Eating Disorders

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85 Eating Disorders

Pediatricians are well positioned to screen their preadolescent and adolescent patients routinely for eating disorders. With increased awareness, pediatricians can often effectively decrease the progression of disordered eating and manage potentially harmful consequences of significant weight loss, including electrolyte abnormalities, risk of osteoporosis, and chronic patterns of disordered eating. During adolescence, many teens become self-conscious and report food restriction or increased exercising to achieve a thinner appearance. For most adolescents, these are short-term behavioral changes that do not negatively impact long-term health, but for adolescents at risk for an eating disorder, these common behaviors may result in significant long-term medical and emotional sequelae.

Etiology and Pathogenesis

In the United States, it is estimated that the lifetime prevalence of anorexia nervosa is 0.5% and 1% to 3% for bulimia nervosa. Ten percent of all eating disorder patients are males. The current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) outlines the criteria for the diagnosis of anorexia nervous and bulimia nervosa as summarized in Box 85-1. Although a main feature of the diagnosis of anorexia nervosa is a body weight that is below 85% of that expected for age and height, for younger patients, the diagnosis can be made without weight loss from previous visits if the patient fails to make the expected weight gains of normal growth. The DSM-IV criteria for bulimia nervosa require recurrent episodes of regular binge eating with inappropriate compensatory behaviors to avoid weight gain. Eating disorder not otherwise specified encompasses eating disorders that do not meet full DSM-IV criteria for either anorexia or bulimia nervosa. Some reports show that more than 50% of adolescents with eating disorders fall into this category; these patients still require appropriate treatment because they have the same underlying eating behaviors and can develop the same life-threatening complications.

Box 85-1

Overview of Anorexia Nervosa and Bulimia Nervosa Diagnostic Criteria

Anorexia Nervosa Diagnostic Criteria

A Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight <85% of that expected or failure to make expected weight gain during period of growth, leading to body weight <85% of that expected)

B Intense fear of gaining weight or becoming fat even though underweight

C Disturbance in body image, undue influence of weight or shape on self-evaluation, or denial of the seriousness of the current low body weight

D Amenorrhea or the absence of at least three consecutive menstrual cycles (A woman is considered amenorrheic if her periods occur only after estrogen administration.)

Based on American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4, text revision. Washington, DC: American Psychiatric Association, 2000.