Helping families to reduce stigma around weight through supportive language and linking them with appropriate services are among the recommendations
Eating disorders can be complex and hard to identify and treat in children and teens, but the earlier an eating disorder is detected, the better chance at a healthy outcome for a young patient.
The American Academy of Pediatrics in a new clinical report, “Identification and Management of Eating Disorders in Children and Adolescents," describes common eating disorders, their physical manifestations, and the pediatrician's role in the assessment and management of them.
The report is published in the January 2021
Pediatrics, offering recommendations for pediatricians on disorders that research indicates may be underdiagnosed and undertreated.
Who is affected by eating disorders?
“For too long, eating disorders were considered a disease that afflicted mostly affluent white teenage girls," said Laurie L. Hornberger, MD, MPH, FAAP, lead author of the report, written by the AAP Committee on Adolescence. “We know today that girls and boys of all ages, income levels and racial and ethnic groups may be struggling with eating disorders. Our hope is to help counter the stigma they may experience and provide an environment for open nonjudgmental conversations."
The clinical report contains the most recent definitions of eating disorders as described in the “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition" (DSM-5.) The report also details the estimated prevalence of various eating disorders, which vary widely according to population and criteria used to define an eating disorder. Many fall under the categories of anorexia nervosa; avoidant/restrictive food intake disorder (ARFID); binge eating disorder (BED): and bulimia nervosa.
Studies have shown a delay in identifying boys and young men with eating disorders because of misperceptions that these are female disorders. Boys and young men may be focused on leanness, weight control, and muscularity, and signs that indicate a possible eating disorder may include purging, use of muscle-building supplements, substance abuse, and depression.
The mean age of a child with an eating disorder is 12.5 years old, according to the report.
Eating disorders in disguise?
“Some adolescents may have dietary habits that disguise eating disorders, such as those who become increasingly restrictive about the quality—as opposed to the quantity—of their food consumption," said Elizabeth Alderman, MD, FSAHM, FAAP, chair of the AAP Committee on Adolescence.
“Teens may spend excessive amounts of time in meal planning and experience extreme guilt or frustration when their food-related practices are interrupted."
After diagnosing an eating disorder, a pediatrician arranges appropriate care, whether it is an urgent referral to a hospital for a patient who is medically unstable or a referral for those with less severe symptoms to outpatient nutrition and mental health professionals. Because early response to treatment may be associated with better outcomes, the preference is to involve a specialized multidisciplinary team, when available. If resources do not exist locally, pediatricians may need to partner with health experts who are farther away for care.
Establishing healthy habits
The AAP offers additional information in an existing clinical report, “Preventing Obesity and Eating Disorders in Adolescents," that focuses on establishing healthy habits with patients and families rather focusing on than weight and dieting. Recommendations include more frequent family meals, discouraging “weight talk" and “weight teasing" in the home, closely monitoring weight loss in patients advised to lose weight, and promoting a healthy body image.
“As pediatricians, there is much we can also do outside the clinic to advocate for our patients, through legislation and policy that support services, including medical care, nutritional intervention, mental health treatment, and care coordination," said Margo Lane, MD, FRCPC, co-author of the report.
“Mostly, we can begin by using sensitive language and demonstrating supportive attitudes toward kids of all shapes and sizes."