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Disordered eating can be defined operationally as any eating behavior, or food or body image obsession, that negatively affects health, work, or relationships. This may include restrictive dieting or fasting, abuse of laxatives or appetite suppressants including caffeine and nicotine, skipping meals or avoiding meals with family and friends, overuse of meal supplements, excessive exercising (“exercise bulimia”), chewing then spitting out food, or infrequent binging or purging. Adolescents obsessed with body image may endanger themselves by abusing bodybuilding supplements and performance-enhancing drugs, including steroids, or may relentlessly pursue cosmetic surgery, including liposuction. Disordered eating also includes unsafe dieting techniques such as severe caloric restriction and “zero-carb” diets. Disordered eating is often not recognized because the person suffering may not look ill and does not consider his or her behavior as rising to the level of an eating disorder. In fact, both overweight and athletic youth are most at risk for developing disordered eating. Children with disordered eating may engage in dieting or fasting that seems unnecessary, avoid eating and eating situations, secretly binge, or make overly critical statements about their own body weight, shape, or size.

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Disordered eating thus spans a wide spectrum of maladaptive behaviors and attitudes rooted in dissatisfied body image and unhealthy eating habits. These attitudes and behaviors may not meet diagnostic criteria for anorexia nervosa, bulimia nervosa, body dysmorphic disorder (a disorder characterized by severe hatred of one’s body), or eating disorder not otherwise specified (EDNOS), but they may adversely affect health. Disordered eating may be encouraged by athletic coaches advocating bodybuilding and weight control (up to 62% of female and 33% of male athletes engage in disordered eating, according to the National Athletic Trainers Association) or by parents who themselves have disordered eating and overemphasize thinness. Pediatricians encouraging weight loss may unintentionally be supporting disordered eating habits.

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Disordered eating, especially binge eating, occurs prominently in one third to one half of adolescent obesity cases. Seventy-nine percent of overweight adolescents admit to unhealthy weight control behaviors, and 17% admit to severe behaviors such as extreme fasting, use of diet pills, and/or purging.1

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Adolescents with disordered eating are at higher risk for growth, hearing, sleep, and headache problems and are more likely to report depressive symptoms, including suicide ideation, poor body image, and low self-esteem. Boys with disordered eating report higher incidences of physical and sexual abuse than their peers, and girls with disordered eating are more likely report histories of molestation and to engage in risky sexual behaviors and substance abuse.2 Early detection and treatment is vital to prevent the harmful effects of disordered eating as well as to prevent their escalation into full-blown eating disorders. Recognizable signs of disordered eating almost always precede diagnoses of anorexia and bulimia nervosa. Early detection may be hindered by infrequent visits to a pediatrician, too little time during visits to obtain a thorough history, and reluctance by pediatricians to intervene if a child does ...

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