With eating disorders on the rise among boys, minorities and younger children, doctors need to keep an eye out for unexpected cases, according to the author of a new report. The stereotype that eating disorders affect only affluent, white teenage girls no longer applies, said David S. Rosen, MD, MPH, who wrote a clinical report on the topic that was published in the December issue of Pediatrics. “It’s also happening to boys, young children, people of color and middle-aged women. It’s more of an equal opportunity disorder,” said Dr. Rosen, a professor of pediatrics, internal medicine and psychiatry at the University of Michigan.
Males, for example, now represent up to 10% of all cases of eating disorders. The number of children younger than 12 who are hospitalized for eating disorders increased 119% from 1999 to 2006, according to an analysis by the Agency for Healthcare Research and Quality cited in the report (www.ncbi.nlm.nih.gov/pubmed/21115584/). Young children who develop eating disorders are more susceptible to serious medical consequences such as stunted growth and organ damage, Dr. Rosen said.
Early intervention recommended
He urges physicians, nurses, parents, school social workers and others to intervene early. Health care professionals should take note when patients, particularly young ones, make derogatory comments about their appearance or talk about going on a diet. The report said screening questions about eating patterns and body image should be asked of all preteens and adolescents.
Fewer than 1% of adolescent girls in the U.S. have anorexia, and 1% to 2% percent have bulimia. Experts estimate that between 1% and 14% of Americans exhibit some physical and psychological symptoms of an eating disorder. Male and female athletes, including gymnasts, runners and wrestlers, and performers, such as dancers and models, may be more at risk.
The report said eating disorders may have more of a genetic link, similar to alcoholism and depression, than previously thought. The discovery that some children may be genetically predisposed to the condition may “help to take away some of the blame or stigma,” Dr. Rosen said. With more children obese, physicians should choose their words carefully when counseling a child about his or her weight, Dr. Rosen said. He sees young patients with eating disorders who claim their problems with food began when their doctor told them to lose weight.
Dr. Rosen recommends that physicians discuss healthy eating practices, not dieting, with patients and focus on a healthy lifestyle, not losing weight. “There’s a perception that, like alcoholism, [an eating disorder] never goes away and that the best you can do is keep it under control,” he said. But if caught early, “most children and teens can expect to recover completely.”
Even young children appear to be consuming more caffeine, so much so that caffeine could be contributing to sleep problems in primary school children, researchers found. Three-quarters of children ages 5 to 12 consumed caffeine on an average day in a survey of parents at routine clinic visits by William J. Warzak, PhD, of the University of Nebraska Medical Center in Omaha, and colleagues. The more caffeine children consumed, the fewer hours they slept on average (P=0.02), the researchers reported online in the Journal of Pediatrics, although not drawing a causal link. The average intake was two or three times higher than the 22- to 23-mg daily average reported nearly a decade ago, they noted.
Eight- to 12-year-olds in Warzak's study averaged 109 mg of caffeine — the equivalent of nearly three 12-oz cans of soda each day. But even the 52 mg of caffeine consumed by 5- to 7-year-olds on an typical day was well above the level known to have a physiologic effect on adults, the researchers noted. “There's really no role for caffeine in kids,” Marcie Schneider, MD, of the Albert Einstein College of Medicine in New York City, emphasized in commenting on the study. “We know that caffeine raises your blood pressure, raises your heart rate, and can be addictive.” Unlike older teens who are likely drinking coffee to wake up in the mornings for school, the assumption is that younger kids are getting most of their caffeine from soda, noted Schneider, who serves as a member of the American Academy of Pediatrics Committee on Nutrition.
She urged pediatricians to raise parents' awareness of the issue, perhaps as part of the yearly checkup. “We routinely ask kids what they're eating and drinking,” “It may be something that is worth pediatricians pointing out to parents that this kid does not need caffeine in their life partially because it does some things that are negative.”
Warzak's group surveyed parents of 228 children seen at an urban outpatient pediatric clinic during routine visits about the children's average daily consumption of drinks and snacks with an emphasis on caffeine-containing items. None of the children had a known sleep disorder or medical condition that might cause bedwetting. Illustrated depictions were provided to help parents accurately estimate serving sizes.
Nearly all of the caffeine intake was consumed through beverages. Few children got a meaningful amount of caffeine from food. “Caffeine's diuretic properties have encouraged behavioral health practitioners to eliminate caffeine from the diet of children with enuresis,” the researchers noted. However, they found that intake didn't correlate with the number of nights a child wet the bed (P=0.49). Overall, enuresis was actually less likely in children who consumed caffeine.
The researchers cautioned that interpretation of these results may be complicated by cultural differences in reporting children's behavioral health concerns and that their study could not draw any causal conclusions. Schneider also noted the use of parental reports and the relatively small sample as limitations. Although the findings offered no support for removing caffeine from children's diets on the basis of bedwetting, Warzak's group concluded in the paper that “given the potential effects of caffeine on childhood behavior, a screen of caffeine consumption might be beneficial when evaluating childhood behavioral health concerns.”
Source: Warzak WJ, et al “Caffeine consumption in young children” J Pediatr 2011; DOI: 10.1016/j.jpeds.2010.11.022.