Friday, June 06, 2008

SOTD*: Teens and "eating problems"

A new study out of Finland and reported in the Journal of Advanced Nursing asked 15- to 17-year-olds to report on whether they had eating "problems" along with a host of other health issues (insomnia, depression, etc.). About 18 percent of teens said they had some level of eating problems that persisted over two years. I'd love to know exactly what "eating problems" means in this context--it could be anything from picky eating to active restricting/purging.

Interestingly, and right in line with other new research, there was a strong correlation between eating "problems" and anxiety/depression:

47% of students with persistent problems reported anxiety, compared with 12% of non reporters.
• 31% reported depression, compared with 5% of non reporters.
• 77% were unhappy with their weight and 46% with their appearance. This was much higher than the 8% and 18% reported by students without eating problems.

So far, so good. Researchers went on to look at height and weight records kept by school nurses and "found that even students with persistent eating problems were more likely to be normal weight than over or underweight."

From this they concluded, "Our study backs up previous research that shows that eating problems often fluctuate in children of this age and in 50 to 60% of cases last about one to two years. However in ten per cent of cases their eating problems can persist into adulthood. Although almost a fifth of the students who took part in our study reported eating problems at some point, these problems clearly sorted themselves out in the majority of cases. However, one in twenty students continued to report problems."

I'm not so sure about that. First of all, these were self-reports, and we all know that even under the best circumstances, self-reports are notoriously unreliable. Second, teens with eating disorders tend to be ansognosic--they can't recognize that they have a problem.

It makes me wonder about the teens who said they did have problems, and what relationship those "problems" have with eating disorders.

It's quite a stretch to conclude from this that the majority of teenage eating issues last one to two years and then "clearly sort themselves out." Maybe the kids just got savvier about hiding e.d. behaviors and stopped self-reporting. Maybe the kinds of problems they were describing aren't related to true eating disorders in the first place. Maybe they had some help in resolving those eating problems that wasn't identified in the study.

I'm grateful to see more studies on eating disorders, but sometimes surprised by the level of analysis brought to the table (so to speak).

*SOTD = study of the day

Tuesday, June 03, 2008

And this just in: Aetna settles!

Remember the class action lawsuit brought by New Jersey mom Dawn Beye, among other plaintiffs?

Well, Aetna, the insurer in question, has just settled. Not only will it pay 100 or so New Jersey families whose e.d.-related claims were denied, but:

For people enrolled in fully insured policies, "Aetna shall cover claims submitted by Aetna Insureds for the diagnosis, care and treatment of eating disorders in the same manner as biologically based mental illnesses," the May 22 settlement in DeVito v. Aetna Inc., civ-07-418 says.

I'm lifting my breakfast fork in celebration here. The Aetna settlement closely follows the Minnesota Blue Cross Blue Shield settlement brokered by a suit involving Kitty Westin some years ago.

This is Progress with a capital P. Go read for yourself.

The "other end of the spectrum"

This article in the Milwaukee Journal Sentinel caught my eye the other day. Whoever wrote the headline--"Young females may be on the path to poor bone nutrition"--missed the real point here, which to my mind is captured in these paragraphs:

One of the most surprising findings was that nearly twice as many of the non-athletes (30%) had poor bone health, compared with the athletes. More than 90% of the non-athletes also were getting insufficient calcium.

The finding shows that while overeating and obesity are problems for a significant number of adolescents, at the other end of the spectrum is a group of young girls who have poor nutrition habits, including not eating enough.

Yes, folks, despite 200+ years of knowledge about eating disorders, we are still surprised to hear that some young women do not eat enough.

Sarcasm aside, I am thrilled beyond measure to read things like this:

"A lot of times we are so focused on obesity that it can play into eating disorders," said Sheila Dugan, an assistant professor of physical medicine and rehabilitation at Rush University Medical Center in Chicago. Dugan was not a part of the study.

Yes, yes, and yes. I am terrified that 5 or 10 years from now, when the children who are now getting a whopping dose of "wellness" curricula in elementary schools hit adolescence, we're going to see a spike in the number of cases of eating disorders.

The last time I tried to make this point to someone In Charge (in this case, a new head of a university hospital's child and adolescent programs), she looked at me like I had two heads.

But osteoporosis is a quantifiable measure. It's not a subjective assessment of eating habits or self-reported nutrition. It's undeniable numbers and for that I am grateful. If that's what it takes to get those In Charge to pay attention, that's a good thing.

Now, who's listening out there?