Crohn's Disease and Excessive Weight Loss
Eating disorders affect thousands of teenage girls across the United States. In response, parents and health care providers have become increasingly sensitive to weight loss in that age group. So much so, that an eating disorder is often suspected after extreme weight loss, even when the cause may be medical in nature.
Jessica Leach of Pleasant Prairie, Wis., was 12 years old when she first started having weight loss issues. Her doctor first suspected an eating disorder. "When the problems started, I was too embarrassed to tell my mom or anyone," she says. "No one wants to talk to anyone about stomach aches and diarrhea. I lost a lot of weight very quickly, dropping me down to about 100 pounds. The doctor started off by asking me if I was anorexic or bulimic. I was so frustrated with her because she did not seem to believe me."
After being referred to a gastroenterologist, Leach was diagnosed with Crohn's disease. They started her on prednisone, and then Remicade, which was administered as an infusion every eight weeks. That put her into remission for three years. About two and a half years ago, she had another flair up and developed a severe reaction to the Remicade. Another medication, Humira, put her into remission again, but Leach will never forget her frustration at having people assume she had an eating disorder when she actually had a serious disease.
Eating Disorder or Something Else?
Dr. Sonia Ramamoorthy, an assistant professor of Surgery, Colon and Rectal Surgery at the University of California, San Diego Medical Center, says that misdiagnosis in favor of eating disorders is becoming more and more common. "In recent years, there has been heightened awareness about recognizing eating disorders as many of the early cases went undiagnosed for some time," she says. "Perhaps the pendulum has swung too far to the other side whereby other important digestive disorders are being overlooked."
One of the common medical problems thought to be an eating disorder is Crohn's Disease. The symptoms of Crohn's include severe diarrhea, which can lead to weight loss. If a teen is not comfortable talking about diarrhea, parents and physicians may only see the weight loss and make assumptions.
Dr. Jeffery Hyams, head of Digestive Diseases, Hepatology and Nutrition for the Connecticut Children's Medical Center in Hartford, Conn., says that misdiagnosis of eating disorders can be avoided through careful evaluations. "Weight loss can be a sign of an eating disorder, but one needs to evaluate the clinical context," he says. "Is there also abdominal pain, vomiting, fever, diarrhea, rectal bleeding, fatigue, arthritis, rash? Is there a family history of gastrointestinal disease? Are there factors that may be causing psychological distress? Are there factors that suggest an adolescent may have a disturbed body image? In summary, weight loss needs to be evaluated in the context of a careful complete history, physical examination, and if necessary, laboratory studies."
According to Dr. Hyams, when a teen presents with abdominal pain as the only initial manifestation, the diagnosis of Crohn's disease may be delayed as it is often thought no serious disease is present and that stress may be causing the problem. When diarrhea begins, and particularly if there is blood in the stool, more prompt medical attention is often sought. "However, teenagers are notorious for not telling their parents about stool characteristics, so parents may not know about this more serious development," he says. "Poor appetite is common in children with Crohn's disease, and weight loss ensues. Some children with Crohn's disease have minimal gastrointestinal symptoms and present primarily with poor weight gain and slow growth. It is not uncommon for symptoms to be present for months to years before a diagnosis is made."
Talking to Your Teen
Because of the prevalence of eating disorders in teens, it is crucial that you pay attention to your child's eating habits and weight. However, it is also important that you refrain from making assumptions that your teen has an eating disorder. Talk to your teen. Ask if they have been dieting or trying to get fit. It might be as simple as your teen trying to lose a few pounds for the homecoming dance or an increase in physical activity. These do not necessarily translate into an eating disorder or Crohn's disease. If the weight loss continues, then it's time to get serious. Be straightforward in your questions. What is she eating? Is she having bouts of diarrhea? Is she experiencing abdominal pain? Then visit the doctor together.
A good health care provider will not only take a complete history, but also do labs before making a diagnosis. Encourage your teen to be direct with her answers, as that will assist the doctor in making an accurate diagnosis. Whether your teen has Crohn's disease or an eating disorder, it is important that any extreme weight loss be addressed immediately. The quicker the diagnosis the sooner you can get your child the help she needs.
Common Symptoms of Crohn's Disease
According to Dr. Ramamoothy common symptoms of Crohn's disease include these:
- Abdominal pain or cramping
- Nausea, loose stool or diarrhea with or without blood
- Weight loss
- Growth retardation
- Low energy levels
- Poor appetite
"Symptoms can often be vague and intermittent," says Dr. Ramamoothy. "Kids may not complain right away and many of their symptoms are written off as due to other causes. It becomes important for parents and caregivers to observe children, their weight, energy levels, eating habits and moods to get a sense of whether this is a chronic problem or the flu that will pass in a couple weeks."