By Duke Medicine News and Communications

Disordered eating behavior, including such conditions as anorexia nervosa and bulimia, affects as many as one in every 10 adolescents. The vast majority of those diagnosed with these psychological disorders are teen-age girls and young women.

Eating disorders, which can be serious and sometimes fatal, typically affect girls between the ages of 14 and 19. But some experts caution that girls are now becoming concerned with diet behaviors and body shape at a much earlier age.

According to Terrill Bravender, M.D., assistant professor of pediatrics at Duke University Medical Center, there are two peak ages for true eating disorders. "The first is usually about age 14, toward the end of the major physical changes of puberty," he says. "We see it again in early college-age kids, ages 18 or 19, during a time that for some people is a tough transition period."

Bravender, who is medical director of the Duke Eating Disorders Program, notes, however, that early signs of disordered eating behavior are increasingly beginning to appear in younger girls.

"Concerns about body and diet are starting at very young ages, as early as age 7 or 8," Bravender says. "It's not uncommon to hear girls of this age say they need to be on a diet or that they're watching what they eat. One survey a few years ago actually showed that about 40 percent of 9- and 10-year-old girls said that they were on a diet to lose weight."

Bravender says this could be an early warning sign of danger ahead.

"While we haven't seen an increase in the number of very young kids presenting with symptoms of an eating disorder, the more body and diet concerns that are out there, the more it opens the door for potentially developing eating disorders years hence. If it starts at a younger and younger age, that means we have more and more kids at risk."

"We live in a media- and diet-saturated culture," he adds, "and younger kids tend to imitate what they see around them. They imitate what they see on television, what they read in magazines, and they certainly imitate their parents' behavior.

"This is why one of the most important things parents can do is to examine their own eating behaviors. If you call a food 'bad,' as in, 'I was so bad tonight. I had dessert,' kids will internalize this sort of message. Parents can help by taking a healthy and moderate approach to food themselves."

Bravender says he does not want to alarm parents about early warning signs for potential problems, but he does suggest some things to look for.

"All kids will go through phases of eating different kinds of foods, so I wouldn't want parents to worry if a child stops eating something they used to enjoy. But if a child begins to show anxiety about food -- always worrying about how fattening it is -- or starts to show a lot of body-shape concerns -- spending an unusual amount of time in front of the mirror -- I'd be concerned."