The Pennsylvania Department of Health mandates height and weight screenings annually in all schools, to assess BMI (Body Mass Index) of students and determine who may be at risk for being over- or under-weight. The World Health Organization (WHO) uses words such as “stunted” and “wasting” to describe children at an unhealthy low weight. The CDC defines “underweight” as a BMI below the 5th percentile for age and sex. Students who maintain a BMI below the 5th percentile, or who have a sudden drop in weight, are a concern for health care providers. The cause can be due to many reasons, such as any one of a number of health concerns, obsessive exercising, anorexia or bulimia.



    Eating disorders used to be limited to adolescent females. But more recently, eating disorders are found across the board, most prevalently in younger girls as well as adolescents, athletes of both sexes (such as dancers, skaters, gymnasts, long distance runners, and wrestlers) who desire a sleeker body size. The prevalence in school-age children may be as high as 14%.

    Anorexia Nervosa is the failure to maintain a healthy body weight, accompanied by an intense fear of gaining weight, body image distortions, denial of the seriousness of the low BMI, and loss of menses for girls. Usually, there are two types of Anorexia Nervosa:  restricting intake (not eating), or binge eating/purging (eating small amounts and privately vomiting). Signs include:

    • Restrictive eating (severely limited food intake)
    • Excessive exercise
    • Extreme thinness
    • Relentless pursuit of thinness and unwillingness to maintain healthy weight
    • Extreme use of laxatives, diuretics, enemas, diet pills, and/or self-induced vomiting to promote purging (after a binging episode)
    • Symptoms after a prolonged time include
    • Anemia
    • Osteoporosis or osteopenia
    • Muscle weakness and wasting, lethargy
    • Dry skin that has a yellow appearance
    • Brittle Nails and Hair
    • Constipation
    • Cardiac problems
    • Multi-organ failure leading to death

    Bulimia is characterized by frequent recurrent binge eating episodes (defined as eating more than most people would in a 2-hour period) and then vomiting what was eaten to avoid weight gain. Persons with Bulimia often fall within the normal limits for ideal body weight and have less distorted views of body image than the anorexic does. Signs include:

    • Calloused knuckles (from self-induced vomiting)
    • Eating large amounts, followed by a period of vomiting
    • Chronic sore throat
    • Swollen glands in neck and jaw
    • Dental issues such as tooth decay and loss of enamel, due to repeated vomiting
    • Gastrointestinal issues such as acid reflux
    • Dehydration, electrolyte imbalance, which lead to cardiac issues


    If you have concerns that your child may be underweight, or experiencing anorexia or bulimia, please contact your school nurse and your child’s primary care physician.

     CDC Healthy Weight website https://www.cdc.gov/healthyweight/index.html


    April 27, 2020