Girls who make themselves throw up to control their weight are putting their health at risk, even if they do so only occasionally and even if their weight is in a healthy range, finds a study published in May's Journal of Adolescent Health. Analyzing data from nearly 2,800 high school girls in the National Eating Disorders Screening Program, researchers at Children's Hospital Boston found that girls who vomited to control their weight just one to three times per month were 1.6 times more likely to have irregular menstrual cycles than girls who didn't report such vomiting. Girls who vomited once per week or more were 3.2 times more likely to have irregular cycles.
"The reason we are so concerned about irregular menstrual cycles in teen girls is that they can be a warning sign of an underlying disturbance in hormonal balance," says S. Bryn Austin, ScD, a public health researcher in the Division of Adolescent and Young Adult Medicine at Children's. "Given that adolescence is the period of peak bone development and that normal hormonal functioning is essential for healthy bone growth, we are especially worried that these girls may be setting themselves up for a host of health problems, including low bone density, stress fractures, and osteoporosis later in life."
Overall, 12 percent of high school girls in the screening program reported self-induced vomiting at least once per month in the prior three months, yet only 16.5 percent of them had ever received treatment for an eating disorder.
Austin sees her findings as a wake-up call to clinicians, parents, school staff, and even friends of teen girls: If a girl's menstrual cycles are irregular, she may be using vomiting as a method of weight control and may be disrupting her hormonal balance in ways that could weaken her bones.
"A girl may keep her vomiting a secret from everyone, but she may talk about having irregular periods with her clinician, parents, or friends," says Austin. "If we can recognize warning signs like these, we can take this opportunity to help girls get the right kind of treatment they may need for symptoms of bulimia."
The screening program was carried out in high schools across the country in 2000 by the national nonprofit organization Screening for Mental Health, based in Wellesley, MA, and funded by the McKnight Foundation.
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