Eating disorders among female adolescents

On this page in the past, we have looked at the problem of difficulties with feeding of various types affecting several age brackets. We also discussed the fact that some of these problems underscore an occult mental health status. This week, we beam our searchlight on the adolescent female and discuss how to approach a wide-scale issue that gives many parents sleepless nights, anxiety and worry. In some cases, parents have taken their children from one hospital to another in search of an enduring solution. In other instances, we have seen young girls transition from the overweight growing child who consumes every edible thing in her field of vision into a finicky young adolescent who has become obsessed with her physical dimensions, body shape and body weight. As they become more self-conscious and also more self-assured, their parents are, on the other hand, filled with so much anxiety that they often push these anxieties onto the growing girls. Some are mentally tough enough to resist their parents’ efforts or concerns, while others begin to crave the increased level of attention and seek to take undue advantage of the situation. In between these positions, careful evaluation by a skilled physician often helps to bring out the promoting factors behind the changes in behaviour in ways that might help in reaching a solution. Investigating anorexia and weight loss in a female adolescent requires a medical, nutritional and psychosocial approach to rule out organic causes while assessing for eating disorders. Here is a step-by-step framework that works in most situations, and one in which a proper approach to the scale of the problem can help with evaluation. It will all begin with initial triage and establishment of the patient’s safety. These are done by assessing the medical stability of the young girl. On arrival at the hospital, the vital signs are checked to identify a slow heart rate, low blood pressure, lower-than-normal body temperature, changes in blood pressure in the standing, sitting or reclining positions, and the basal metabolic rate percentile. Even during that first visit, red flags for hospitalisation include a heart rate of less than 50 beats per minute in the daytime and less than 45 at night, blood pressure of less than 80/50 mmHg, body temperature of less than 35.5°C, electrolyte imbalances such as low potassium or low sodium levels, or abnormalities observed on an electrocardiogram tracing. In a good healthcare facility, these baseline parameters are obtained even before the patient has seen a doctor. In the consulting room, obtainin