This web site was
partially supported by the Health Resources and Services Administration,
Maternal and Child Health Bureau through grant number 6T76-MC00011
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
Chapter 1 Eating Disorders During Adolescence
[Table of Contents]
Consequences of disturbed nutrition during a vulnerable
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.
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
Eating Disorders: 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
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.
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.
Background: Body image and psychosocial
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
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
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
Failure to normalize eating and exercise patterns.
Unrealistic expectations for themselves.
Failure to develop autonomy.
Difficulty in accomplishing the normal psychosocial tasks of adolescence.
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.
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.