Eating Disorders in Kids: An Update

Kenisha Campbell, MD, MPH


October 27, 2014

Editorial Collaboration

Medscape &

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Hello. My name is Kenisha Campbell. I am an adolescent specialist at The Children's Hospital of Philadelphia. I'll be talking to you today about eating disorders in children and adolescents. Eating disorders are extremely common illnesses. In pediatric patients, they're actually more common than type 2 diabetes. The epidemiology of eating disorders is changing; they're presenting more in younger age groups and in males, with up to 25% of cases occurring in males and in overweight and obese adolescents.

The etiology of eating disorders is multifactorial. They're highly inheritable. If you have a relative with an eating disorder, you have 7 to 12 times the risk of developing one yourself. There is a complex interplay between genes, environment, and also neurobiological factors, which is currently being studied.

Eating disorders are extremely serious illnesses. They have very high morbidity and mortality. They are accompanied by a high rate of psychiatric comorbidities. Medical complications can occur in every organ system and they can occur at any weight; it just depends on the overall percentage of weight loss. It's important to understand that all patients who present to you with weight loss, disordered eating behaviors, any body image concerns—especially in younger patients—failure to make expected gains in weight or height, or pubertal delays should be evaluated for the possibility of an eating disorder. In pediatric patients, there is also a potential for serious complications because of their young age.

Early diagnosis for eating disorders is extremely critical. When eating disorders are diagnosed and treated early, you avoid complications, reduce the risk for relapse, improve overall recovery rates, and, most important, decrease the likelihood that the eating disorder will become a chronic illness. In 2013, the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders was released and the eating disorder category was revised. This was done in order to improve the precision and accuracy of diagnosis of eating disorders, which would then improve targeting and effectiveness of specific treatment methodologies.

There has been a major paradigm shift in eating disorders. The old paradigm really focused more on an over-controlling parent, leading to a child who then developed maladaptive eating behaviors. The newer paradigms take into account the very complex and multifactorial nature of eating disorders. This lends to family-based treatment, the most evidence-based treatment for treating anorexia nervosa specifically in adolescents. There's also increasing evidence for its use in bulimia nervosa and in younger patients with other restrictive eating disorders. Family-based treatment takes an agnostic view and no one is blamed for causing the disorder. The disorders actually externalize from the child, and the caregivers are seen as critical allies to treatment. Nutritional rehabilitation is the focus of treatment, and only after that is accomplished do we see improvements in cognition and development of possible insight into the illness.

There have been many studies about the use of medications in eating disorders. In anorexia specifically, medication use is not evidence-based. However, medications are definitely used in patients who are resistant to treatment or in those with premorbid psychiatric illnesses.

In bulimia nervosa, there is great evidence for the use of selective serotonin reuptake inhibitors, specifically fluoxetine, in decreasing the frequency of binge-purge episodes.

Primary care providers are critical in the success of eating disorder treatment, especially family-based treatment. They serve as consultants to both the caregivers and the family-based treatment providers. They also are trusted by the family and can help the family understand how serious these illnesses are, and how important it is to treat early and aggressively in order to avoid complications and chronicity of illness. They also can serve as continued medical follow-up to make sure that a patient reaches full recovery and weight restoration.

Finally, prevention is key. It is important for us as healthcare providers to focus on the development of healthy lifestyle habits with our patients and their families. The focus should not be on a patient's weight, body size, or shape solely as an indicator of health. We really want to promote a positive body image, and this is the way that we can do it.

Thank you.