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Michelle's parents did not address her anorexia until she weighed less than 85 pounds. At 5'10", she was a skeleton compared to the healthy teen she had once been. "My mom and dad said nothing to me about my weight loss, until one morning at breakfast when my father slammed a stack of pancakes down in front of me and demanded I eat them," she said. "I refused." Michelle's eating disorder began when her older sister died in a car accident. "At first I didn't want to eat, I was grieving so much. But the subject of my sister's death was taboo at my house—we weren't even allowed to mention it. I continued to refuse food because of the pain I was in, and their unwillingness to see it." Fortunately, after that breakfast table incident, her mother sought treatment for Michelle with a counselor who specialized in eating disorders. "I'm sure it saved my life," said Michelle.

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She's not exaggerating. Of all psychiatric illnesses, eating disorders have the highest fatality rate. Nearly 45,000 people die from them in America each year, and that number is growing. Even after patients have sought treatment, eating healthfully becomes a lifelong struggle. Angela Blier, a clinical counselor who treats patients with eating disorders in Portland, Maine, explains this by comparing it to someone with a drug addiction. "When you give up drugs and get clean, you never do them again. With an eating disorder, you have to eat to survive, so there's always the chance to backslide."

The two most common eating disorders are Anorexia Nervosa—where the person has a distorted body image and severely restricts their intake of food, sometimes to the point of starvation—and Bulimia Nervosa, where the key symptoms are binge eating followed by purging, either by vomiting or using laxatives. Many factors play into the weight loss obsession, including genetic predisposition to the disease, family attitudes about food, the friends a teen chooses to hang out with, the presence of depression or anxiety, biological make-up, and a perfectionist or obsessive personality. In addition, images from the media of painfully thin models and actresses bombard kids daily, teaching them a distorted definition of what is normal, and encouraging them to aspire to a goal that is unattainable for most. Often, like in Michelle's case, a traumatic event may trigger the onset of a disorder—a death, their parents' divorce, sexual abuse. The statistics about where we're headed as a nation are disturbing: 40% of fourth graders report that they diet either "very often" or "sometimes." According to a Mayo Clinic study, three out of every one hundred girls will develop an eating disorder as they mature. Though it's less talked about, boys are not immune to the illness—one out of every 10 people with an eating disorder is male, and that number is growing as well, according to Dr. Roberto Olivardia of Harvard Medical School, a clinical psychologist who primarily treats men and boys with the disease.

If you suspect your child might have an Eating Disorder, take them to your family physician or pediatrician right away.

It's important to trust your instincts when it comes to your child, says Dr. Patrice Lockhart, Medical Director of the New England Eating Disorders Program. The youngest children now being seen there are seven years of age. "You can't hurt your child by bringing up concerns, but you can hurt your child by avoiding them," says Dr. Lockhart. "So many parents come in here and say, 'Oh, I wish we'd called 6 months ago.' You've known your child since birth. The minute you have any concerns, trust your gut."

Experts advise that you approach your child in a loving way, directly expressing your concerns for their health and the fact that you are worried about them. Don't be surprised if your child denies the problem. "The danger with eating disorders is denial—denial with a capital D," says Blier. "It's easy to defend not eating a lot and exercising. If your child denies the problem, the next step is the doctor."

When you take your child to your family physician for a check-up, tell them why you are doing so. "As a parent, you always have the responsibility to be as honest as you possibly can, if you want your kids to be honest," says Dr. Lockhart. "Expressing concern makes children feel safer than not telling them why they're going to the appointment." Giving the child some control over what's happening is also a good idea. Allow them to see the doctor first on their own, but tell them you will speak to the physician as well. "This gives kids control in a safe way," she says.

During the check-up, ask their physician to do tests to rule out any other problems. "Changes in electrolyte levels will show that something's not quite right and the child is not healthy. If there are other reasons for the change in weight, good for you as a parent for checking," says Blier. "You've found out something else that might be wrong. Getting the help of your child's doctor is essential. That's the one thing that helps with denial: numbers. The facts are there."

Disorders - Eating Disorders