When a teenager develops an eating disorder, refuses to eat and begins to waste away, a parent is sure to agonize. The pain can be compounded when parents decide it's their fault somehow--and are treated like guilty parties who should stay out of the way when they seek help.

Daniel le Grange, director of the Eating Disorders Program at the University of Chicago Hospitals, uses the opposite approach. He encourages parents to lead the charge in helping their teens battle the disease. He has documented his technique in a new book, "Help Your Teenager Beat an Eating Disorder" (The Guilford Press, $16.95), which he co-wrote with Dr. James Lock of Stanford University.

"We have had parents who have come in and will be frank and say, `Someone previously told us it's our fault.' They have taken on that guilt themselves," he said.

No evidence shows parents are responsible for an eating disorder; causes remain unknown, le Grange writes in his book. Besides, time spent trying to figure out causes is time better spent seeking help. And the book continually emphasizes the need to act fast.

"I can't stress that enough," le Grange said. "I always use the analogy of cancer when I meet with parents of kids with eating disorders. With an eating disorder, there's a sense of, maybe I should take a step back and it will take care of itself. You would never do that with cancer. And with eating disorders, the shorter the duration of the problem, the better the outcome. If you leave it, it doesn't go away, it gets worse."

The book gives several symptoms to be on the lookout for. They are:

- Fasting and skipping meals regularly.

- Refusing to eat with the family.

- Two skipped periods (in girls) in conjunction with weight loss.

- Any binge-eating episodes.

- Any purging episodes.

- Discovery of diet pills or laxatives.

- Excessive exercise (more than an hour a day) and weight loss.

- Persistent and unremitting refusal to eat non-diet foods.

- Refusing to allow others to prepare foods.

- Extreme calorie counting or portion control (weighing and measuring food amounts).

- Refusing to eat with friends.

If you notice such symptoms, get your teen to his or her pediatrician. The doctor can determine or rule out other causes for the problem. However, often pediatricians are untrained in eating disorders, so trust your gut, and if you don't believe what you hear, seek a second opinion. Then it's time to find a specialist.

Le Grange's center, for example, uses a team to treat patients, which includes a child psychologist and an adolescent-medicine physician. The team works with the parents so the parents know what to do with the teen at home.

One thing for parents to keep in mind, le Grange stressed, is that they are battling a disease, not a stubborn child.

"Your child doesn't hide food because she's devious, or give it to the dog to be willful and spiteful. She does it because she's frightened of the impact it will have on her," he said. "Some parents get this separation from adolescent behavior very quickly, and others don't.

"Again, I use the cancer analogy. If the tumor grows, the adolescent didn't have control over that. If someone is schizophrenic and hears voices, do you blame them? If they're depressed, do you blame them?"

What might be most crucial at home is that parents present a united front in getting their child to eat.

"Parents have to be on the same page every minute," le Grange said. "They have to be in total agreement concerning what they expect of their child. And they have to do it over and over again. This illness has tremendous stamina."

A 16-year-old from a Chicago suburb whom le Grange successfully treated said her parents showed such unified persistence.

"They would both say, `You have to eat, you have no choice.' If I would fight for hours, it wouldn't matter. Finally, I ate."

The teen had dropped to 80 pounds and "was freaked out. I knew I had to eat, but it's easier to say than to do." She is now up to 120 pounds and eating well on her own--and her mother is grateful.

"Dr. le Grange's program was very empowering. We were given the tools for what to do once we got home," the mother said. "It wasn't at all about why this happened or who did what. I was feeling hopeless, and he gave us hope. I was afraid it was going to be a lifetime disease."

Le Grange's ultimate message is one of optimism and faith in parents.

"Parents are usually very good at what they're doing," he said. "I encourage them to remain actively involved and seek treatment where they can be participants. Illness might come and trip them up, but once they find their footing, they do know what they're doing."

----------

To reach the Eating Disorders Program at the University of Chicago Hospitals, call 773-702-0789.

drose@tribune.com