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Further Causes of Malnutrition 179
(Neumark-Sztainer et al. 1997) vegetarians were: than restriction or ‘good versus bad foods’ is
important.
●● twice as likely to report frequent dieting
Eating disorders
●● four times more likely to vomit for weight
control A concern about body image becomes more serious
if an eating disorder develops. This occurs most
●● eight times more likely to use laxatives. commonly between 15 and 25 years of age.
Although eating disorders are most common in
In the 1997 NDNS, 10 per cent of 15- to 18-year- girls, studies have shown that about 10 per cent of
old girls stated that they were either vegetarian patients with eating disorders are male.
or vegan (but only 1 per cent of boys of the same
age) (Gregory et al. 2000). This is not a problem Genetic make-up and the attitude of other
in itself but if the diets are poorly planned and family members to food may have some influence
imbalanced, the result can be an inadequate on susceptibility. It can occur in children with any
intake of some micronutrients. Common cultural or racial background.
pitfalls are failure to consume foods which
sufficiently compensate for the loss of haem Eating disorders usually develop from a
iron from the diet. In addition, alternative combination of many factors that make one feel
sources of protein and vitamin B12 are needed unable to cope with life. This includes events,
in a vegan diet. feelings or pressures such as:
Inappropriate slimming ●● low self-esteem
Adolescence is the peak age for body ●● problems with friends or family relationships
dissatisfaction, and surveys of UK teenagers
consistently show that more than 50 per cent of ●● peer pressure
girls feel fat and want to lose weight. Up to 25 per
cent of young adolescent girls report dieting to lose ●● the death of someone special
weight, their motivation driven by weight and
shape dissatisfaction (Hill 2002). The Minnesota ●● problems at school, college, university or work
Adolescent Health Survey of 30,000 teenagers
revealed that 12 per cent of girls were dieting, ●● high academic expectations
30 per cent binge eating, 12 per cent vomiting and
2 per cent using laxative or diuretics (Neumark- ●● lack of confidence
Sztainer et al. 1998). The NDNS in 1997 found that
16 per cent of girls aged 15–18 years (and 3 per cent ●● sexual or emotional abuse such as being bullied
of the boys) were dieting to lose weight (Gregory
et al. 2000). Boys are usually more concerned that ●● feeling too fat.
they are not muscular enough.
Eating disorders have been divided into three
Unsupervised and unnecessary slimming can different categories: anorexia nervosa, bulimia
result in low micronutrient intakes as ‘the diet’ nervosa and eating disorder not otherwise specified.
often involves missing meals, particularly
breakfast. Body image can be improved by Anorexia nervosa
encouraging physical activity, but care must be Anorexia nervosa is most common in females
taken when discussing diet with girls who are 15–19 years but can occur in younger children. It is
concerned about their weight in case an over-focus characterized by:
on food encourages a drift towards an eating
disorder. Emphasis on variety and balance rather ●● weight loss or no weight gain during a period of
growth
●● intense fear of gaining weight
●● distorted body image
●● amenorrhoea in females – absence of at least
three consecutive menstrual cycles.
