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Monday, October 22, 2012

A Rare Eating Disorder in a young Boy

Worries about weight, shape and eating are common, especially among young girls. Eating disorders are being increasingly recognized, yet there is a lot of underreporting in our country. These disorders mostly affect teenage and young girls.
A lot of young people, many of whom are not overweight in the first place, want to be thinner. They often try to lose weight by dieting or skipping meals. For some, worries about weight becomes an obsession. This can turn into a serious eating disorder. The most common eating disorders are  – anorexia nervosa and bulimia nervosa.
 Someone with anorexia nervosa worries all the time about being fat (even if they are skinny) and eats very little. Girls lose a lot of weight and their periods become irregular or stop.
Someone with bulimia nervosa also worries a lot about weight. They alternate between eating next to nothing, and then having binges when they gorge themselves. They induce vomiting or take laxatives to control their weight. These disorders are very rare in young boys.
Recently a 14 year old boy was treated at the SevenHills Hospital at Marol Andheri  East  for anorexia and depression. This boy was apparently well 2 years ago when he weighed 32 kg which was appropriate for his age, then two small incidences took place where he had an altercation with schoolmates triggering off his altered behavior which has then persisted. On admission to the hospital the boy weighed 12 kg. For the past few years he has had persistent vomiting, peculiar food fads , preferred only to have black tea. Parents had consulted many doctors and the child was extensively investigated. He had received some medicines from a psychiatrist as he had two attempts of running away from home. A firm diagnosis of an eating disorder was made in March 2011. Our consultant gastroenterologist performed an endoscopy for his vomiting however no obstruction was detected. The child was further evaluated by Dr Archana Kher Consultant Pediatrician and Dr Arti Sasane Consultant Psychiatrist. Patient had many serious problems like low proteins, lowered body temperature, reduced potassium and calcium, irregular heart rate, convulsions, atrophy of organs like the brain. He had three admissions in a period of five months and was successively revived from life threatening complications. During the stay in the hospital he would be very uncooperative, noncommunicative, hide beneath a blanket, refuse to eat, induce vomiting, pull out feeding tubes, and throw medicines in the dustbin. The intense medical management, counseling, psychotropic drugs improved his medical problems and temperament marginally.
During the present admission to the hospital the doctors decided that given his serious morbidity he required a long stay with intense support both physically and psychologically. The patient came from a poor socioeconomic background, the father being the sole bread winner works as a driver. The family approached the management for financial consideration. Given the challenge the management readily agreed and the patient was duly given the financial benefit. During the stay of one month he showed good progress, started relating with the doctors, accepted his regular diet and medications, the vomiting reduced to some extent. When persuaded he indulged in activity like drawing and crafts.
This case posed a real challenge to the doctors and the nursing personnel at the hospital and the patient was discharged after he achieved a weight of 16 kg, blood parameters were stabilized.
Patients with eating disorders have peculiar personality traits like low self esteem, feelings of helplessness. Such disorders can run in families, there can be a genetic predisposition. They can affect young people of all backgrounds and cultures. Research is on way to detect the role of possible chemical imbalances in the brain.
It’s important to remember that, if allowed to continue unchecked, both anorexia and bulimia can be life-threatening conditions. Over time, they are harder to treat, and the effects become more serious.

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