This DataBank indicator is no longer being updated
In 2013, female high school students were three times more likely than males to report they vomited or took laxatives in order to lose weight or keep from gaining weight.
Taking laxatives and vomiting to lose weight are both symptoms of bulimia, an eating disorder. Bulimia is characterized by a cycle of excessive eating (binging) followed by vomiting (purging), the use of laxatives, or other means of weight control. Bulimia, like anorexia, is a psychological disorder, which often begins with dissatisfaction with one’s body,
but which also has a substantial genetic component. 
The practices of vomiting and using laxatives can lead to serious medical problems. Self-induced vomiting, which exposes the mouth, esophagus, and colon to acidic gastric contents, can lead to oral complications (such as erosion of tooth enamel and swelling and soreness of salivary glands), ulcers, ruptures of the esophagus, and other health problems.  The overuse of laxatives can cause intestinal and systemic complications, such as a dependency on laxatives or the loss of colonic function. An increased risk of suicide attempts is also associated with bulimia. 
Related eating disorders, such as binge eating, and purging, are also associated with adverse health outcomes. According to one recent study, female adolescents with binge eating disorder were more likely to become overweight or obese, or develop symptoms of depression; females with purging disorders were more likely to start using drugs and engage in binge drinking. 
From 2003 to 2009, the proportion of all youth in grades 9 through 12 who reported vomiting or taking laxatives to control their weight decreased from six percent to four percent. The rate has remained at four percent since then. (Appendix 1)
Differences by Gender
Females are more likely than males to engage in disordered eating, with seven percent of females reporting vomiting or using laxatives to control weight in 2013, compared with 2.2 percent of males. However, the gap has been shrinking since 2003: while the rate for girls has declined between 2003 and 2009, the rate for boys has remained the same. (Figure 1)
Differences by Race and Hispanic Origin
In 2013, Hispanic female students were more likely than black females or white females to report disordered eating (seven versus four percent, each). Black and Hispanic males were more likely than white male students to report engaging in disordered eating (three versus 1.3 percent). (Figure 2)
Differences by Grade
In 2013 there were no significant differences by grade level in the proportion of students who reported disordered eating. (Appendix 1)
State and Local Entities
2013 estimates for selected states and cities are available from the Youth Risk Behavior Survey (YRBS): see Table 112.
Included in the U.S. Healthy People 2020 initiative is a goal to reduce the proportion of adolescents who engage in any disordered eating behaviors in an attempt to control their weight, from 14.3 percent in 2009 to 12.9 percent in 2020.
More information is available here. (Goal MHMD‐3)
What Works to Make Progress on This Indicator
The American Academy of Pediatrics recommends that providers of primary care for adolescents screen for eating disorders as part of an annual health visit or during examinations prior to sports participation. Evidence for effective treatment of bulimia is sparse, but most adolescents with eating disorders fully recover. 
Also, see Child Trends’ LINKS database (“Lifecourse Interventions to Nurture Kids Successfully”), for reviews of many rigorously evaluated programs, including the following which have been shown to be effective:
The data presented in this indicator are based on the percentage who report vomiting or taking laxatives to lose weight or to keep from gaining weight in the past 30 days. Both vomiting and taking laxatives to lose or control weight are unhealthy dietary behaviors and are symptoms of bulimia. However, students who have engaged in these behaviors are not necessarily bulimic. More information, such as the length and frequency of these behaviors, is needed for diagnosis.
Students from California, Oregon, Washington, and Minnesota were not included in the survey in any year. Additionally, students from Colorado, Iowa, Indiana, and Pennsylvania were not included in the 2013 survey.
Centers for Disease Control and Prevention (CDC). (2014). 1991-2013 High School Youth Risk Behavior Survey Data. Accessed on 8/4/2014. Available at http://nccd.cdc.gov/youthonline/.
Raw Data Source
Appendix 1 – Percentage of Students in Grades 9 through 121 Who Report They Took Laxatives or Vomited to Lose Weight or to Avoid Gaining Weight2: Selected Years, 1995-2013
|1 Estimates do not include youth who dropped out of school and therefore may not reflect total national values. Students from California, Oregon, Washington, and Minnesota were not included in the survey in any year. Additionally, students from Colorado, Iowa, Indiana, and Pennsylvania were not included in the 2013 survey.2 During the 30 days preceding the survey.
3Race/ethnicity estimates from 1999 and later are not directly comparable to earlier years due to federal changes in race definitions. In surveys conducted in 1999 and later, respondents were allowed to select more than one race when selecting their racial category. Estimates presented only include respondents who selected one category when choosing their race.
Source: Centers for Disease Control and Prevention (CDC). (2014). 1991-2013 High School Youth Risk Behavior Survey Data. Accessed on 8/4/2014. Available at http://nccd.cdc.gov/youthonline
 National Institute of Mental Health. (2011). Eating disorders: Facts about eating disorders and the search for solutions. NIH Publication (No. 01‐4901). Available at: http://www.nimh.nih.gov/health/publications/eating-disorders/index.shtml
 Rosen, D. S., and The Committee on Adolescence, American Academy of Pediatrics (2010). Clinical report, identification, and management of eating disorders in children and adolescents. Pediatrics, 126(6), 1241‐1253.
 American Psychiatric Association. Disease definition, epidemiology, and natural history. Table 6: Physical Complications of Bulimia Nervosa. APA Practice Guidelines: Treatment of Patients with Eating Disorders, Third Edition Available at: http://psycho.silverchair.com/content.aspx?aID=139788
 Rosen, et al. (2010) Op. cit.
 Field, A. E. , Sonneville, K. R., Micali, N., Crosby, R. D., Swanson, S. A., Laird, N. M., Treasure, J., Solmi, F., & Horton, N. J. (2012). Pediatrics, 130(2), e289 ‐e295.
 Hispanics may be any race. Totals for whites and blacks in this report do not include Hispanics.
 Rosen, et al. (2010) Op. cit.
Last updated: August 2014