at how much is being eaten, and feeling disgusted, depressed, or guilty afterward. 

Bulimia nervosa involves binge eating followed by purging via vomiting or laxatives or excessive exercise. 

Anorexia nervosa is the most dangerous of the eating disorders, according to Dr. Badal. Young people ages 15 to 24 diagnosed with anorexia nervosa have 10 times the risk of dying compared with their peers. Approximately 5% of individuals with anorexia nervosa die from the disorder, with half of the deaths by suicide. 

The goals of medical treatment for anorexia nervosa are restoring a healthy weight and resumption of menstruation. Treatment for the eating disorder often involves individual or family therapy. 

Some adolescents may need residential treatment. Anorexia nervosa can cause the heart rate, blood pressure and body temperature to drop and can stop normal growth and development.