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The question: My teen is going to the gym often and taking an interest in counting calories. While I'm all for her being active and healthy, how do I know if she has or may be developing an eating disorder?

The answer: Sometimes it feels like you just can't win when you're a parent. You spend years trying to convince your children of the benefits of physical activity and healthy eating only to find that when they start to take an interest you now worry about eating disorders. Go figure.

At this age, it is very natural for some adolescents to develop an interest in health and fitness. They are finally allowed to go the gym and participate in more intensive weight training and workouts. Many teens also start to experiment with new eating habits, such as high-protein diets and vegetarianism.

I believe these new interests are positive for most teens. While I don't always agree with every aspect of teen training programs and fad diets, I do like the fact that young adults are taking an interest in their health. I always hope that this represents the start of good habits that will last a lifetime. This is certainly preferable, in my opinion, to the teens who pass their time playing video games while snacking on junk food.

You are correct in recognizing that this is also an age where eating disorders develop and early recognition of these conditions is important. While eating disorders can occur in both sexes, they are much more common in girls and are particularly prevalent in high-risk groups including elite athletes, dancers, and models. Here are some warning signs:

  • Irrational fear of obesity: There is a subtle but important difference between striving to be as fit as possible, and striving to lose weight at all cost. Those with anorexia nervosa are never happy with their current weight and body image, and perceive themselves as overweight even when this is obviously not the case. An overwhelming preoccupation with weight loss is cause for concern.
  • Obsession with food: Young adults, particularly athletes, need adequate fuel in the form of calories. Portion sizes and food choices need to be adequate for healthy growth. Consult a registered dietitian if you have concerns your teen’s diet may not be meeting their needs. Be concerned if your child’s portion sizes seem unreasonably small, if she takes unusually long to finish her meal, or starts eating in private.
  • Preoccupation with exercise: Unless your teen is a high-performance athlete training under a professional coach, working out for an hour a day is sufficient. Rest days are also a critical aspect of any training program. Teens who exercise for prolonged periods of time, particularly alone or in secret, may be at risk of having an eating disorder.
  • Social withdrawal: The teen years are usually a very social time of life. Beware if your daughter starts to withdraw from her normal social activities or if you see a decline in her academic performance.
  • Significant weight loss: Monitoring you child’s weight is tricky. On the one hand you don’t want to miss significant weight loss, on the other you don’t want your daughter obsessing over her weight. I discourage the use of bathroom scales for this reason. It’s better to have your child’s weight monitored periodically (perhaps monthly) by your physician or dietitian to ensure that your child’s nutritional needs are being met. A teenage girl who stops having menstrual periods is always a cause for concern and should be investigated by a physician immediately.

Dr. Michael Dickinson is the head of pediatrics and chief of staff at the Miramichi Regional Hospital in New Brunswick. He's a staunch advocate for children's health in Atlantic Canada through his involvement with the Canadian Paediatric Society.

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