What's Behind the Dramatic Rise in Childhood Eating Disorders Hospitalizations?

One shocking recent statistic, released by the American Academy of Pediatrics in fall 2010, is that from 1999 to 2006, hospitalizations for eating disorders increased sharply - 119% - for children younger than 12 years old. The academy also noted significant increases in prevalence of eating disorders among minorities and males.

I spoke to Ovidio Bermudez, MD, medical director of child and adolescent services at Denver's Eating Recovery Center and a board member of The National Eating Disorders Association (NEDA). The 119 percent rise in hospitalizations for such young children, Dr. Bermudez said, is "likely to be a good proxy for a rise in incidence," meaning that as incredible as it sounds, it probably accurately reflects the increase in the number of kids under 12 who are suffering from eating disorders, especially, as Dr. Bermudez points out, when you consider how carefully third-party reimbursing organizations scrutinize hospital stays, and how reluctant they are to okay them.

The reasons for this scary rise in children's hospitalizations, says Dr. Bermudez, are complex, the result of a variety of forces that have created a "perfect storm very likely related to changes in the environment and changes in people's experience."

Here's how Dr. Bermudez believes this "perfect storm" has taken shape: Imagine that we can divide children our society into two groups, one that is genetically protected from eating disorders (meaning they have no family history of them), and another that is "genetically vulnerable" (meaning there is a family history of such disorders). Suppose a child in the latter group grows up in a "protective environment," let's say where there is no dieting peer group, no obsession with fashion and popular culture, or perhaps no obsessively dieting parents. Such a child is not likely to develop an eating disorder. "If that environment is altered and becomes a ‘promotive environment,'" explains Dr. Bermudez, "even someone who is more genetically protected" might be affected. The child who is really going to be adversely affected, though, and who is most likely to develop an eating disorder is the genetically vulnerable child exposed to the promotive environment.

Dr. Bermudez speculates that what we're seeing now is a cultural shift from a "protected" environment to a "promotive" environment and notes, "in a lot of ways we're seeing the same thing in other areas: childhood obesity, diabetes, and respiratory illnesses. My sense is that we are changing, the earth is supporting seven billion of us and that brings all kinds of added challenges, not only from a physical, and environment standpoint, but from an emotional and socio-cultural point of view."

Dr. Bermudez cited 2010 findings from the American Psychological Association's annual Stress in America, survey, which found that the number one stressor on families is their financial situations, and that nearly half of all children reported feeling saddened or worried about family problems. He calls it "stress by proxy," meaning that kids "are not living the financial difficulties to the extent that their parents are, "but they were picking up the stress because we don't live in isolation." He adds, "the world in general, is becoming a more stressful place to grow up, in. Everyone has access to mass media and there are things being promoted that aren't healthy, about body image, fitness, about the tolerance of violence.....and we know that exposure matters."

In addition to be bombarded by potentially triggering mass media messages, kids face other challenges: "social competition, pressure to perform, to be multitalented, and engaged in so many things," adds Dr. Bermudez. The pace of change and the level of tension in our society, he believes, are creating a culture that's very difficult for our kids to get a stake in." The message: "If you're not a super go-getter, you may not make it," and not everybody takes that message well.

So what can parents do? "First of all," says Dr. Bermudez, "alleviate stress for yourself, and for your family. Maybe you do with less: work two jobs instead of three, and take care of yourself in appropriate ways." (The American Psychological Association Stress in America report notes that managing stress levels, eating right, and getting enough sleep and exercise are key.)

Another thing: "Without kind of pushing your kid outside of the space within the bell curve, you want your kid to skew toward the side of less intensity, and fewer expectations of immediate performance." When he speaks, Dr. Bermudez tells audiences, "I'm so grateful that a good chunk of my childhood was in Cuba, playing in the streets and flying kites...I didn't take any lessons...now kids take everything, and if they're not doing that, they're out of the mix."Instead of trying to cram in sports, arts, academic and enrichment programs all at once, Dr. Bermudez suggests rotating them "rather than all of them all the time at all costs."

Another way you can help counteract an increasingly "promotive" environment is to, as Marcia and I advise in our book, model healthy attitudes and behaviors when it comes to food, eating, shape and size, and make exercise an enjoyable and regular part of your lives.

Nutritionist Marcia Herrin and Nancy Matsumoto, co-authors of The Parent's Guide to Eating Disorders, Gūrze Books. Marcia is also author of Nutrition Counseling in the Treatment of Eating Disorders.