Thousands of Connecticut adults and children – some as young as 10 – struggle with eating disorders with many suffering secretly because the life-threatening psychiatric condition has gone undiagnosed and untreated, experts in the field report.
"We used to see eating disorders start at 13 or 14. Now we frequently see 10- and 11-year olds," said Dr. Diane Mickley, founder and director of the Wilkins Center for Eating Disorders in Greenwich, which has treated females and males for three decades. Mickley is a founder and past president of the National Eating Disorders Association (NEDA).
"We're concerned that there are many boys and girls flying under the radar who could be struggling with eating disorders that aren't diagnosed or treated," said Craig Brown, a founder and chief executive officer for Center for Discovery, which since 2011 has opened two adolescent residential treatment centers in Fairfield County for youth ages 11 to 17.
"We've been getting calls throughout the years that have progressively involved younger and younger children."
An estimated 30 million Americans have eating disorders such as anorexia, bulimia and binge eating disorder, reports NEDA. In Connecticut, 3.4 percent of the population has an eating disorder with females twice as likely to be afflicted than males, according to statistics cited by the National Association of Anorexia Nervosa and Associated Disorders.
Anorexia has the highest mortality rate of any psychiatric illness, reports the National Institute of Mental Health.
In Connecticut, an increasing number of younger teens overall and Hispanic teens in particular engaged in disordered eating between 2009 and 2011, according to the most recent data available from the Centers for Disease Control and Prevention (CDC) in its Youth Risk Behavior Surveys. Disordered eating refers to harmful behaviors – such as restricting your food intake – that could lead to an eating disorder.
Among the Connecticut findings from the CDC:
• Nearly 18 percent of ninth grade girls surveyed in 2011 (compared to 12.2 percent in 2009) indicated they had not eaten for 24 or more hours during the previous 30 days due to weight considerations.
• Food restriction rates were higher for Hispanic teens (11.9 percent) compared to their African American (8.4 percent) and white (8 percent) peers in grades nine through twelve in 2011.
• The rate of food restriction among Hispanic male teens grades nine through twelve was 13.3 percent in 2011, up from 10.1 percent in 2009. Hispanic male teens were more likely to restrict food than Hispanic female teens (10.1 percent) in 2011 – an inverse of national statistics showing females are more likely to engage in disordered eating than males.
"It's a pressing public health issue. These are serious psychiatric disorders that can lead to death," said Rebecca Puhl, deputy director of the Yale Rudd Center for Food Policy and Obesity.
What Are Eating Disorders?
A combination of biological, psychological and social factors cause eating disorders. Anorexia is characterized by self-starvation and excessive weight loss. People with bulimia have recurring binge-and-purge cycles, consuming large amounts of food, followed by self-induced vomiting, over-exercising or the use of laxatives. People with binge eating disorder (the most prevalent type of eating disorder) eat very large amounts of food, but they do not engage in purging behaviors.
Eating disorders can lead to serious medical consequences, including abnormally low heart rate and blood pressure, osteoporosis, kidney failure, hair loss, gastric ruptures, tooth decay, loss of menstrual cycles and death. Treatment options can range from inpatient care and residential programs to partial hospitalization programs and intensive outpatient services with a team of physicians, psychiatrists, therapists, nutritionists and others. Many people with eating disorders have additional substance abuse or psychiatric conditions, including alcoholism, depression or self-injury behaviors.
"You die looking beautiful," said Natalie Hoeffel, site director of the Renfrew Center of Connecticut in Old Greenwich, referring to the unseen internal bodily damage. "People see a good-looking young woman who looks like a model. Her family says she's healthy because she exercises three hours a day and swims and plays lacrosse. But they don't understand that she is going to drop dead on the field if we don't get her into treatment."
"Perfect Storm" Fuels Disorders
While definitive answers remain elusive, experts point to a "perfect storm" of factors that may be contributing to the growing number of youth with disordered eating – relentless pressure from trusted adults to excel academically and athletically, misguided attempts by society to fight obesity, and the barrage of social media messages glorifying thinness.
"It's tougher to be a kid these days. It's really stressful," said Jennifer Henretty, director of outcomes and research for Center for Discovery. "But it's not easy being a parent, either. Society gives us messages that we should push our children to be well-rounded and top achievers. But many of these factors may be setting up children to be at an increased risk for eating disorders."
The focus on body mass index (BMI) – an indicator of fat based on height and weight – doesn't help matters. "Medical providers focus on keeping people's weight under control without thinking about quality of life issues and someone's natural body type," said Margo Maine, of West Hartford's Maine & Weinstein Specialty Group and a founder and past-president of NEDA.