Appearances, as I’m sure you know, can be deceiving. In one all-too-common example, adolescents and young adults with disordered eating habits or outright eating disorders often go unrecognized by both parents and physicians because their appearance defies common beliefs: they don’t look like they have an eating problem.
One such belief is that people with anorexia always look scrawny and malnourished when in fact they may be of normal weight or even overweight, according to recent research at the University of California, San Francisco.
The researchers, led by Dr. Jason M. Nagata, a specialist in adolescent medicine at the university’s Benioff Children’s Hospital, found in a national survey that distorted eating behaviors occur in young people irrespective of their weight, gender, race, ethnicity or sexual orientation. And it’s not just about losing weight.
The survey revealed that among young adults aged 18 to 24, 22 percent of males and 5 percent of females were striving to gain weight or build muscle by relying on eating habits that may appear to be healthy but that the researchers categorized as risky. These practices include overconsuming protein and avoiding fats and carbohydrates. The use of poorly tested dietary supplements and anabolic steroids was also common among those surveyed.
The Covid-19 pandemic has likely exacerbated the problem for many teenagers whose daily routines have been disrupted and who now find themselves at home all day with lots of food being hoarded in kitchens and pantries, Dr. Nagata said in an interview. “We’re seeing more patients and referrals for eating disorders and their complications,” he said.
Without a proper diagnosis and intervention, young people with distorted eating behaviors can jeopardize their growth and long-term health and may even create a substance abuse problem. The findings suggest that abnormal behavior with regard to food and exercise is often overlooked, misunderstood, ignored or perhaps viewed as a passing phase of adolescence.
This is especially true among teenage boys. One-third of the high school boys surveyed said they were trying to gain weight and bulk up, and many were using risky methods to achieve their goals, Dr. Nagata told me. Sixty percent of the girls surveyed said they were trying to lose weight. Some consumed unbalanced diets that can jeopardize their growth and long-term health; others resorted to induced vomiting or abused laxatives, diuretics, diet pills or engaged in other hazardous behaviors like fasting or excessive exercise.
Over all, distorted eating was more than twice as common among females than males. It was also reported more often among those who described themselves as Asian/Pacific Islanders, gay, lesbian or bisexual.
The survey was conducted among a national sample of 14,891 young adults who were followed for seven years, starting at an average age of 15. The goal was to see if the youngsters’ perceptions and habits surrounding food and exercise could serve as warning signs of behaviors that could injure them physically and emotionally.
Among the boys in the study, those most at risk worried that their bodies were puny — too small, too skinny or insufficiently muscular, prompting them to consume unbalanced diets, exercise obsessively and take supplements or steroids that are a hazard to their health. When overly fixated on building their bodies, they can become socially withdrawn and depressed and develop a disorder called muscle dysmorphia that can lead to heart failure, resulting from insufficient calories and overexertion.
A missed diagnosis is likely when a young person’s relatives or doctors have preconceived notions about how someone with an eating disorder looks or behaves. For example, Dr. Nagata said, a teenage girl or young woman who is anorexic can fall under the medical radar because her weight is normal or even overweight.
Although diagnosis of an eating disorder like anorexia or bulimia was twice as common among the young adults whose weight was normal or underweight, the fact that these disorders also exist in heavier young adults is often overlooked, Dr. Nagata said.
“Almost half of those with anorexia nervosa are at or above normal weight,” he said. “Young people with atypical anorexia have the same body image distortions and severe psychological distress as those with regular anorexia. They’re at high medical risk and just as likely to be hospitalized for complications caused by their distorted eating behaviors.”
Dr. Nagata’s colleague and co-author of the study, Dr. Kirsten Bibbins-Domingo, an internist at the university, said in an interview, “Physicians who care for young adults should think about patterns of eating that are harmful, and not just among very thin women. Young adults with abnormal eating habits too often fall between the cracks because physicians think of them as healthy. However, abnormal eating patterns are not uncommon in adolescence and young adulthood, and that’s when patterns of behavior related to later health and disease are established and solidified.”
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Frequently Asked Questions
Updated July 23, 2020
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What is school going to look like in September?
- It is unlikely that many schools will return to a normal schedule this fall, requiring the grind of online learning, makeshift child care and stunted workdays to continue. California’s two largest public school districts — Los Angeles and San Diego — said on July 13, that instruction will be remote-only in the fall, citing concerns that surging coronavirus infections in their areas pose too dire a risk for students and teachers. Together, the two districts enroll some 825,000 students. They are the largest in the country so far to abandon plans for even a partial physical return to classrooms when they reopen in August. For other districts, the solution won’t be an all-or-nothing approach. Many systems, including the nation’s largest, New York City, are devising hybrid plans that involve spending some days in classrooms and other days online. There’s no national policy on this yet, so check with your municipal school system regularly to see what is happening in your community.
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Is the coronavirus airborne?
- The coronavirus can stay aloft for hours in tiny droplets in stagnant air, infecting people as they inhale, mounting scientific evidence suggests. This risk is highest in crowded indoor spaces with poor ventilation, and may help explain super-spreading events reported in meatpacking plants, churches and restaurants. It’s unclear how often the virus is spread via these tiny droplets, or aerosols, compared with larger droplets that are expelled when a sick person coughs or sneezes, or transmitted through contact with contaminated surfaces, said Linsey Marr, an aerosol expert at Virginia Tech. Aerosols are released even when a person without symptoms exhales, talks or sings, according to Dr. Marr and more than 200 other experts, who have outlined the evidence in an open letter to the World Health Organization.
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What are the symptoms of coronavirus?
- Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
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What’s the best material for a mask?
- Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.
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Does asymptomatic transmission of Covid-19 happen?
- So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
The problem of disordered eating behaviors among teens and young adults is often encouraged or compounded by participation in certain competitive sports and other activities that overemphasize a particular body weight and physique. Among these are gymnastics, wrestling, dance, figure skating, weight lifting and bodybuilding.
Social media, with its heavy focus on appearance, has fostered the problem as well, Dr. Nagata said. Even toys, like Barbie dolls and action figures, have made a contribution. “A study of male action figures found that they have become bigger, more muscular and more extreme in their appearance over a 30-year period,” he said.
“If youngsters are obsessed with an idealized body image, their thinking and behavior become disordered and can take over their lives,” he said. “The detrimental effects can be subtle. Prior to the pandemic, they may have rejected going out with friends so they could spend more time in the gym. It’s a warning sign when they withdraw from normal activities and become preoccupied with their appearance.”
Unhealthy weight control methods can predispose people to eating disorders and actually lead to weight gain, not loss. I struggled with weight gain in my early 20s and, having failed to control my weight any other way, I eventually resorted to fasting all day until supper. But once I started eating, I couldn’t stop and ended up gaining even more weight. I had developed a binge-eating disorder that resolved only when I stopped trying to diet and returned to eating three wholesome meals a day, including one small snack so I didn’t feel deprived.
Dr. Bibbins-Domingo wants doctors to be proactive in asking about eating and exercise habits when treating adolescents and young adults. “They should have a conversation about what these young people are eating, when they’re eating and how they’re eating, and be able to give advice about healthy eating patterns.
“Without making a value judgment about body size, they can open the door to a discussion about eating and exercise habits,” Dr. Bibbins-Domingo suggested. “The physician might ask, ‘What did you eat yesterday, and where, and what do you think about the choices you made?’ or ‘Do you want to address weight issues?’”
The pandemic may offer one silver lining, Dr. Nagata said. “With more families eating meals together, it’s easier for parents to monitor what their kids are eating.” Having family meals together is one of the basic tenets of therapy for eating disorders, he said.
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