Disordered eating describes a spectrum of abnormal eating behaviors with negative health impact. These behaviors often begin as a misguided attempt to control weight. In studies of school-based populations, about one-third of normal weight and three-quarters of overweight girls say that they are trying to lose weight. While they report attempting to make the positive lifestyle changes that we suggest in clinic, such as decreasing soda and exercising more, the majority are also engaging in disordered eating practices such as skipping meals and fasting. Of note, 10% of these normal weight girls and 18% of the overweight girls reported extreme behaviors including vomiting and laxative use. These disordered eating behaviors covary with other health damaging behaviors such as alcohol and tobacco use, negatively impact nutritional intake, predict significant weight gain over time, and increase the risk for development of an eating disorder.
Eating disorders represent the far end of the disordered eating spectrum in terms of severity and frequency of abnormal eating behaviors. Formerly considered relatively rare diagnoses, recent studies show that up to 8% of adolescents meet criteria for the range of eating disorders described in Tables 76-1, 76-2, 76-3, 76-4, 76-5, which will be the focus of this chapter. Such patients often present to clinic with acute medical consequences requiring hospitalization and/or intensive outpatient care. Thus, a large proportion of patients in any pediatric clinic will present with a range of disordered eating and associated health outcomes, which clinicians must be equipped to identify and address. Pica and rumination disorder are eating disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5); however, they will not be discussed here, nor will feeding disorders.
TABLE 76-1Summarized DSM-5 Criteria for Anorexia Nervosa (AN) |Favorite Table|Download (.pdf) TABLE 76-1 Summarized DSM-5 Criteria for Anorexia Nervosa (AN)
Restriction of energy intake relative to requirements, leading to low weight
Intense fear of weight gain or becoming fat, although underweight
Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
Subtypes of AN:
Restricting type: During the last 3 months, the person has not regularly engaged in binge eating or purging behavior (ie, self-induced vomiting or the misuse of laxatives, diuretics, or enemas).
Binge eating/purging subtype: During the last 3 months, the person has regularly engaged in binge eating or purging behavior (ie, self-induced vomiting or the misuse of laxatives, diuretics, or enemas).
TABLE 76-2Summarized DSM-5 Criteria for Bulimia Nervosa (BN) |Favorite Table|Download (.pdf) TABLE 76-2 Summarized DSM-5 Criteria for Bulimia Nervosa (BN)
Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
Eating, in a discreet period ...