Child eating disorders on the rise

Swimming outdoors, playing with the family pet and enjoying an ice cream cone -- that is the summer life of a typical 9-year-old girl.

Not for Sarah Smith. As a child, Smith (whose name has been changed to protect her privacy) formed habits that would eventually lead her to develop both bulimia and anorexia nervosa, both of which she is still dealing with today.

Smith remembers her parents using food in a reward-punishment system. When she was good, she got treats; if she was bad, snacks were forbidden.

"I think there was a mixture of ... intentionally restricting my food and then going to try to find the food my parents were hiding," Smith said. "Even in childhood, it became sort of obsessive."

When Smith was born in 1989, child eating disorders were a rarity. Today, they are far more commonplace.

A study conducted by the Agency for Healthcare Research and Quality showed that hospitalizations for eating disorders in children under 12 increased by 119% between 1999 and 2006. More recent numbers are unavailable, but experts say the problem isn't getting any better.

Children will come in to her office already showing signs of malnutrition, dietician Page Love says. They often have low energy levels and low iron counts and are reporting hair loss because of their extreme weight loss.

Most, like Smith, do not recognize that their restrictive habits are actually an eating disorder that could ultimately be fatal.

Dina Zeckhausen is a psychologist and founder of the Eating Disorder Information Network. She sees kids in third and fourth grade who are already worried about being fat.

"There is so much emphasis on obesity," Zeckhausen said, "that there's a danger that we are going to produce a lot of anxieties in kids around weight."

Zeckhausen says that starting overweight kids on diets can trigger an obsession with food that could lead to an eating disorder. She recommends putting overweight children in a sport or becoming more active as a family and providing healthier food options.

Children at risk of an eating disorder share similar personality traits: high anxiety, perfectionism and obsessive-compulsive tendencies, according to Zeckhausen. They are also often subject to external pressures such as school bullying, abuse or a divorce. Restricting food intake is a way for a child to feel in control of their life.

"The eating disorder is the voice," said Love. "The eating disorder is a way to communicate (and say) 'I'm struggling. I'm hurt. I need help.' "

Smith's parents did not realize there was something going on until she was 13; her eating disorder was not professionally addressed until she was 17. As a result, Smith has been in and out of treatment facilities practically her whole life.

Experts say that getting help at a young age is the key to effective treatment.

"The longer an eating disorder goes on, the more potential physical and psychological damage can occur," Zeckhausen said. "It's particularly important to be in recovery before puberty begins so the child can accept and cope with the normal weight gain of puberty."

Love says that a lot of the time, she meets parents who say, "I didn't realize my child had lost this much weight until I saw them in a bathing suit."

"Unfortunately, some of these parents don't notice this weight loss until it's already significant," Love added.

A sudden change of portion size, cutting out foods the child enjoyed in the past, avoiding fat calories and sudden weight loss are all warning signs that a child is developing an eating disorder.

Smith said her family did not recognize her eating disorder as a problem. Now, a decade and a half later, she is still struggling.

"I think what I would tell them is to do their very best not to fool themselves," Smith said of her advice for children suffering with an eating disorder. "There are people out there, even if they aren't in their direct surroundings, who are filled with compassion and want to help."

A Post-American World in Progress

The past year has been filled with tumultuous events--the Arab Spring, the euro-zone crisis. But the most striking trend of 2011, one that will persist in 2012, was one that got little notice: the emerging powers that weren't.

By now everyone knows that a new and rising group of nations, including China, India, Brazil and Russia, are reshaping the globe. Yet if 2011 demonstrated anything, it was the inability of these countries to have much influence beyond their borders. They continue to grow their economies, but they all face internal and external challenges that make them less interested and less capable of exercising power on an international or even regional scale.

Let's start with China. Chinese growth continues to be robust, though clearly the government is worried about the inflationary effects of the massive stimulus program it implemented after the financial crisis, which has created a boom-bust cycle and inflationary pressures across the country. The regime, however, is expert at dealing with economic challenges; political ones are harder. China faces a transfer of power in 2012 that is unprecedented. About 70% of the country's senior leadership-- the top 200 or so members of the Central Committee--will be replaced by autumn. The new leaders--Xi Jinping and Li Keqiang--are the first generation that was not personally blessed and selected by Deng Xiaoping, the architect of modern China. Perhaps as a result, we are beginning to see factions develop within the Chinese Communist Party along regional, functional and ideological lines. The change comes at a delicate moment. Beijing's foreign policy assertiveness over the past two years on the South China Sea and related territorial issues has provoked other Asian powers to stand up to China, band together more closely and ask openly for American involvement in the Pacific. The result is that Beijing is now quieter on the regional stage. Global leadership is unthinkable. No Chinese leader today has the authority or the inclination to make big, bold decisions that would involve, say, shoring up the euro or initiating a new East-West climate compact.

India is even more obsessed with domestic affairs than China is. With a bewildering array of local and regional pulls on it, the central government has had little scope for foreign policy--or indeed any policy. Facing opposition on every front, with state and national elections looming, the coalition government of Manmohan Singh is like a patient on life support grabbing for the oxygen mask, simply trying to survive.

Goldman Sachs' Jim O'Neill noted in late December, on the 10th anniversary of his coining the term BRIC, that the greatest disappointment among those emerging stars has been India. Indian growth rates are declining, its currency is the worst performer in all of Asia, foreign investment is slowing, and government policy has alternated between populism and paralysis. In this context, foreign policy has been almost entirely secondary, confined to regional issues like Pakistan and Afghanistan, and even in those showing little in the way of leadership.

The other emerging powers face their own challenges. Russia has presidential elections in 2012, though the outcome is predetermined. Still, it faces new political dissent on a scale not seen since the rise of Vladimir Putin. Abroad, it has a skeptical Europe on one border, an expansive China on another and a hostile and increasingly radical Muslim population on a third. Brazil is in better shape, though its economy actually contracted in the third quarter of 2011. (If that happens in the fourth quarter, it will technically be entering a recession.) And its moves to become a regional leader have run up against a Mexico that is determined not to be forgotten or dominated. Turkey has been the one emerging power that has successfully projected influence in its region, but there are natural limits to that influence. The rise of the rest is real, but the emerging powers are not ready for prime time.

The U.S. has been able to fill the leadership vacuum quite effectively in some places. It has deftly expanded its role in Asia; continues to forge strong ties with India, Brazil, Indonesia and Turkey; and has maintained a good relationship with Russia on nuclear-weapons reduction. But American influence is not what it used to be. During the Mexican and Asian crises of the mid-1990s, the U.S. managed global economic problems almost unilaterally. Today no one expects or believes that Washington could solve the euro-zone crisis or direct the outcome of the Arab Spring. It is a post-American world out there, one characterized more by the absence of great powers than by their presence.