STORY BYPart II of a Series
on Eating Disorders
In Part I of Eating Disorders in Teens we discussed that an estimated one-half percent to one percent of females 13-18 have anorexia. Another 1-3 percent are bulimic and many researchers believe these conditions are seriously underreported.
Self-starvation and the resulting nutritional deprivation wreaks havoc on their young, developing, and often, arrested bodies. They often have no periods. Their bones are brittle. Their estrogen and thyroid levels are imbalanced.
Then they grow up and want to have children.
As these girls grow into their would-be peak reproductive years, they may have married and now want children. Fertility though, is elusive to women who have struggled with eating disorders all of their adolescence.
As a reproductive specialist and professor at the University of Texas Medical School at Houston in the departments of Internal Medicine and Obstetrics, Gynecology and Reproductive Sciences, Dr. Shahla Nader sees patients who are referred by other physicians who cannot figure out what is wrong.
After taking an in-depth health history she will ask the patient, "Do you consider yourself to have an eating disorder?" The patients usually say yes if they do. Nader's goal is to replace the hormones and help the patient correct her body weight.
Nader explains that women have to have a certain critical level of body weight for the very sensitive internal clock, located in the brain's hypothalamus, to work. If a young woman is starving, she will not reproduce.
"A woman comes to me, wanting to get pregnant, but has amenorrhea—no menstrual flow. Sometimes being underweight is the reason," obstetrician/gynecologist Pamela D. Berens observes. Just a five percent weight gain may bring back her monthly cycle and ovulation.
It is important for Berens to know if the underlying reason for the patient's weight loss is an eating disorder, which she says must be fixed, with the patient gaining weight for six to 12 months, before becoming pregnant.
"Gaining weight is more effective than using fertility drugs. If a drug were used to make her ovulate and she became pregnant, but the eating disorder was not under control, she would be dealing with those symptoms throughout her pregnancy and not gaining weight properly. This in turn has a potentially negative effect on the growth of the fetus," says Berens, who is an associate professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at the medical school.
It is best for the expectant mother to gain weight throughout her pregnancy (usually 22 - 26 pounds if she is at her ideal body weight when she becomes pregnant). A woman with an eating disorder history should be seen frequently during her pregnancy to be sure she is gaining weight each trimester.
"A woman who does not gain weight properly could have a low birth-weight baby that is growth-restricted or even stillborn," Berens warns. "I try to explain to my patients that it is not a good thing to have a petite baby, who is poorly grown and undernourished."
New mothers are under increased physical strain and sleep deprivation under the best of circumstances. Their emotions may be turbulent as they settle in to a new hormonal rhythm. Eating disorders that might have been under control during the pregnancy may rear mightily after childbirth, right when nutritional value is crucial for mom and nursing child.
It is imperative for the new mother to be in control of any eating disorder symptoms while she is breast-feeding. "New mothers who are weight-conscious will immediately notice that one of the benefits of breast-feeding is that it uses up lots of the mom's calories - usually 500 - 600 a day," comments Berens, who has successfully helped many patients who have come to her wanting to get pregnant. However, those calories must be replaced to keep both mother and child healthy.
Women with diagnosed eating disorders are urged to confide their issues to their doctors before trying to get pregnant. Treatment options and support groups are available.
For a compendium of websites on eating disorders and support groups, go to: http://dmoz.org/Health/Mental_Health/Disorders/Eating/Support_Groups/
UPDATED: 12-11-2003
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Dr. Shahla Nader is an endocrinologist and professor of internal medicine at the UT Medical School.
See Dr. Nader also at:
Dr. Pamela Berens is an associate professor in the Department of Obstetrics and Gynecology at the UT Medical School.
See Dr. Berens also at:
Make an appointment
with your stress—
and keep it!
Set aside a specified time of day, say 3:00 to 3:20 P.M. Keep this appointment with yourself—make it as important as a client or a child’s reading time.
Now, let the stress pour out of you, all the worry, guilt, what-ifs, if-onlys. Hold nothing back. Imagine every possible scenario that intrudes on you, day and night. Funnel it into that 20-minute period.
When the bell goes off, you are done, finished, until your next appointment with yourself.
When you’re tempted to let stressful thoughts crawl across your mind, remind yourself that you have 20 minutes to address them—tomorrow.
