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Adolescent Nutrition and Eating Disorders

Chapter 1  Eating Disorders During Adolescence

Chapter 2  Anorexia Nervosa In Adolescence

Chapter 3 Onset of Anorexia Nervosa during Adolescence

Chapter 4  Initial Stage of Anorexia Nervosa in Adolescence

Chapter 5  Crisis Stage Anorexia Nervosa in Adolescence

Chapter 6  Long-Term Recovery Stage Anorexia Nervosa in Adolescence

Chapter 7 Bulimia Nervosa in Adolescence

Nutritional Care Summarized - Table

Selected References & External Links

List of Reviewers

N.W. Regional Web Symposium
MPH Student Research 
Biographical Information

Eating Disorders during Adolescence:  Nutritional Problems and Interventions

Jane Mitchell Rees, PhD, RD, CD
Departments of Health Services and Pediatrics 
Maternal Child Health and Adolescent Medicine 
University of Washington, Seattle, WA 98195

Eating Disorders
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Useful Links



Risky Eating Behaviors

Weight Management

Chapter 1  Eating Disorders During Adolescence

[Table of Contents]

Consequences of disturbed nutrition during a vulnerable period

Adolescents must be adequately nourished to ensure their growth and development progresses normally and continuously.  Monitoring and modifying the wide swings in nutritional status during the course of eating disorders in order to maintain normal growth and development requires specific knowledge. The most sophisticated techniques available to the physical health and social sciences today must be applied to help teenagers change disturbed eating behaviors that impair their nutritional health;  behaviors not included in diagnosable syndromes as well as those which are included.  Knowledge and expertise regarding treatment for these complicated problems is expanding.  Principal nutritional aspects of anorexia nervosa and bulimia nervosa, documented through research and practitioner consensus, are reviewed here. 

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Eating Disorders:  Prevalence 

The number of adolescents with diagnosed anorexia nervosa or bulimia nervosa is growing and many adolescents with various eating disorders and disordered eating behaviors remain undiagnosed and untreated.  Uncounted teenagers preparing to be models, entertainers, dancers, gymnasts, jockeys and other athletes who manipulate their weight also suffer from long-term effects of chronic malnutrition, whether they do or do not meet the criteria for anorexia nervosa or bulimia nervosa.  They may be categorized as having an "Eating disorder not otherwise specified" when they have combinations of symptoms that do not fit the exact criteria of the other described eating disorders.

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Eating Disorders:  Characteristics

Eating Disorder Spectrum of Physical Characteristics

Spectrum of physical characteristics seen among adolescents with eating disorders.  Those with acute anorexia nervosa are usually among the thinnest and the developmentally obese* among the heaviest.  Adolescents across the spectrum are affected by various underlying psychosocial disturbances.  While the physical aspects may obviously require treatment, interventions should be directed to all aspects of these complex conditions, not solely the physical symptoms.
(Modified from Rees JM: Eating disorders.  Copyright Mahan LK, Rees JM Seattle, Wash, 1989. Originally published in Mahan LK, Rees JM: Nutrition in Adolescence, St. Louis, 1984, Times Mirror/Mosby.)
*Note:  The developmental obesity referred to develops through specific family interaction from birth (described by Hilde Bruch in 1973 - Eating Disorders: New York, Basic Books).  It is one of the many types of obesity, a condition with many etiologies.

Physically, adolescents with eating disorders form a spectrum, from the extremely thin to the extremely heavy, as the drawing above illustrates.  Between the extremes are various types of  physiques.  Along the spectrum, adolescents with disordered eating behaviors have underlying problems interfering with normal nourishment; they use food inappropriately.  Food related behaviors and associated deviation in body weight are two obvious characteristics of these disorders.  These outward symptoms are obvious to the affected adolescent, the public, and  health professionals. Understanding the underlying neuro-physical and psycho-developmental issues is essential to dealing adequately with the disorders.

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Background:  Physical growth and development. 

Rapid physical growth and development in adolescence constitute the unique background for development of eating disorders at this stage of life. Self-esteem problems intensify in many normal young women in the process of doubling their body weight, increasing the percent of body fat, gaining about 4 inches in height, developing breasts and acquiring other features of the mature female body, as well as experiencing menarche.  Given that this development occurs within a 6-8 year period, the rapidity of change contributes to the difficulty of the task of acceptance.

The intensity of physical growth and development also accounts for the vulnerability of any adolescent to long-term consequences if they experience semi-starvation.  All organisms are subject to the greatest harm from food deprivation at periods when they are synthesizing tissue;  they need nutrients to build into tissues and food energy to fuel the process.  Human teenagers are no exception to this basic biological rule.

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Background:  Body image and psychosocial development

Adapting a mental image of one's unique body (the body image) is a basic feature of adolescent development.  Body image distortion is a core characteristic of anorexia nervosa and bulimia nervosa.  Thus, these disorders are commonly seen in adolescence, the period when young people are vulnerable to body image problems. Whether as cause or effects, progress in adopting adult body image is interrupted for the teenager with an eating disorder. 

Teenagers with severe eating disorders also fail in varying degrees to accomplish other psychosocial developmental tasks of adolescence. The most striking of the developmental problems first described by Hilde Bruch in 1973 (Eating Disorders.  New York, Basic Books) is a struggle to develop autonomy.

  • Inability to develop and use formal operational thought processes, especially in reference to themselves.
  • Inability to experience bodily sensations originating within themselves as “normal” and “valid”.
  • Unrealistic perceptions of body size.
  • Preoccupation with weight and food, reflecting dependence on social opinion and judgment.
  • Failure to normalize eating and exercise patterns.
  • Unrealistic expectations for themselves.
  • Failure to develop autonomy.
  • Difficulty in accomplishing the normal psychosocial tasks of adolescence.
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Background:  Etiology 

For many adolescents disturbed eating has developed slowly throughout earlier life, though seeming to appear suddenly in adolescence.  The origin of eating disorders is very complex. Individual and familial, biological and psychological characteristics contribute.  Cultural values combined with eating habits common in modern societies create a milieu that is said to foster eating problems.  To reflect the multiple influencing factors, eating disorders are said to have a multi-factorial etiology.

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This Web Site is a reference for health care professionals, students and educators; it is not intended to provide advice or treatment to people with eating disorders.  If you have an eating disorder or disturbed eating patterns, consult a qualified physician who specializes in eating disorders.

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