Anorexia is a serious psychiatric disease that can be life-threatening. Photo shutterstock.com

Dr Mattias Larsson*

Hà is a 14-year-old academically motivated girl; she has good grades and is also interested in physical activity and nutrition. Some months ago, she decided that she wanted to be vegan. Her parents who had a diverse diet first had some objections, especially their cooking would be more challenging. But Hà remained firm in her passion for animal rights, and the severe environmental impact of meat production. In fact, also the parents started to enjoy vegan food more as they prepared it for each common meal.

However, they also noticed that Hà ate less and less and that she spent a lot of time exercising. In the beginning, they were not that worried as she seemed to do well, her grades at school were still excellent. One day the mother Nhung received a call from the school nurse. Hà had fainted in school. One of Hà 's friends told the nurse and Nhung that in the afternoon Hà had been very tired, then suddenly fainted during class. She also mentioned that Hà hardly ate lunch, just took a little, and sipped on some water. This had been ongoing for several months. The school nurse gave Hà some rehydration solution, so she could recover and go home.

Nhung took her daughter to the local doctor who did an examination but did not find any specific disease. He prescribed some antibiotics in case it was an infection. Once back home Hà explained that she ate only a little to not become fat, which was her biggest fear. It seemed to be a common topic amongst her friends too. They compared their bodies, and weight and shared tips they got from influencers on social media. Hà promised to take care of herself and see to it that she ate enough.

Nhung however, kept a close eye on her daughter and found she had thrown away food in her room. Nhung also detected that Hà had not used the sanitary napkin for menstruation in months. Ha looked increasingly skinny but hid it under large clothes. On the scale, Nhung noticed her daughter had lost about 10kg in a few months, almost 20 per cent of her body mass. When confronted Hà became agitated, she said it was not her mother’s business.

Nhung was worried. She heard Family Medical Practice (FMP) had good services for youth. The pediatrician first discovered Hà's BMI was only 13.5, way too low for age.  She also had a low heart rate.

In the discussion with the doctor, Hà mentioned that she felt obese and was repelled when she looked at herself in the mirror. She had an intense fear of gaining weight, and she tried to do anything to lose it.  She also felt sad and depressed, as she thought she did not fit in. 

After the paediatrician, Hà met a psychologist who discussed her feelings about herself and her altered perception of body weight or shape. Then a dietician explained how much energy the body needs to sustain the body functions, repair organs and grow.

The three healthcare professionals concluded that Hà met the diagnostic criteria for anorexia including

1. Restricted caloric intake relative to energy requirements and slow body weight.

2.Intense fear of gaining weight and behaviours consistently interfere with weight gain

3. Altered perception of one’s body weight and shape and lack of acknowledging the seriousness of her condition.

Anorexia is a serious psychiatric disease that can be life-threatening.  Support at home is needed to ensure food intake. Access to scales and mirrors should be restricted for a while. Hà also had weekly follow ups at FMP with the team of apediatricians, psychologists, and dieticians.

After a difficult period for Hà and her family, at 18 she had gained weight and had an almost normal BMI of 19 and normal periods. She was still afraid of being obese but had learned strategies to handle that. Family Medical Practice 

Dr Mattias Larsson. Photo courtesy of Family Medical Practic

*Dr Mattias Larsson is a paediatric doctor at Family Medical Practice and associate professor at Karolinska Institutet and has a long experience in research on infectious diseases. He has worked with the Oxford University Clinical Research Unit and the Ministry of Health of Vietnam. He is fluent in English, Swedish, Vietnamese, German and some Spanish.

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