Identifying eating disorders
2/27/2023 by Jocelyn Lebow, Ph.D., Marcie Billings, M.D., Paige Partain, M.D., Angela Mattke, M.D.
As many as 3%–13% of children or adolescents will have an eating disorder by the time they reach adulthood. Further, 30% of boys and 55% of girls report at least one risky eating behavior, such as fasting, significantly restricting their diet or smoking for weight control, during adolescence.
Eating disorders are dangerous psychological disorders, and they are associated with one of the highest rates of death. Therefore, it is important for caregivers to be aware of eating issues in children and be prepared to intervene quickly. This is frequently difficult, as eating disorders often are characterized by secrecy, shame and denial of the illness's severity.
So what's a caregiver to do?
Here are some red flags that should prompt concern:
- Physical changes
Physical changes associated with an eating disorder are often hard to spot in a growing child. By the time changes in weight or other physical signs become obvious, the eating disorder is often already extremely serious. Weight loss, and irregular or missed menstrual cycles, are cause for concern, as is failure to achieve expected height and weight milestones. Contrary to widespread belief, however, eating disorders are not always characterized by overall weight loss. Despite common misperceptions, those with eating disorders, including anorexia, do not always appear emaciated and cannot usually be identified by eyeballing their shape or weight. Often these children present at an average — or even higher — weight, but they still meet criteria for a deadly eating disorder. For these children, the effects of an eating disorder will only be seen in changes to developmental trends and evident through their personal growth chart, like the type your health care team keeps. - Dieting
Studies have found that teenagers who are considered serious dieters have a 1 in 5 chance of developing an eating disorder, compared to the 1 in 500 chance for those who do not diet. Even exposure to caregivers' attempts to diet can increase a child's risk of an eating disorder, so work to eliminate dieting from your home and be alert for any dieting behaviors in your child. - Social withdrawal
Eating disorders are unusual in that sick children are often able to maintain high levels of achievement in school and activities. At the same time, however, children and adolescents with eating disorders often become isolated from friends and family. If your child seems more withdrawn, more reluctant or worried about socializing, or if he or she appears depressed or anxious — and this is a departure from normal — intervention is likely needed.
If you suspect that your child might be developing an eating disorder, the best thing to do is act. Early intervention is associated with the best outcome, so it is better to overreact if you notice any red flags. Treat an eating disorder like you would any other life-threatening illness and seek an evaluation immediately. You also should be prepared to play a role in treatment. Family involvement is often a crucial component of successful child or adolescent eating disorder treatment.
If you have concerns, you're encouraged to schedule an appointment with your primary care clinician and discuss what you are seeing in your child. Integrated Behavioral Health also can be a helpful resource to assess for the presence of an eating disorder and make a referral to the correct type of care.
Other resources for caregivers include the National Eating Disorders Association website, Families Empowered and Supporting Treatment for Eating Disorders parent group, as well as these parent manuals:
- "Help Your Teenager Beat an Eating Disorder" by James Lock and Daniel Le Grange
- "I'm, Like, So Fat" by Dianne Neumark-Sztainer
Primary Care in Rochester and Kasson's Integrated Community Specialties Eating Disorders program specializes in identifying and treating child and adolescent eating disorders in primary care patients. This program is staffed by health care professionals from the Department of Psychology and the Division of Community Pediatric and Adolescent Medicine at Mayo Clinic, including:
- Jocelyn Lebow, Ph.D., a child and adolescent psychologist in the Division of Integrated Behavioral Health, which is part of Primary Care in Rochester and Kasson.
- Marcie Billings, M.D., chair of the Division of Community Pediatric and Adolescent Medicine, which is part of Primary Care in Rochester and Kasson. Her primary area of practice is adolescent medicine.
- Paige Partain, M.D., a pediatrician in the Division of Community Pediatric and Adolescent Medicine, which is part of Primary Care in Rochester and Kasson, at Mayo Family Clinic Northeast in Rochester. Her areas of interest include preventive medicine and pediatric behavioral health, particularly attention-deficit/hyperactivity disorder, depression, anxiety and eating disorders.
- Angela Mattke, M.D., a pediatrician in the Division of Community Pediatric and Adolescent Medicine, which is part of Primary Care in Rochester and Kasson. She also hosts Mayo Clinic's "#AskTheMayoMom" interactive Facebook Live show, where she discusses and answers audience questions about common pediatric health topics. You can follow her on Twitter at @DrAngelaMattke. For more information about pediatric health topics, follow @mayoclinickids on Twitter.