Adolescents & Anorexia Nervosa: Malnutrition Considerations

Our culture has become sadly complacent regarding adolescents and body image issues.

Picking one’s body apart, comparing oneself to others, and learning and engaging in restrictive eating or compensatory movement are now seen as rites of passage instead of negative consequences of the bodies that our culture over-values.

It is because of this complacence that eating disorder diagnoses in children and adolescents continue to increase worldwide.

Anorexia Nervosa (AN), the mental illness with the highest mortality rate, is also frighteningly the third most common chronic illness to be experienced by teens [1].

The truth of what occurs when these concerning behaviors become full-blown eating disorders is even more frightening, as it disrupts the physical, mental, and emotional transition from childhood to adolescence to adulthood.

Physical

Optimal functioning of body processes is necessary for teens to progress and grow in their transition through young adulthood.

All individuals that struggle with AN experience dire physical consequences, however, these are even more concerning in teens, as they can result in lifelong alterations to the growth and development process.

One key concern in supporting physical rehabilitation of teens with AN is avoiding “Refeeding Syndrome,” which is the “potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding [2].”

These shifts, which are a result of hormonal and metabolic changes, become even more apparent in teens, whose hormonal and metabolic processes are already often in extreme flux.

Not only that, when the body is starving, it pulls from it’s fat stores to receive the nutrients needed.

In this, “‘Children are at a much greater disadvantage,” says Zucker. “With anorexia nervosa…we have to act a lot more quickly, because children and teens have fewer stores available; they’re growing and their metabolic needs are greater [3].”

Teens have unique nutritional requirements to support them in their current stage of life and transitional growth and this must be considered when it comes to refeeding and medical stabilization.

Mental

Proper nutrition is necessary for continued psychological development and growth in teens.

However, when the body is malnourished, the brain becomes malnourished as well.

One study learned that “while white matter typically returns to healthy levels upon weight restoration, loss of gray matter can persist [4].”

Not only that, the brain cannot function optimally, as it runs on glucose, which is the energy carbohydrates are broken down into. No carbohydrates, no glucose.

This “brain starvation” results in reduced concentration, focus, memory, cognitive flexibility, and fear responses.

Emotional

In addition to the physical and mental, malnourishment also impacts emotional regulation and expression.

Lack of proper nourishment of the body and brain is shown to cause disturbances in serotonin production, often leading to increased symptoms of anxiety and depression.

Additionally, loss of the grey matter in the brain, as mentioned above, can lead to depression, schizophrenia and addiction [4].

Emotional disturbance unsurprisingly also follows lack of nutrition. Consider the irritability, fogginess, and emotional vulnerability you experience when you are hangry throughout the day.

Now, consider how much worse that would be if your body hadn’t been properly nourished for days, weeks, or months at a time.

Individuals find it difficult to not only identify their own emotions but to then use coping or communication skills to regulate and cope with them.

For teens, whose hormones and the general stressors of youth are already likely causing occasional emotional distress and uncertainty on how to communicate and cope, this makes what is already difficult even harder.

Adolescence is a tumultuous and challenging time as is and teens engaging in dieting and compensatory movement behaviors takes this transition from difficult to dangerous.

---

Resources

[1] Proulx-Cabana, S. et al. (2021). Initial inpatient management adolescents and young adults admitted with severe malnutrition due to anorexia nervosa: protocol for a systematic review. Journal of Eating Disorders, 9:36.

[2] Mehanna, H. M., Moledina, J., Travis, J. (2008). Refeeding syndrome: what it is and how to prevent it and treat it. BMJ; 336:7659.

[3] Brink, S. (2016). What happens to the body and mind when starvation sets in? WAMU – American University Radio. Retrieved from https://wamu.org/story/16/01/20/what_happens_to_the_body_and_mind_when_starvation_sets_in/.

[4] Unknown (2020). Does anorexia cause brain damage? The Recovery Village. Retrieved from https://www.therecoveryvillage.com/mental-health/anorexia/faq/does-anorexia-cause-brain-damage/

---

About the Author:

Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

---

The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published May 5, 2021, on EatingDisorderHope.com
Reviewed & Approved on May 5, 2021, by Jacquelyn Ekern MS, LPC