TEEN HEALTH Watch out for warning signs of eating problems

I think my friend may have an eating disorder. ... What should I do?
In our food- and image-obsessed culture, it can be hard to tell whether someone has an eating disorder. It doesn't help that many of the actors on your favorite TV shows and the models in the magazines you read are extremely thin.
Lots of teens are critical of their bodies and lots of them diet or exercise to try to change them. Constantly talking about food and your body and striving to be skinny to fit into that bathing suit or prom dress can start to seem normal.
It crosses the line when a person starts to do things that are physically and emotionally dangerous and could have long-term health consequences. This could mean going on a starvation diet and getting down to an unhealthy weight (like with anorexia nervosa), or it could be bingeing and purging, either through forced vomiting, compulsively exercising, taking laxatives or a combination (also known as bulimia nervosa). And although they're more common in girls, guys get eating disorders, too.
Signs to look for
Other than dramatic weight loss, some signs that your friend may suffer from an eating disorder are:
U She has an obsession with weight and food -- even more than general comments about how many calories she eats in a day. It seems like she never talks about anything else.
U She knows how many calories and fat grams are in everything that you and she eats -- and she's always pointing them out.
U She works out compulsively -- even when she's sick or exhausted.
U She avoids hanging out with you and her other friends during meals. For example, she avoids the cafeteria at lunch or the diner where you all hang out on weekends.
U She wears big or baggy clothes. (By itself, this may not be a symptom -- lots of teens wear baggy clothes, but a teen who wears baggy clothes to conceal parts of her body she doesn't like isn't following a fashion trend.)
U She goes on severe diets, cuts food into tiny pieces or moves food around on the plate instead of eating it.
U She goes to the bathroom a lot, especially right after meals, or you've heard her vomiting after a meal.
U She always talks about how fat she is, even though she's lost a lot of weight.
U She takes laxatives, steroids or any other kind of diet pill.
U She has a tendency to faint, bruises easily, is very pale or often complains of being cold. (Cold intolerance is a symptom of being at a dangerously low weight.)
If your friend shows these symptoms and you're concerned, the first thing to do might be to tell her that you're worried, as gently as possible. Try to be a supportive listener. Of course, it's not your job to diagnose your friend -- that's the job of a doctor who has been trained to make sure that what's going on is really an eating disorder and not something else. You're a good friend for wanting to help, and encouraging your friend to get medical care for what could be a dangerous situation is the best thing you can do for her. If she's willing to seek help, offer to go with her to talk to a counselor or doctor.
Other ways to help
Be as supportive as you can. You might also direct her to one of the many organizations, Web sites, hot lines or other resources devoted to helping people who are battling eating disorders.
Avoid talking about food, trying to force her to eat or reinforcing the idea that this is all about her physical appearance by telling her she "looks sick" when she's dieting or "looks good" when she gains some weight.
If your friend won't admit she has a problem, you need to get help from an adult you trust -- her parents, your parents, a teacher, or a counselor, for example. Eating disorders are serious, and they can cause permanent health problems or even death.
Trying to help someone who doesn't think she needs help can be like fighting an uphill battle -- people who are in the midst of an eating disorder often have trouble admitting, even to themselves, that they have a problem. Because teens with eating disorders often have low self-esteem, the best thing you can do is be supportive and caring and let your friend know you care about her -- no matter what she weighs.
XFor other health articles written just for teens, go online to http://www.TeensHealth.org.

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