Eating disorders are often under diagnosed in children

I recently saw a patient in my adolescent medicine clinic about a possible eating disorder. The patient felt overweight because a family member called her fat, even though she had a normal weight and body mass index (BMI) for her height. She spiraled out of control with a restrictive pattern of eating and excessive exercising to lose weight, which led to significant mental health concerns. This patient said her pediatrician said she should not gain weight because her BMI was exactly where it needed to be, and additional weight would categorize her as “overweight”. Unfortunately, this is not an uncommon story.

Eating disorders are under diagnosed. Higher rates are now seen in younger children, boys and minority groups, and it is increasingly being recognized in patients with a history of obesity. Overweight and obese children are at risk for delayed diagnoses and complications. Medical complications are common and affect every organ system. Early intervention can affect prognosis.

The average American woman is 5 foot 4 inches tall and weighs 140 pounds. However, the average American model is 5 foot 11 inches and weighs 117 pounds. Most models are thinner than 98 percent of American women, so there is an obvious difference between reality and what is portrayed in the media. On average, 25 percent of American men and 45 percent of American women are dieting. Forty-nine percent of teenagers worldwide have access to the internet and there are websites that promote eating disorders as a lifestyle choice, not as a disease. These include pro-anorexia (“pro-ano”) and pro-bulimia (“pro-mia”) websites committed to maintaining, promoting and supporting eating disorders by teaching young people the best way to starve themselves, purge and avoid detection.

These signs may help identify a child with an eating disorder: food rituals, refusal to eat foods they once enjoyed, avoiding meals with family and friends, exercising excessively, eating secretly, a preoccupation with food, calorie counting, fear of becoming fat, binge eating, purging and food phobias or avoidance. If a child or adolescent is demonstrating eating behaviors such as anxiety around food and eating, depression, irritability and sudden mood changes, they should be evaluated. Other signs include obsessing about calories, cutting out groups of food, rapidly dropping weight or failing to meet weight gain requirements for developmental stages.

Eating disorders are real. Parents must be mindful of how to discuss healthy eating and exercise to avoid disordered eating behavior. Reinforcing healthy behavior is the key to long-lasting weight management and preventing stigmatizing children and adolescents for their weight.

The goal should be to talk less about weight and do more to help children and teens achieve a healthy lifestyle.

Dr. Rachel Dawson is an adolescent medicine physician at Baylor Scott & White McLane Children’s Medical Center.  -tdtNews