Always first. And worse and worse. Anorexia, bulimia, binge eating disorder are an epidemic in the Covid pandemic, and it has mainly affected adolescents. Yes, because it is precisely in that “middle ground” between childhood and adulthood that these problems “become apparent”, to quote the expression most used by specialists. In fact, it is mostly between the ages of 9 and 14 that the first signs of these disorders can be recorded.
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Early diagnosis makes a difference
Knowing what signs to look for to suspect the diagnosis of an eating disorder is essential for parents. As a rule, these problems – according to data from the Ministry of Health, in Italy there are about three million young people who suffer from them – occur between the ages of 15 and 19. But problems have often been smoldering for some time.
“In the last twenty years we have witnessed an increasingly precocious onset of eating disorders: especially among girls it is not uncommon to detect cases between the ages of 8 and 9, when they begin to perceive their own body image – she says from her observatory. Giuseppe Banderali, director of the pediatric complex operating unit of the San Paolo hospital in Milan -. That is why, from this age on, a parent must be prepared to record any alarm bells. “
When meals are at the center of everything
Which are many, and different and are not limited to the refusal of food. “With the exception of the restrictive avoidant disorder of food intake, the problem is the perception that one has of one’s body and food: when meals and what you eat end up in the center of everything, it is necessary to raise the level of guard, adds the expert, who is also vice president of the Italian Society of Pediatrics.
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Be aware of the signs of anorexia early
In most cases, as mentioned, at the base of these disorders there is an obsessive attention towards one’s body. It is therefore not surprising that almost all cases share excess weight from the start. A study just published on Jama Pediatrics confirmed how a high body mass index represents a risk factor: potentially able to leave room for both anorexia (you avoid eating with the aim of losing weight) and bulimia (you can’t avoid eating, but you does everything possible to minimize the “consequences” on physical fitness).
In manifestations, eating disorders have peculiar characteristics. Let’s start with the most common, anorexia (42.3 percent of the total). A predominantly female problem (in 9 out of 10 cases), characterized by calorie restriction aimed at achieving an excessively low body weight and an excessive fear of becoming fat.
Self-esteem linked to physical fitness
Fixed thoughts that lead children to put physical fitness at the top of the scale of values that determines self-esteem: even when low weight begins to represent a serious health risk. Banderali: “Anorexia is not an acute disease: there are always signs that precede the onset of the disease – adds the expert -. We must pay attention, for example, to a series of repetitive behaviors such as always looking in the mirror, making excessive comparisons with the physical fitness of a peer, practicing sports until exhaustion. Following a correct and balanced diet is important. But what we tell parents is to let children free in certain contexts, such as birthday parties. continuous stigmatization of certain behaviors, such as drinking carbonated drinks or exaggerating sweets from time to time, can determine an opposite effect in the child’s head, which completely eliminates these consumption “.
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The second most frequent disorder is bulimia (18.2 percent), characterized by binge eating and compensatory behaviors adopted immediately afterwards: to prevent excessive food intake from modifying the shape of the body. Unlike anorexia, this disorder tends to appear with a very similar prevalence between boys and girls. “Again, some repetitive behaviors can be intercepted,” he explains Arianna Banderali, psychotherapist and medical director in the eating disorders and nutritional rehabilitation unit of the Villa Garda nursing home. The two brothers are on vacation together. But they don’t shy away from the confrontation.
Binge eating and then vomiting or laxatives
“At the base, there is always a binge of food – continues the specialist, who is also vice president of the Italian Association for Eating and Weight Disorders (Aidap) -. Immediately after, compensatory behaviors appear that aim to eliminate the The effect of the high food intake on the organism. Above all, vomiting. But it is not the only one. There are those who also take laxatives and those who exhaust themselves from sport in an attempt to burn all the extra kilocalories taken. If one of these behaviors is intercepted and especially if you have a child who does everything he can not to eat with his parents or peers, it is appropriate to raise the level of guard “. She tightening the shirts of the controls, confronting her boyfriend. And possibly talking to a pediatrician.
How to recognize other eating disorders?
So far, the indications for the most well-known ailments. But not the only ones. There is for example binge eating disorder. The first manifestations (binge eating) are similar to those found in the case of bulimia. In addition to the origin, sometimes due to emotional problems, the difference is represented by the absence of compensatory behaviors. However, the similarity between the two conditions does not prevent the transition from one (binge eating disorder) to another (bulimia).
When they are too selective at the table
“Usually the tendency to compensate for excessive food intake appears when a boy perceives his own body weight as excessive”, adds the expert. Another condition was also reported in the latest version of the Manual for the Diagnosis of Mental Disorders (DSM-5). This is the avoidance or restriction of food intake disorder (Arfid), which occurs when a child is very selective at the table and tends to exclude most foods: to the point of no longer meeting his needs nutritional, experiencing significant weight loss and experiencing meals as occasions of strong emotional tension.
A complex disease
“We are not faced with the classic child who does not eat one or more dishes, which is quite common – explains the pediatrician -. But a particularly complex disease, which manifests itself when avoidance behaviors determine a significant weight loss and an alteration of growth: in terms of weight and height “. Also in these cases, which usually derive from a trauma during childhood or from the excessive anxiety of one or both parents, a “spy” is represented by the desire of the children to eat alone: avoiding all convivial occasions .
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Over 90 treatment centers throughout the country
Also to meet a growing need for health, the Istituto Superiore di Sanità has published the list of structures that deal with the diagnosis and treatment of eating disorders. From the mapping – the list includes 91 public centers, but will also be integrated with those of the private healthcare agreement – a greater capillarity emerges in the Regions of Northern Italy. Emilia Romagna stands out, with sixteen centers.
The interventions available in the centers
There are different types of intervention available, often integrated: psychotherapeutic (individual, family or group), psychoeducational, nutritional, pharmacological and physical and social rehabilitation. Residential pathways – which include hospitalization – are foreseen in 17 percent of the structures.
The correct scheme: 3 meals and 2 snacks
“Nutritional rehabilitation aims to restore the adoption of a correct diet: structured on three main meals and two snacks – concludes the psychotherapist -. Scientific data tell us that the recovery of a normal condition like this reduces by 70 percent. binges in people suffering from bulimia. And, of course, it contributes to the gradual recovery of normal body weight. Alongside this path, there is also a cognitive therapy that aims to restore the acceptance of dishes or foods feared until then. once this goal has also been achieved, people are ready to leave a structure and gradually take their lives back in their hands“.