It's estimated that more than 30 million Americans are currently battling an eating disorder. But the highest increase in those dealing with the disorders has come for teenagers.
"Since about 2000, we are seeing that there has been a rise just for individuals aged 15 to 24," explained Dr. Krista Caldwell, an Eating Disorder Psychologist at Akron Children's Hospital. "Adolescence is the prime time where we see those symptoms start. Either in early adolescence, right around with puberty, in having those bodily changes take place, and also for our transition-aged youth that is going to college. That's where we'll see those behaviors begin as well."
While eating disorders most commonly impact females, 25% of anorexia nervosa patients are males.
And while every patient presents with individual symptoms and signs, the experts at Akron Children's Hospital say a sudden attentiveness toward healthy eating could be one of the first signs of an eating disorder.
"A lot of times we see patients come in that have certain beliefs around what foods are categorically safe or healthy and those that are unhealthy," Caldwell explained.
"It can be very individualized for patients. Sometimes it's something they may see a family member doing with changing their eating behavior or sometimes its things they've learned from peers at school," she said. "A lot of times it will just start with, I want to be a bit healthier, so I'm going to cut out this food group. And then, all of a sudden, we'll see that it's really been restricted down to maybe only three or four things that we see as safe, and then we're not getting the nutrients that we need."
"Some of the big things to look out for is patients restricting down to certain calorie counts per day, looking at labels, maybe counting calories, looking at fat grams, and trying to avoid sugar in some way. We start to see this severe categorization. Maybe you had a kid who used to love having ice cream at night and now ice cream is seen as not happening, you can't do it," Caldwell explained.
Dr. Jessica Castonguay, an adolescent medicine specialist at Akron Children's Hospital, explained that not eating the proper amount can have a lasting impact on a teenagers body.
"Your body needs nourishment. I often tell my patients it's like putting gas in a car. If you don't put gas in the car, the car won't go and eventually, neither will your body. And so at first, it might feel like nothing is changing," Castonguay said.
"But young men and women who are restricting their intake may start to feel dizzy, light-headed, fatigued, poor energy, might not be concentrating or focusing well on tasks that they may be able to do," she continued.
Also, teens who participate in sports during their struggle with an eating disorder may be at risk for a lower bone mineral density and can be more prone to stress fractures than other athletes.
Both Caldwell and Castonguay say there are several things to watch for, including changes that are both physical and non-physical.
"If we're noticing a sudden change in weight or if we're noticing a lot of body checking; looking in the mirror a lot, or constantly checking reflections," Caldwell said.
"Has the sleep pattern changed, is the child sleeping more often or been complaining of lower energy?" Castonguay said.
"Is the child cold all the time, are they wearing long sleeves or sweatshirts in the middle of summer, or multiple layers in the winter when others are comfortable with just a long sleeve? We call that cold intolerance," which Castonguay explained, is a sign of a possible eating disorder. "Your body needs calories coming in to fuel the fires to keep you warm. If your body is losing heat through your blood vessels in your hands and your legs it's going to clamp down those blood vessels; so less blood is flowing, and then your hands, your feet, your arms, your legs will start to become cold. That's your bodies way of keeping the heat centralized to where it needs it to make sure your organs are working to the best of their ability."
Both doctors said to look for a sense of isolation or a change in interests.
"So we see a sort of shift in values that occurs where we may have patients who were very focused on school, very focused on friendships, focused on sports, and now we're isolating more, we're not spending time with peers because we need to focus on exercising or we need to focus on getting the right nutrition in and it just becomes so time-consuming that those other elements of life just get lost," said Caldwell.
"Is the youth eating away from the family, or always full at mealtimes and saying I'll eat later? Are they asking to eat in their room rather than with the family? So these sorts of behavioral changes might indicate something is going on," Castonguay added.
Besides, parents need to watch all teens, not just those that are labeled "skinny."
"You don't have to be skin and bones to have an eating disorder," Castonguay explained.
She says the majority of bulimia patients are either at or above normal weight because their bodies cannot compensate for all of the calories taken in during a binge.
But she also said that there are an increasing number of atypical anorexia patients, which present with "normal" body weight, but are experiencing the symptoms of a restrictive eating disorder.
"One of the things that we do see quite a bit is, I think related to the diet culture we have in the United States, is we have a lot of overweight teens, and we know that this is a problem. There's an obesity epidemic. But these teens are getting constantly bombarded by social media, by magazines, by television about what the perfect body is supposed to look like," she said. "And so a lot of the times what we'll see is a young man or woman who started overweight and is now at a healthy weight, but very sick with all the symptoms of a restrictive eating disorder."
Castonguay continued saying, "What's happened along the way, and what makes it more difficult to treat, is that people, who mean very well, are telling them what a great job they're doing, keep it up, you look great, you're getting so healthy. And so that positive reinforcement makes it harder to break the cycle of poor eating habits when we do see those kids."
Caldwell says that parents can try to help by changing the way they address and talk about certain foods, by refraining from using words like "healthy" and "unhealthy."
"Instead of saying things, for certain food groups, like oh that's healthy. Try saying, oh this is going to give you better energy so that you can do the activities that you love to do. Just focusing on food as fuel is one of the big statements of our clinic," she said.
It's a sentiment that Castonguay echoed, saying that even carrots can become unhealthy if that's the only thing a teen is eating.
When it comes to talking to a teen about an eating disorder, Caldwell suggests being upfront and honest.
She suggests asking the teen if they are concerned about their weight, or how often they find themselves thinking about what they look like.
Castonguay says that parents and pediatricians, or family doctors, should work together to ensure that even older teens stay on the appropriate growth curve.
She noted that any suspicions should be talked about or referred to a specialist since the longer an eating disorder goes untreated, the harder the habit will be to break.
For information on anorexia nervosa, atypical anorexia, bulimia, Avoidant Restrictive Food Intake Disorder, or other eating disorders, click here.