Archive for January, 2011

You read the definitions and complications of eating disorders in Part I of this series.  In this segment, I want emphasize secondary prevention, or the early identification of disordered eating behavior.  To identify an eating disorder, you need to look for any of the following warning signs:

  • Weight fluctuations. Rapid weight loss or gain is one of the hallmark signs of eating disordered behavior.  Don’t just focus on weight changes.  Younger children may not gain weight or height as expected.
  • Drastic dieting.  Viewing foods as good or bad, avoiding high fat or high calorie foods, denying hunger, frequent weighing, obsessively counting calories and avoiding eating out are red flags.  Dangerous behaviors that may go along with dieting include, taking diet pills, laxatives, and diuretics.
  • Sudden changes in eating behaviors. Any abrupt variations in eating patterns like skipping meals, becoming a strict vegetarian, avoiding specific foods, eating abnormally large amounts of food and going to the bathroom immediately following meals could mean that something is going on.  Be on the look-out for food rituals like cutting food into small pieces, eating foods in a certain order, not allowing foods to touch each other, or weighing food.
  • Excessive exercise. Compulsive working out can be evidence of an eating disorder.  Look for extra trips to the gym or clues of extreme exercising like distress over missing a work out, continuing to exercise when injured or skipping social events to be active.
  • Physical changes. Bodily changes like unusual swelling of the cheeks or jaw, calluses on the back of hands or knuckles, and staining of teeth are marks of self-induced vomiting.

If you witness warning signs, your child may need treatment.  Be proactive, ignoring behaviors will not make them go away!

There are three things you must do:

  1. Get professional help.  Your first stop should be your child’s pediatrician.  If an eating disorder is suspected or diagnosed, consider getting a treatment team involved.  A treatment team usually consists of a physician, psychiatrist, therapist, and registered dietitian that specialize in eating disorders.  To find treatment professionals in your area, go to a reputable source like the Academy of Eating Disorders’ website and the  find an ED professional page.
  2. Educate yourself. Learn as much as you can about eating disorders.  Read books, articles, and brochures.  Don’t forget reputable sources on the Internet like The National Eating Disorders AssociationGurze bookstore is a great resource for finding books about preventing and understanding eating disorders.
  3. Ask questions.  You can never ask too many questions when it comes to your child.  See the National Eating Disorders Association’s handout, Treatment of Eating Disorders for questions to ask professionals.

The Eating Disorder Coalition of Tennessee has more helpful links for you to share with other families.

Treatment is available and recovery is possible!  Remember, the earlier treatment is sought, the higher the likelihood of a full recovery.

Stay tuned for next week’s post:  The Parent’s Role in Preventing Eating Disorders

Contributing Author: Katherine Fowler, MS, RD, LDN


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With growing concern and rising numbers of eating disorders in our youth, we are launching our 3-part series on Eating Disorders, written by eating disorder specialist and colleague, Katherine Fowler, MS, RD, LDN.

I am sure you have heard discussions about diets and resolutions of weight loss in past weeks.  Your child is probably listening to these conversations and may be thinking about going on a diet or losing weight.  Did you know that dieting is linked to disordered eating behaviors?  Studies have found that young dieting girls are seven to eight times more likely to develop an eating disorder than girls who do not diet.  Because dieting talk is everywhere this month, I thought this an appropriate time to launch a series on the parent’s role in preventing, identifying, and treating this growing problem.

So what exactly are eating disorders? They are a serious disturbance of eating behavior.  Eating disorders are not diet strategies or trends, rather, they are serious psychological disorders that have the highest mortality rate of any mental illness. There are many types of eating disorders and they are not limited to gender, age, socio-economic status or ethnicity.

This issue is affecting kids at younger ages than ever before.  According to the National Association of Anorexia Nervosa and Associated Disorders Ten Year Study, 10% of those affected report an onset before the age of 10 years or younger. Not a surprise considering one study found 81% of 10 year old girls are afraid of becoming fat.  Kids’ exposure to thin idealism and dieting from TV, movies, magazines, and the Internet is not fading anytime soon. The National Eating Disorders Association’s description on factors that may contribute to an eating disorder provides more information.

There are three categories of eating disorders; you can view the DSM-IV criteria for eating disorders for more details.

1. Anorexia nervosa (AN)

Refusal to maintain body weight at or above a normal weight for the child’s age and height; an intense fear of gaining weight or becoming fat.

2. Bulimia nervosa (BN)

Uncontrolled or binge eating accompanied by behaviors to prevent weight gain, such as self-induced vomiting, laxative use, fasting, excessive exercise, and others.

3. Eating disorders not otherwise specified (EDNOS)

Disordered eating that meets some, but not all, of the criteria for anorexia or bulimia; includes more uncommon eating disorders.  Binge eating disorder (BED), or compulsive overeating without behaviors to prevent weight gain falls into this category. Most people with BED are overweight or obese.  Binge eating is often done alone and parents may not be aware their child’s weight gain is related to binge eating.

Even though EDNOS is not as “well-known”, it can still be just as serious as anorexia or bulimia.  Complications of eating disorders can create countless health consequences that can be lethal in severe cases.

The most important thing you need to know is that parents can help prevent eating disorders in their children. And, the earlier treatment is sought, the higher the likelihood of a full recovery.

Raise awareness by sharing this post with other parents!

Stay tuned next week for Part 2 of this series, Warning Signs Parents Need to Look For.

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Vitamin D is making headlines once again, with yet another update to daily requirements.  As part of our Alphabet Soup Vitamin series, we attempt to sort out the ins and outs of Vitamin D for you.

What Does D Do? Vitamin D’s main job is to maintain normal levels of calcium and phosphorus in the blood, which are important for bone growth and maintenance.  Vitamin D may also play a role in providing protection from osteoporosis, hypertension (high blood pressure), cancer, and several autoimmune diseases.

The Downside of D-ficiency: Rickets occurs with vitamin D deficiency in children, causing bone malformations and bowed legs. A host of other problems have been linked to Vitamin D deficiency in children, as well.  If you are exclusively breastfeeding your infant, supplementation of Vitamin D is needed due to low levels in breast milk.

Can There Be Too Much D? Vitamin D is fat-soluble, and therefore stored in the body.  Toxicity is possible, and can lead to serious problems such as hypercalcemia, lung, heart, and kidney problems.  Intake should not exceed 1,000-4,000 IU per day, depending on the age of the child.

The D Diagnosis: A blood test can identify vitamin D deficiency.  Infants and children should be screened for deficiency if they have: poor growth, gross motor delays, exclusively breastfed, unusual irritability, dark pigmented skin, presence of Vitamin D lowering medications, mal-absorption syndromes or inflammatory bowel diseases, frequent fractures, low bone mineral density, obesity, low intake of vitamin D-rich foods, limited sun exposure, and high altitude residences.

The D Double-take: Often known as the “sunshine” vitamin, about 90% is made by the body when skin is exposed to UVB rays from sunlight.  Experts believe that as little as 10-15 minutes in the sun three times a week is sufficient to meet needs.  The other 10% comes from food, which is made easier with Vitamin D fortified products.

Getting D in your Diet: Oily fish, such as tuna, mackerel, sardines, salmon, and cod liver oil are great naturally rich sources of Vitamin D.  Enhanced and fortified foods include eggs, milk, orange juice, and cereal.  Just be sure that the packaging indicates that vitamin D has been added. Fortified milk is the main source of vitamin D for Americans.  Shoot for 3-a-Day of dairy products (this little tracker will help you) and a variety of sources.

So, How Much D a Day? Adequate levels of intake for infants are 400 IU/day with a maximum of 1,000 IU/day for infants 0-6 months of age and 1,500 IU/day in infants 6-12 months of age.  Children and teens 1-20 years of age should get between 400 and 600 IU/day.  Check out the newest report from the Institute of Medicine.

Vitamin D is crucial for any growing child.  Whether it’s the sunshine of your active life, or your family table, the benefits are the same.  Getting a mix of both is the best way to ensure your kids are covered.  Yet another reason to eat a good breakfast and spend more time playing outdoors!

Contributing Author:  Cami Ruark

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This is probably the easiest Dinner Bar yet.  And with the many prepared items now available in the produce aisle of most grocery stores, it may also be the fastest. Although it is considered vegetarian, there is plenty of protein in the cottage cheese, and the beans and corn together provide complimentary proteins.  You will need:


  • (See Grains and Legumes)
  • (See Dairy)


  • (See Vegetables)


  • Black Beans, canned


  • Russet Potatoes (about 1 per person)
  • Corn, canned (also a grain)
  • Green Onions, sliced
  • Salsa

Fruit/Healthy Mono-unsaturated Fat:

  • Avocado


  • Cottage Cheese
  • Mexican-blend shredded cheese

First, wash the potatoes, pierce them with a fork a few times, and wrap tightly with aluminum foil.  Bake at 350 degrees for about 1 hour, or until tender. Alternatively, choose microwaveable, pre-washed and shrink-wrapped potatoes to cut the usual time down to just 10-minutes.

In the meantime, open, drain, and rinse the black beans and corn.  Chop the green onions and slice the avocado.  Open the cottage cheese, shredded cheese, and salsa.  Choose a place for your Dinner Bar and lay out the spread in individual bowls.  It’s up to your family to choose what and how much they will load on their potatoes.

This is a great meal to fix when you’re pressed for time.  It’s also filling and packed full of nutritious fuel for active kids.  Keeping the ingredients on hand will make it even faster than any fast food excursion, not to mention healthier.  Sorry, no more drive-through excuses!

Contributing Author:  Cami Ruark

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