10 things every pediatrician should know about eating disorders

eating-disorders-what-pediatricians-need-to-know

If you feel unprepared to help a child or teen with an eating disorder, you’re not alone. A 2015 study of Family medicine, Internal medicine, Psychiatry (general,child, and adolescent) and Pediatrics residency programs revealed that less than 10% included specific training on eating disorders.

Too often, all eating disorders are lumped together as one disease with a simple prescription: eat more.

But there are lots of different types of eating disorders, as well as a whole spectrum of eating behaviors that are destructive but not clinically diagnosable.

“It’s not just ‘eat more’ or ‘eat better’. Eating disorders are about more than just food intake,” says Sara Forman, MD, director of the Boston Children’s Hospital Outpatient Eating Disorders Program. “Eating disorders are psychological illnesses with physical manifestations. You can’t just expect someone to change their behaviors without supportive medical and psychological care.”

As more research on the various forms and pathologies of eating disorders is documented, more effective treatments and support services are understood.

Before discussing this issue with your patients and their families, here are a few important things you should know.

10 little-known facts about eating disorders:

no1The most common eating disorder is binge eating disorder. It is more prevalent that anorexia and bulimia combined.

no2Many young people have disordered relationships with food that do not fall into the formal category of an eating disorder. These behaviors, such as obsessive calorie counting or excessively exercising after eating, also warrant attention because they can turn into destructive behaviors and impact mental health.

no3Eating disorders can and do affect everyone: boys, girls, rich kids, poor kids, kids who look too skinny and kids whose weight seems fine.“It’s important to remember that eating disorders affect persons from all racial/ethnic and socioeconomic groups and are very common in youth with overweight/obesity,” says Tracy Richmond, MD, director of the PREP weight management program in Adolescent Medicine.

no4There are a lot of medical problems associated with eating disorders besides malnutrition. For example, eating too little can lead to:

  • hypothermia
  • tooth decay
  • stress fractures

“It’s not just ‘eat more’ or ‘eat better’. Eating disorders are about more than just food intake.” – Sara Forman, MD

no5Eating disorders, like addictions, can take years to overcome and may not ever truly resolve. Often, they re-appear over time, but can be effectively managed with the appropriate self-awareness, therapy, and/or trained behavioral responses. Patience and understanding from providers and family members are very important.

no6The good news is: The majority of children and teens with an eating disorder recover in a timely manner provided they get professional help.

no7

 The co-existence of obesity and
eating disorders in children make effective
school-based “healthy weight” programs
become overly concerned about their
body mass index (BMI). Even programs that
and eating habits have been shown to induce
disordered behavior in  children.

Cognitive based therapy (CBT) and family-based therapy have both shown promising results.

  • CBT is a type of psychotherapy that is goal-oriented and focuses on changing the patterns of thinking and behaviors in patients.
  • Family-based therapy is a way of re-empowering the family to feed the child at home. All meals are supervised and prepared by the adult, and everything is done under the care of a therapist. Gradually, the child takes back the responsibility of feeding him/herself.

no8

 

 

 

In some cases, medications have proven helpful for certain eating disorders. “SSRIs (selective serotonin re-uptake inhibitors, commonly used as anti-depressants) like Fluoxetine have been proven helpful for some cases of bulimia,” says Forman, adding, “There’s still so much we’re learning.”

no9

 

 

 

Parents of children with eating disorders often need support, too. They may feel guilty for not noticing the problem sooner. “Eating disorders are often illnesses of denial and secrecy, and it is not uncommon for parents to have no knowledge of a problem,” says Richmond.

no10

 

 

 

There is evidence of a genetic component to eating disorders. Yet while genes can make someone more prone to an eating disorder, there is no direct correlation between a parent having an eating disorder and his/her child also developing one. More research on these genetic factors is needed.

 

Resources for parents, patients and families struggling with eating disorders:

Multi-service Eating Disorders Association (MEDA)

Academy for Eating Disorders

Center for Young Women’s Health

National Eating Disorders Association (NEDA)

 

Learn more about the Boston Children’s Outpatient Eating Disorders Program.