Eating disorders are becoming a growing problem for the nation's children and hospitals find themselves on the front line battling this complicated illness.
Among those younger than 12, hospital stays jumped 119 percent from 1999 to 2006, according to data from the Agency for Healthcare Research and Quality. A report, published in the December 2010 issue of Pediatrics, highlights an increasing recognition of eating disorders in males, who now represent up to 10 percent of all cases.
"We used to have one or two boys in treatment at any time. Now, we actually have a psychotherapy group just for boys and another for men," says Joel Jahraus, M.D., executive director of the Melrose Institute, an eating disorders program of Park Nicollet Health Services in suburban Minneapolis.
Between 5 and 10 percent of its patients are boys and men in their early 20s. "Everybody feels the pressure of society today to look the perfect part," Jahraus says. "With women, they want to be smaller, and with men, they want a tiny waist and broad shoulders. And you can't have it all—all the time. So they end up dieting to the extreme, and if they have a predisposition to an eating disorder, sometimes that's the start."
Specialized programs address the root of such problems. "These are mental illnesses with physical components," says Lynn Grefe, president and chief executive officer of the National Eating Disorders Association in New York. Most hospitals can help restore weight and vital signs for seriously ill patients, but "unless they have a specialized treatment for eating disorders, it's more like a drive-through McDonald's."
Eating disorders often are missed in youngsters because pediatricians don't notice the signs, but Eric Sigel, M.D., an associate professor of pediatrics at the University of Colorado in Denver, says primary care providers are doing a better job of identifying problems and intervening by referring youth to specialized facilities. Engaging family members is also important. That's why a support group for parents of boys and girls with eating disorders meets four days a week at The Children's Hospital, which is affiliated with the University of Colorado.
Upon discharge, regular follow-up is crucial to prevent relapse, says Metee Comkornruecha, M.D., an adolescent medicine physician at Miami Children's Hospital.
Decline in reimbursement for mental health services complicates this process. "Because of insurance issues and the volume of patients," he says, "it can be hard for psychologists to keep up with these numbers. Some of these patients need to be seen multiple times per week."