Friday, June 23, 2017

EFFECTS OF EATING DISORDERS ON ORAL HEALTH

EFFECTS OF EATING DISORDERS ON ORAL HEALTH

by town care dental.com 
Eating disorders are dangerous psychological conditions in which one's negative feelings, often about their bodies or food, affects their eating behavior. A person with an eating disorder may eat too little food or they may have sessions where they overeat and then purge or eliminate what has been eaten. At other times, some people with eating disorders may eat too much. These abnormal eating behaviors can create a host of severe health problems, including oral ones. While the state of the mouth may not be the first thing that comes to mind when one hears the term eating disorder, it is very important that people are aware of the risks.
Each of these eating behaviors represents a different type of disorder. Bulimia nervosa, binge eating disorder, and anorexia nervosa are likely the most recognized and common. Often, people with eating disorders will ultimately develop severe and, depending on how long the problem continues, permanent oral damage. One common reason why people with eating disorders experience problems with their teeth and gums is their inability to get proper nutrition as they are either not consuming enough food as is the case with anorexia, or they are eating the wrong kinds of foods and are potentially purging. When people do not get the nutrients that they require they may develop certain problems such as xerostomia, which is commonly referred to as dry mouth, and their gums may become swollen as gingivitis becomes a real threat. Additionally, lack of good nutrition can also be one of the causes of bad breath if there is a lack of niacin in one's diet. As eating disorders can prevent an individual from getting enough vitamin D and calcium, one's risk and susceptibility to tooth decay also increase.
When a person who has bulimia, for example, purges the food that they've eaten it creates a specific set of problems in the mouth. Vomiting is one of the ways purging is done, either manually with a finger down the throat or by taking something that will cause one to throw up. Because this occurs frequently, manual manipulation may injure or bruise the soft tissues in the mouth. Salivary glands may become swollen and a source of pain as a result of routine purging. These glands may even become so enlarged that they are visible to others. One may also suffer from a loss of tissue in their mouth and lesions or sores.
Vomit itself is highly destructive to one's teeth. When a person vomits, they bringing up acids from the stomach that are corrosive and damaging. The corrosive nature of this acid erodes tooth enamel and makes one's teeth weak and brittle. People with eating disorders that involve vomiting may also have thinning of their teeth, which may also make them appear translucent. In some, the thinning can be severe around the edges where they may be susceptible to chipping. Decay is another consequence of the stomach acid in vomit that coats the mouth and hits the teeth when it is expelled. Often, even the vigorous attempts to brush one's teeth after each of the numerous daily vomiting episodes associated with conditions such as bulimia can be problematic in terms of decay.
Individuals with disorders that cause them to overeat, such as binge-eating disorder, do not induce vomiting after eating; however, they do consume large amounts of foods. Often, these foods are high in sugar, are acidic, low in nutrition, or are made with other ingredients that lead to cavities and decaying of the teeth. These items, for example, may include cakes and other sweets or carbonated sodas. Cavities and decay, as they worsen, can eventually lead to tooth discoloration, sensitivity to hot and cold foods and drink, and even infection and tooth loss. In addition to these problems, the various eating disorders may also cause degenerative arthritis of the temporomandibular joint and pain due to teeth that have worn down and may have cracked.



    Friday, June 2, 2017

    Using the Family Dinner to Model a Food Neutral Mentality

    By Laura Cipullo, RD, CDE, CEDRD, RYT
    You sit down to eat dinner with the family. Perhaps you think my due diligence is done – I can now check off “family dinners” on my “Good Parenting List.” Is this true? Is eating together the answer to raising healthy and happy eaters? As with anything, it depends, and of course, differs for each child and/or family. However, in general dinner conversation, food served and food eaten affects our children’s relationship with food and body. Use the family dinner as an opportunity to create a neutral food and body mentality.

    The Family Dinner

    Have you said?
    Oh, I can’t eat dessert; it goes straight to my thighs?
    We only get the bad stuff on weekends.
    Since you behaved at the doctor’s office, you earned your after dinner dessert.
    Reframe and ask –
    Are you hungry for dessert?Are you eating a variety of foods throughout the entire week?Are you proud of your behavior today?
    What happens at your dinner table? What messages have you intentionally or unintentionally relayed to your children? Is dinnertime a positive time to share stories from the day or a tense gathering with arguing? Do you and your spouse make comments about each other’s food choices? Is there a power struggle surrounding food quantities? If your child asks for seconds, do you oblige or tell them they need to watch their weight? Is your TV turned on? Has food been labeled as good or bad? Do you currently label food as healthy or unhealthy? What foods do you serve yourself versus the children? Are all three macronutrients – carbohydrates, proteins, and fats served to each dinner guest? Do all children get to choose the same sides? The answers to these questions likely affect how your child views food and their own body. However, it is not necessarily their experience of the food with their body. Rather, it is your judgment imposed on them. Think about using the dinner meal as an opportunity to neutralize food and even body for you and your whole family.

    Neutral Food  

    Webster’s dictionary defines neutral as “not engaged on either side; specifically:  not aligned with a political or ideological grouping.” (https://www.merriamwebster.com/dictionary/neutral?utm_campaign=sd&utm_medium=serp&utm_source=jsonld) In regards to food, this means not aligning foods in good or bad groupings. It also means not even aligning foods in healthy versus unhealthy groupings. And the same goes for the body. There is no right or wrong body.  This means fat is not right or wrong or good or bad.
    When specifically applying this neutral mindset to food, one attempts to be mindful without judgment. Instead of judging which food is better for you or your child by choosing “healthy” or “good” foods, you can make observations and then draw conclusions.
    First, rid food of labels noting value or morals. Ideally, an apple is an apple and chocolate is chocolate. We eat foods, meals, and snacks. Foods are carbohydrates, proteins, and fats. They break down to carbon, hydrogen, oxygen, nitrogen, and fatty acids. There are no treats, food rewards, or food decisions based on “deserving.”
    If you must categorize food, consider acting like a scientist and quantifying a food’s nutrient density based on objective (not subjective) measures rather than an adjective such as good or bad. A food can have a high, average, or low nutrient density. This is based on the amount of macronutrients, micronutrients, processing, and other additives in a specific size or portion of food. Just because one food is denser than another, it does not mean that said food is better or worse for your overall health. For example, a runner may need a food with a low nutrient density such as cane sugar to provide a quick source of fuel for their muscles, while a tween whose body is readying for puberty may need a nutrient dense food or snack before taking high school entrance exams to help sustain focus. There may also be times when you eat a food just because you want it regardless of its nutritional density.
    After removing the value judgments from food, you can further neutralize food through mindfulness.  Eat the food mindfully using the five senses and then observe if and how it energized you; if and for how long it helped you to remain full; what purpose it served. Sometimes, you need food for fuel and at other times you may want food for hedonic, emotional, or behavioral reasons. You can choose to eat different foods at different times for different reasons. The choice is that of the individual.
    When determining if a food works for your mind, body, and spirit, ask yourself and or your child the following questions after you/they have eaten it without judgment. This will help you/them determine which foods work best with your/their mind, body, and spirit, and at what specific times. 
    • Did the food provide even energy? A burst of energy? No noticeable difference?
    • Did the food increase your fatigue? Eliminate your fatigue? Have no affect?
    • Did the food sustain you for one hour, two hours, three hours, or more? 
    • Did the food meet the purpose (taste, satisfy, sate…)?
    If possible, make dinner meals, especially the first few minutes, peaceful, free of distractions like arguing and TV, so that you and your children can be engaged in the process of the eating mindfully to begin learning what works and/or doesn’t work for the mind, body, and spirit. Starting from a neutral place with neutral foods can pave the way to having a positive mind, body, and eating experience.



    Can You Try Too Hard to Eat Healthy?

    By Jessica Setnick, MS, RD, CEDRD-S
    Messages about food can be so complex! They intermingle dimensions of health, “fitness,” nutritional content, size, shape, and physical appearance… misusing scientific terms to make a food seem better or worse than others… and blatant marketing tactics like labeling cherries “gluten-free.”
    I’m a dietitian and I’m not immune. I find it impossible to avoid food messages, even as I am cursing them silently in my mind. They are right here in my home, I see them as I drive down the highway, and they’re almost everywhere in stores and in the media. They are very “sticky” since many of them are intended to cause an emotional response. It’s not a coincidence that magazines have delicious foods on the cover and weight loss articles on the inside.
    You may be the kind of person who can ignore food messages – you choose, purchase, and eat foods based on your personal preferences, occasionally branching out to try something new. Or, you may be someone who tries to keep up with food news when you can, replacing outdated information with newer thinking, opting for ‘Meatless Monday’ or ‘Taco Tuesday’ to spice up your routine, trying to feed yourself and your loved ones to the best of your abilities while maintaining balance in other aspects of life.
    There is a third group among us, and you may be or may know someone like this… This person sticks to a certain way of eating no matter what, does not want to be flexible or try something new, and believes so strongly in a certain way of eating that they miss out on other parts of life due to this dedication.
    There are many reasons you may eat so strictly. It may have developed over time as a response to confusing food messages, a sort of protective group of foods that are unequivocally nutritious and safe. It may be a response to a health scare, either your own or a loved one’s, facing the fact that eating is one of the few aspects of health that we can control. Or, it may have been prescribed by a doctor, such as foods to avoid or eliminate due to an allergy, medical diagnosis, or preventative measure.
    Some of us are able to adhere to a specific diet on a lifelong basis, happy and healthy, and balanced. And others of us become consumed by the demands of eating and limiting and avoiding and controlling, continuously shortening the list of foods that are acceptable to eat, and ultimately the quest for “eating healthy” morphs into an archenemy of the original goal. This enemy is orthorexia.
    Orthorexia nervosa was coined and first used by Dr. Steven Bratman in 1997 to describe an “obsession with healthy eating” that he observed among his family practice patients. The obsession was actually impairing their ability to eat normally or appropriately, due to a fear of doing something wrong.
    Dietitians often notice this type of obsession and restriction among our clients, even those who do not meet criteria for eating disorders. Individuals who come to us for help with their chronic illness, sports nutrition, or just to “eat right” can associate eating certain foods with guilt and shame, disease, anxiety, fear, and death.
    They are often surprised when we tell them that the excessive focus they are putting on food is actually the problem, not the individual foods they are eating. Some clients refuse to further meet because they feel we don’t understand proper nutrition, or we have an ulterior motive to get them to violate their rules.
    These feelings are understandable in the context of orthorexia. Anyone who wants, asks, or expects you to change your eating against your will can be viewed as your enemy. It is wise to be suspicious of anyone who tells you his or her food or product will cure disease, save your life, or make you a good person. But what about the voice inside your mind telling you the same things?
    • Do you feel bad about yourself depending on what or how you eat? Do you ever punish yourself after eating something you shouldn’t have?
    • Do you eat differently when you are alone as opposed to when there are other people around?
    • How much of your day do you spend on food planning and preparation? Is this enjoyable or does it feel pressured and stressful?
    • What happens when you are at a social function and you aren’t able to control what is served? Can you manage or do you feel nervous or guilty?
    Honestly answering these questions might clue you in to something you might not want to know, something you might be hiding from yourself. Look at the chart describing Positive and Pathological Nutrition. If your quest for health through eating has become pathological, it’s time to get back in control of your eating instead of allowing eating to control you.
    Pathological Nutrition.gif - Setnick
    There’s no shame involved in how you eat. It doesn’t make you bad or good or anything else. You are a good person already; the way you eat reflects that when you are following a combination of your internal senses, your wealth of personal experience, and your knowledge of food and nutrition.
    If you have become detached from listening to these cues, an eating disorder specialist can help you return to your roots. If you feel that you were raised with food in an unhealthy manner, that same person can help you craft a new, personal way of eating now.
    Ultimately your goal is to find the sweet spot of healthy eating that balances good nutrition and a good attitude. It may take time, but it’s worth it to invest in your health and your future. You already know that, you just need someone to help you find the right direction. If that person is a dietitian, you can find one in your area or someone to meet with virtually at www.IFEDD.com/treatment-finder. And if you are concerned about someone in your life, a consultation with an eating disorder specialist can help you find ways to approach that person and support them in recovery.

    Binge Eating and Impulsivity

    By Dr. Cari Pearson Carter
    Binge eating, which involves consuming an unambiguously large amount of food while feeling a sense of loss of control (American Psychiatric Association, APA, 2013), occurs across eating disorders, including in anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). In fact, in the general population, between 8-12% of 11-12 year old girls report engaging in binge eating behavior (Combs et al., 2012). This percentage seems to increase in late adolescence (up to about 24%) and then decline into adulthood, with about 5-8% of adult women endorsing regular binge eating behavior in mid-adulthood (Keel et al., 2007; Stice, 2001; Tanofsky-Kraff et al., 2007), though these numbers appear to be increasing as more research focuses on adult obesity. Unfortunately, binge eating behavior tends to be chronic and many individuals continue to struggle despite treatment. This is particularly striking when considering the fact that binge eating is associated with several psychiatric and medical problems, including obesity, Type 2 diabetes, high blood pressure, high cholesterol, heart problems, depression, relationship problems, and substance use problems (APA, 2013).
    Given the profound negative consequences and the chronicity of binge eating, a crucial question for eating disorder researchers is: What risk factors make one vulnerable to initially engage in binge eating behavior? One such important risk factor appears to be impulsivity.
    A useful way to understand the development of eating disorders is that initial binge eating is typically considered an impulsive or rash act. Indeed, initial engagement in many potentially harmful behaviors is often described as impulsive. Early binge eating episodes, consumption of large amounts of alcohol, decisions to have sex with someone one has just met, or betting far more money than intended are all thought to involve acting on an impulse or acting rashly. Engaging in such behaviors appears to be characterized by a focus on meeting one’s immediate need, or acting on an immediate urge, without due consideration of the possible negative consequences of the act with respect to one’s long-term interests, goals, or health. One way to describe impulsive or rash acts is in terms of failures of, or ongoing deficits in, self-control. When a girl engages in her first binge eating episode, she may do so to address her immediate need or urge (e.g., relieving a negative mood), even though doing so has potential negative effects (e.g., feeling ashamed and physically uncomfortable) and is almost certainly not in line with her long-term interests (e.g., weight gain).
    Though there are many different personality traits that relate to impulsive behavior, the one that has proven important in predicting binge eating behavior is the trait of negative urgency, which refers to the tendency to act rashly or impulsively when distressed (Cyders & Smith, 2007, 2008a; Whiteside & Lynam, 2001). Negative urgency predicts the onset of binge eating behavior among early adolescents and college women (Pearson et al., 2012; Anestis et al., 2007; Fischers et al., 2013). Interestingly, it also predicts engagement in other risky behaviors, such as heavy drinking, smoking, risky sex, drug use, and gambling. Thus, negative urgency may explain why some individuals who binge eat also engage in a host of other dangerous behaviors, and even why sometimes when individuals are able to stop binge eating, another behavior seems to “pop” up and replace it.
    Individuals who are high on negative urgency likely experience distress more frequently and/or intensely and have difficulty sitting with that negative emotion; it likely feels incredibly uncomfortable. As a result, without thinking about the consequences, they are prone to quickly seek a rash behavior (e.g., binge eating) that may distract them from or alleviate that negative emotion. Indeed, binge eating appears to temporarily decrease negative emotions (Smyth et al., 2007), thereby making it more likely that when individuals experience negative emotions again, they turn to binge eating to cope, making the behavior to become more and more likely in the future. Over time, it appears that the behavior may transition from impulsive in nature (e.g., engaging in the behavior without knowing or thinking about its consequences) to compulsive in nature (e.g., engaging in the behavior despite knowing and thinking about its consequences: Pearson et al., 2015).
    Interventions for binge eating that target negative urgency are likely to be particularly helpful for those who are more impulsive. That is, interventions with an emphasis on: (a) enhancing emotional awareness and emotion regulation through describing and labeling emotions; (b) identifying cues for emotional experiences; (c) learning how to tolerate distress in the moment; and (d) learning alternative means of coping that do not harm oneself. The hope is that individuals will learn alternative strategies for responding when they experience intense negative emotions, but in order to do so, they must be able to recognize and tolerate the emotional experience. Current binge eating treatments (e.g., dialectical behavior therapy, DBT; Linehan, 2014) are beginning to incorporate these type of strategies, increasing hope for recovery and full remission.

    Wednesday, May 31, 2017

    Is More Aggressive Refeeding Safe for Severely Malnourished Inpatients?

    Vol. 28 / No. 2  
    More evidence on this controversial question.
    Recently there has been increased interest in the rate of refeeding people with AN. A new article from University of California, San Diego researchers suggests that more aggressive refeeding may be appropriate in selected young patients hospitalized with restricting eating disorders, including AN,  avoidant/restrictive food intake disorder (ARFID), or other specified eating disorders (J Eat Disord. 2017; 5:1, published online before print). The study group of 87 patients 8 to 20 years of age included a subgroup of severely malnourished patients who presented at less than 75% of expected body weight (%EBW).
    On admission, most patients were started on an oral nutritional rehabilitation diet, and the initial caloric level was based on the patient’s recent dietary history. Typically the patients received from 1500 to 1800 kcal/day, but lower-calorie diets (such as 1200 kcal/day) were used if the patient had been using extreme dietary restriction, for example, fewer than 500 kcal/day over several weeks. Daily caloric intake was titrated to achieve 2 kg weight gain per week. If the daily target weight wasn’t achieved for 2 days in a row, the caloric intake was increased; this was also the case for those with persistent or severe cardiac complications, such as bradycardia overnight, symptomatic postural changes in heart rate or blood pressure, or arrhythmias.
    Nasogastric or nasojejunal tubes were used if needed until the patient could consume 100% of daily nutritional and fluid needs by mouth for at least 24 hours. Intravenous fluids were reserved for dehydrated patients unable to tolerate oral fluids.
    On admission, all patients were screened with complete blood counts and complete metabolic panels, urinalysis, and electrocardiograms. Refeeding laboratory findings were assessed daily, concentrating on serum magnesium and phosphorus levels, and urinalysis. Continuous cardiac monitoring was used throughout the patient’s entire hospital stay.
    According to Dr. R. Tamara Maginot and colleagues, %EBW was determined through evaluation of several clinical factors. Although the conventional approach uses the 50th percentile body mass index (BMI, or kg/m2) to calculate expected body weight for children and adolescents, the San Diego researchers customized %EBW to return each child or teen to the growth trajectory in which he or she was healthy. For example, if the patient’s premorbid BMI was greater than the 85th percentile, and the patient was otherwise healthy, the initial %EBW was selected to restore the patient to a BMI at the 75th percentile level. If the premorbid growth patterns were unknown, the authors used the conventional 50th percentile for sex and age.
    Most of the study group had been diagnosed with AN-restrictive subtype (66.7%), while 16.1% had diagnoses of AN-binge-purge subtype, 5.7% were diagnosed with Other Specified Eating Disorders, and 11.5% were diagnosed with ARFID. Fifteen patients required the use of nasogastric/nasojejunal feeding tubes during hospitalization. About 75% of patients were assigned to a higher-calorie diet on admission (66 patients; range: 1500 to 3000 kcal/ day). The lower-calorie group (21 patients) was given a mean of 1185 kcal/day, and had significantly longer hospital stays than other patients (38.3 days versus 31.9 days, respectively).
    The authors note that just as in previous studies, the incidence of electrolyte abnormalities in their sample was not linked to the rate of caloric increase or initial calorie level. Instead, low phosphorus levels were more common among patients who had a lower %EBW on admission. This suggested that the degree of body depletion may be a more important predictor of electrolyte abnormalities than caloric levels. In this study, with every 1% decrease in %EBW on admission, the odds of hypophosphatemia increased by 6%. However, starting severely malnourished patients at on a higher-calorie regimen was not associated with a higher risk of hypophosphatemia, hypomagnesemia, or hypokalemia.
    An important caveat to this study is that refeeding occurred on a medical unit with continuous cardiac monitoring. Although the regimen was well tolerated in this sample, this degree of monitoring would not be available in most ED treatment settings. Future studies of larger patient populations will be needed to help define the safety of administering higher-calorie diets, especially to severely malnourished patients. It is important to define rates that are safe, but also as effective and promptly delivered as possible.

    Tracking Recovery from AN and BN over the Long Term

    Vol. 28 / No. 2  

    Encouraging results for most, but not all, patients over more than 2 decades.
    Gaining weight is a major worry among people with EDs. The Massachusetts General Hospital Longitudinal Study of Anorexia and Bulimia Nervosa has once more provided valuable information about the long-term effects of AN and BN. Dr. Kamryn T. Eddy and colleagues recently reported the results of their 22-year follow-up of women with AN and BN (J Clin Psychiatry. 2017. 78:184). At follow-up, two-thirds of the women had recovered. The Longitudinal Study was begun in 1987 with 246 women, all of who were seeking treatment for AN or BN. As part of the study, the women were interviewed every 6 months for a median time of 9.5 years to assess weekly symptoms, comorbidities, participation in treatment, and psychosocial functioning. Subsequently, 22-year follow-up was completed.
    Dr. Eddy and coworkers reported that one of the indictors of long-term recovery was early recovery. At 22-year follow-up, 62.8% of women with AN and 68.2% of those with BN had recovered. This was vastly improved over the 9-year follow-up evaluation, which showed 31.4% of women with AN and 68.2% of those with BN had recovered.
    Notably, about half of the women who were still ill at the 9-year point had recovered from their ED by the 22-year point. Recovery happened earlier for the women with BN, while recovery for AN patients was slower and continued over the long term.
    A second study shows mortality trends 
    An earlier study by Debra L. Franko, PhD, and her coworkers at Massachusetts General Hospital identified risk factors for mortality in people with AN and BN over time (Am J Psychiatry. 2013. 170:917). These researchers found that a long duration of illness, substance abuse, low weight and/or poor social functioning all raised the risk for death from AN. Among the 246 women who participated, 16 deaths (6.5%) were reported; among the 186 women with a lifetime history of AN, 14 (7.5%) died. Four of the deaths were from suicide Among the 60 women with BN and no history of AN, 2 (3.3%) had died. The authors also reported that the majority of women who had been initially diagnosed with AN experienced crossover from AN to BN, while crossover from those with an initial diagnosis of BN to AN was much less common.
    A return to normal weights for most in a third study
    H.B Murray and colleagues recently published very valuable long-term weight outcome results from a well-described cohort of people with AN and BN (Int J Eat Disord. 2017. Feb 11. doi: 10.1002/eat.22690).
    The authors described the results of their 22-year longitudinal study of an original group of 225 patients with AN and BN. Two hundred and twenty-five were followed for 10 years and 177 were still in the study at the 22-year follow-up point. Over the course of this long study, most weight gain occurred within the first 2 years, and this lessened between years 2 and 5. Thereafter, the subjects’ weight remained relatively stable. Body mass index increased most rapidly during the early years of the study for those with lower weights at baseline (i.e., AN) and plateaued over time, settling in the normal range for most. At the 22-year follow-up point, 69% of participants were in the “normal weight range.” Seventeen percent were overweight or obese, and 14% were underweight.
    Clinically, it seems as though people with AN or BN have various fears related to weight; these include the fear of ending up overweight or obese, but also the fear of gaining any weight. These results will be helpful for addressing the former fear.
    As the longitudinal study continues, we will undoubtedly learn much more, and there is always the hope that recovery rates will move upward.

    Tracing the Path of Disordered Eating Over Time

    Vol. 28 / No. 2  
    Four risk factors emerged in a community sample followed over 10 years. 
    Little is known about how disordered eating behaviors and symptoms that appear in early adolescence may change over time. Results of a recent study gives us new information about this trajectory over time, including the fact that there is a 75% chance that those who had disordered eating would continue to have symptoms a decade later.
    Carolyn M. Pearson, PhD, and collaborators at the University of Minnesota and Columbia University studied a community sample of teens over 10 years to see how risks of ED change throughout young adulthood (Int J Eat Disord. 2017. doi: 10:1002/eat.22692, published online before print). The team studied data from 2,287 participants in Project EAT, a valuable longitudinal study that has assessed eating-related, anthropomorphic, and psychological factors using surveys of male and female middle and high schools students, who are now young adults living in and around Minneapolis/St. Paul, MN. The EAT I survey analyzed teens 11 to 18 years of age and then revisited them as young adults 10 years later (EAT III).
    Stability and transitions
    The researchers found that those who had no symptoms in EAT I tended to remain in the same group 10 years later. For those identified in the dieting group in EAT I, dieting usually persisted. There was a 75% that chance that those with disordered eating symptoms during adolescence would continue to have disordered eating or to transition to the dieting group over the 10-year follow-up period.
    Lower self-esteem, depressive symptoms, and substance use were important predictors of transition to disordered eating, and female respondents had greater odds than males of transitioning to increased symptoms a decade later. Family weight teasing also increased the odds of a teen transitioning to disordered eating; this was nearly statistically significant, and was a more powerful element than peer teasing.
    Two factors were protective: higher self-esteem and family communication/caring. Some positive findings also emerged. One was that most teens who were asymptomatic at the first survey had not developed disordered eating behaviors by the 10-year follow-up. And, 1 in 4 of those with ED behaviors at the first survey was asymptomatic at the 10-year follow-up point. This suggested that some young adolescents with disordered eating do get better over time.
    Screening for and intercepting risk factors early on
    The study underscores the value of early detection and intervention for teens with disordered eating. Screening for psychological and socio-environmental risk factors, particularly low self-esteem, depressive symptoms, substance use, and poor family communication/caring, especially among adolescent girls, may help interrupt transition to EDs in young adulthood.