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Eating Disorders Health Center

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Normal-Weight Teens Can Have Eating Disorders

Researchers saw a nearly 6-fold rise in patients who met all criteria of anorexia except being underweight

WebMD News from HealthDay

By Tara Haelle

HealthDay Reporter

TUESDAY, Aug. 26, 2014 (HealthDay News) -- Teenagers do not need to be rail thin to be practicing the dangerous eating behaviors associated with anorexia, a new study suggests.

Rather, the true measure of trouble may be significant weight loss, and the Australian researchers noted that a drastic drop in weight carries the same risk for life-threatening medical problems even if the patient is a normal weight.

Even more concerning, the scientists saw a nearly sixfold increase in this type of patient during the six-year study period.

Anorexia nervosa is a mental illness characterized by excessive weight loss and psychological symptoms that include a distorted self-image and fear of weight gain. In some patients, this can also include depression and anxiety. Those who have these symptoms but are not underweight enough to qualify for the definition of anorexia fall under a different diagnosis, known as Eating Disorder Not Otherwise Specified (EDNOS-Wt).

"Emaciated bodies are the typical image portrayed in the media of patients with restricting eating disorders such as anorexia nervosa," said lead researcher Melissa Whitelaw, a clinical specialist dietitian at The Royal Children's Hospital in Melbourne, Australia. "This paper highlights that it is not so much about the weight but the weight loss that can lead to a serious eating disorder. The complications of malnutrition can occur at any weight."

In her study, which included 99 teens aged 12 to 19, Whitelaw found only 8 percent of the patients had EDNOS-Wt in 2005, but more than 47 percent of the patients had it in 2009.

"I was surprised to see how much it increased," Whitelaw said. "I was also surprised at how similar they were not only physically but also psychologically. Everything about them was anorexia except that they don't look really skinny." Both groups had even lost a similar amount of weight: a median 28 pounds for those with anorexia and 29 pounds for those with EDNOS-Wt.

Other experts noted that it can be difficult to spot this less obvious eating disorder.

"We are conditioned to think that the key feature of anorexia nervosa is low body mass index [BMI]," said Cynthia Bulik, director of the Center of Excellence for Eating Disorders at the University of North Carolina at Chapel Hill. BMI measures whether a person is a healthy weight for their height.

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