Eating disorders (ED) are becoming more prevalent in younger children and adolescents, creating a significant need for primary care providers to facilitate early detection and treatment of these disorders. It is suggested that the most common eating disorder in children and adolescents may be Binge Eating Disorder (BED).
Early detection and treatment of eating disorders can minimize the long-term developmental damage that frequently results from malnutrition during an early life stage. Patients aged 19 years or younger at the time of ED detection are 4 times more likely to recover from AN and 8 times more likely to recover from BN.
It may be assumed that an ED is a disorder of white, affluent adolescent girls, but they are prevalent among all racial and ethnic groups, socioeconomic classes, age, gender, and body size. Increased rates of disordered eating behaviours have also been found in sexual minority youth. Transgender and gender diverse youth are at an increased risk due to gender- and race-based stereotypes acting as barriers to the diagnosis of ED symptoms.
As said by Janine Averbach, MSW, LCSW, a senior primary therapist at Princeton Center, “In treating transgender patients with eating disorders, we understand that gaining weight is especially difficult as their weight served a very real function for them. Specifically, transgender females often use symptoms such as restricting, purging, or exercising to achieve a more feminine appearance and transgender males often use the same symptoms to suppress secondary sexual characteristics and menstruation,”.
It has also been found that children living in low income households are more likely to participate in unhealthy weight control practices. The stress of having inconsistent access to food or experiencing food insecurity may result in using restriction of food or attempted weight loss as a coping mechanism.
Many individuals with eating disorders begin presenting problems in adolescence, typically between 12 and 25 years, with peaks at ages 14 and 18. Adolescents, in particular, are unlikely to acknowledge the presence of an eating disorder and for this reason, a simple denial by an adolescent does not exclude the possibility of an eating disorder. Any evidence of restrictive dieting, excessive preoccupation with weight loss, a weight loss pattern or failure to achieve appropriate increases in weight and height for age warrants attention. It is also important to keep in mind that more than half of children and adolescents who are treated for EDs do not meet all of the diagnostic criteria for AN or BN, so the use for clinical diagnoses may need to be more lenient for use with children and adolescents.
When assessing a child or adolescent, weight loss is often not a suitable marker for malnutrition in children; instead growth failure is more appropriate. Oftentimes, adolescents will not come to an assessment willingly and instead parents identify the problem and make the referral. Patients who are under 13 years of age often do not participate in more “typical” ED behaviours but instead parents’ concerns often involve:
- Closeted eating
- Hiding food
- Changes in eating patterns (cutting food into very small pieces, moving food around plate)
- Skipping meals
- Strict patterns or rituals surrounding food
- Avoiding particular food groups
- Continual denial of hunger
- Frequent trips to the bathroom
- Evidence of vomiting
- Mood fluctuations
- Changes in sleep patterns and activity levels
Eating Disorder Screening Tools
Primary care providers identified several barriers to providing ED care including insufficient time to identify youth with eating disorders, no simple process for identification, and/or lack of sufficient knowledge to recognize eating disorders. In order to overcome these barriers, we recommend utilizing a brief screening tool such as:
- the Sick, Control, One Stone, Fat, Food (SCOFF) questionnaire
- the Disordered Eating Screen for Athletes (DESA-6)
- the Ottawa Disordered Eating Screen for Youth (ODES-Y)
If an eating disorder is suspected after screening, next steps include establishing the diagnosis (if applicable), evaluating medical and nutritional status, determining severity of the disorder, and performing an initial psychosocial evaluation. Primary care providers are encouraged to perform the aforementioned next steps if they feel competent and comfortable to do so, otherwise, the child should be referred to appropriate medical care and mental health personnel. After screening, the parents’ reaction to the disorder should also be assessed. The presence of parental indifference, denial, or inconsistent views about treatment could negatively affect the course of the disorder and recovery process.
Are You Interested in Learning More?
At Change Creates Change Eating Disorder Care, we strive to educate other healthcare professionals about eating disorders. If you are interested in learning more, check out our Eating Disorders in Youth – A Field Guide for Primary Care Providers.
