By Dr. Joyce Adams
There are far too many children, adolescents and adults in the United States who are overweight or obese. Experts have advised us to eat more vegetables, stay away from fatty foods, cut down or eliminate sugared drinks and get at least 30 minutes of exercise every day (one hour a day for children). While this is good advice for most people, growing children who dramatically change their eating habits while also dramatically increasing their level and intensity of daily physical activity can develop serious health problems.
Joe is 12 years old and just entering puberty. His parents have noticed that he is starting to look a little “pudgy.” He has always been an anxious child, and has some tendency to be obsessive and compulsive. He hears a health talk in school and decides that if fat is bad and too much sugar is bad and exercise is good, he will take all of the advice and do the best job of anyone in his class.
He first cuts out all fast food, then all sweets, then red meat, then eggs and then milk and cheese. He starts running one mile a day and works up to running 10 miles a day. His parents notice that he is losing weight rapidly, and are at first happy that he is “eating more healthy.” However, he is now only eating steamed vegetables and a few bites of fish every day. He is irritable and yells at his parents when they suggest that he should be eating a more well-rounded diet.
When he has his weight and height measured at the pediatrician’s office four months later, his weight has dropped from 100 pounds to 60 pounds, he has not grown at all, and his Body Mass Index (BMI) has dropped from a normal 18 to 14; from the 75th percentile for BMI to well below the fifth percentile. The pediatrician also notices that Joe’s resting pulse is 35 beats per minute, his blood pressure is low, he gets dizzy when he stands up and his hands and feet are cold and blue.
This boy now has severe protein/calorie malnutrition and his body is trying to conserve every bit of energy by lowering his heart rate, blood pressure and temperature and his heart is shunting blood to his core organs instead of his hands and feet. He is at risk for developing fatal arrhythmias (abnormal heart rhythms), osteopenia (thin bones), very low testosterone, arrested growth and arrested physical development.
His “healthy eating,” taken to extremes, has resulted in an eating disorder with medical complications. This is a medical emergency and he needs to be admitted to the hospital for cardiac monitoring and careful “refeeding.”
Joe could just as well be Jennifer, and could be 8 years old or 14 years old or 17 years old. In girls, in addition to the complications mentioned above, menstrual periods can be delayed and not begin when they would be expected to, or can stop after being regular for months or years. Severely malnourished girls will usually have estrogen levels in the range of a woman who has gone through menopause.Surprisingly, children and adolescents who start out obese and loose weight rapidly so that they look like a “healthy” weight for their age and height can also develop all of the medical complications of a child of average weight who becomes severely underweight. Rapid, excessive weight loss is a shock and stress to the body that sends the same message to the brain; all energy needs to be conserved.
It is recommended that if parents notice any of the following, a visit to the pediatrician should be scheduled. Some of the symptoms and signs to watch out for are:
• Losing a lot of weight quickly.
• Not eating meals with the family, saying she/he has already eaten.
• Complaining of being cold all the time.
• Complaining of pain when eating or being constipated.
• Becoming angry and irritable when parents try to have him/her eat more normally.
• In girls, noticing that menstrual periods have stopped.
More information on eating disorders in children can be found at eatingdisorders.ucsd.edu
Dr. Joyce Adams is a pediatrician and specialist in adolescent medicine at Rady Children’s Hospital-San Diego. She is also a professor of clinical pediatrics at UC San Diego. She can be reached at (858) 246-0052 or jadams@ucsd.edu.