TEEN HEALTH:

Terri Schiavo and Our Kids

by Dr. Ann L. Engelland

(March 30, 2005) Sadly, Terri Schiavo finally got her way.

We know that constant attention has been paid to Terri’s tragic story by local and federal courts; constitutional lawyers; pro-life advocates; end-of-life advocates; Jesse Jackson; lawyers out to make a buck writing “advance directives”; the Bush brothers intervening in someone else’s family; the media hovering, and millions of coffee drinkers around the country chatting over the issues while sipping lattes.

In spite of the myriad questions this case has raised for each of us privately and for our country collectively, very little attention has been paid to the apparent fact that Terri Schiavo suffered cardiac arrest at the age of 26 because of an electrolyte imbalance, presumably caused by a chronic eating disorder.

As I scan my list of patients for the day, I am anxiously reminded that each one I see – college students home on spring break, or middle-schoolers questioning their pre-pubescent chubby tummies, or kids from across the street at Mamaroneck High School - may be harboring and hiding an eating disorder. I know it can take months to uncover anorexia, maybe until the child faints or has missed a period for a long stretch. I also know that there is often a delay of years in the case of bulimia. Anyone who works with eating disordered patients knows that moving a family and patient past their anger, denial, fright, and pain is an arduous task that can require a team of skilled clinicians for successful treatment. And sometimes patients are in a life or death situation.

I am always afraid that I will have missed the truth or not given a patient license to divulge her terrible secret and unhappiness. I fear that she will leave my office and have a heart attack. Even if I am aware of the problem, it’s often impossible to predict which patients have done enough damage to their hearts or brains and may be sitting on time bombs.

And so, if we are to believe ABC’s online report of Terri’s junior and senior high school years, we get a picture of a high school girl who was 5’3” and weighed over 200 pounds until she lost some 65 pounds and began to feel attractive and ultimately attracted her husband, Michael. Also lurking in this picture is that Terri had, according to Michael, “peculiar eating habits,” and that friends noted she would often get up to go to the bathroom after meals.

Chances are Terri would swing between restrictive phases, eating very little and supposedly drinking lots of iced tea to keep her weight down and then giving in to cravings and eating a “normal” meal only to feel gross, ashamed, fat, and overwhelmed until she would purge herself by vomiting. The hard part to understand is that for people with bulimia the purging brings such a relief from the negative feelings and such a refreshing sense of control over the food and body that it becomes an addictive behavior, very hard to beat without help. That’s right. An addiction. Not unlike gambling, alcohol, cigarettes, or cutting. The behavior is viewed as an antidote to the problem. Unfortunately it carries with it a huge price: osteoporosis, endocrine disorders, heart disease, reproductive problems, kidney failure, depression and suicide.

On many college campuses this disordered eating is seen as normal. Some of my healthy patients describe not being able to eat with their roommates because of the constant commentary about their appetites, food choices, body size, and calorie intake.

What can we do?

• We can educate ourselves about these problems.
  
  
• We can learn how to prevent eating disorders by starting to value a range of body shapes and sizes.
  
  
• We can address emotional and family problems directly and not use food as a tool.
  
  
• We can teach our children healthy ways of dealing with the huge stressors in our lives.
  
  
• We can lobby to have eating disorders covered by insurance policies. Of all the issues Terri Schiavo brought up this week, The National Eating Disorders Association (NEDA), chose to focus on this one. When patients lack financial support (and the price tag can be as high as a year of college for a year of treatment) it is no surprise that the problem is underdiagnosed and inadequately addressed and treated.

So, in addition to alerting all Americans to the need for a “living will” or “advance directives,” Terri also reminds us that eating disorders are lethal diseases. Amid the sorrow and the irony of thinking that Terri got her way by finally starving to death, we can only hope she will rest in peace.

Dr. Engelland has a practice in Mamaroneck devoted to Adolescent Primary Care. She can be reached at 698-5544. Have a teen health question? Use the form below to send it to Dr. Engelland. Please note: Dr Engelland cannot respond privately to individual queries online. Comments are welcome and anonymous questions may be answered in future columns. Serious medical problems should be referred to your own physician.

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