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Understanding eating disorders in adolescence

Clinical Presentation & Screening

When to suspect or consider an eating disorder

An eating disorder should be considered in children and youth with:

  • Drop/decrease in weight over 6-12 months*
    *Make sure to ask the patient’s highest weight, lowest weight and current weight  extreme weight loss may have happened > 12 months ago and they may be maintaining their low weight through harmful behaviour (e.g. purging, excessive exercise)
  • Unexplained growth stalling, stunting or pubertal delay
  • Unhealthy weight control behaviors such as dieting, binging, purging, laxative abuse, and/or over exercising (exercising for the purpose of losing weight or in response to guilt after a binge)
  • Preoccupation with body image (For eating disorders such as AN and BN; with ARFID, low weight is often associated with stress or fear or depression or low appetite)
  • Males may present with intense body building, preoccupation with body shape and musculature and use of anabolic steroids.
  • Younger children may have an atypical presentation.
    • Instead of rapid weight loss, they may present with failure to meet expected gains in weight or height.
    • They may not endorse body image concerns or exhibit behaviors of binging and purging.
    • They are often anxious

Screening

Screening for pediatric and adolescent eating disorders should be considered with annual health exams. Weights and heights should be taken at every visit, regardless of the reason for the visit and:

  • Should always be plotted on the WHO growth charts specific for gender and age 2-19.
  • Deviations from normal are easier to determine visually (nutritional insufficiency may show as falling off the curve rather than an actual weight loss).
  • A simple denial from the youth does not exclude the possibility of an eating disorder. Obtain collateral history from the primary caregivers, separate from the patient.

A simple screen for eating disorders is the Youth Disordered Eating Screen (YoDES) — a screening tool for youth that aims to identify patients struggling in the realms of nutrition or body image. The test poses two simple questions:

  1. Over the past three months, has your weight and/or shape influenced how you think about (judge) yourself as a person? (YES or NO)
  1. Over the past six months, have you fasted (skipped at least two meals in a row) or eaten what other people would regard as an unusually large amount of food (e.g. a quart of ice cream) given the circumstance? (YES or NO)

A patient that answers YES to either question requires a more in depth assessment for disordered eating/eating disorder.

Important tips

Important tips for assessing a patient suspected of having an eating disorder, consider the following areas:

  • Eating habits
  • Attempt at weight loss or dieting
  • Stressors that may have caused the weight loss
  • Use of laxatives, diet pills, excessive exercise
  • Satisfaction with body shape/size/appearance
  • How their perception of their body/weight affects their impression of themselves
  • Self-esteem, stressors, mood, mental health (eating disorders tend to be associated with thoughts of being “not good enough”)
  • Ask for the highest, lowest and current weight
  • History of menses (if applicable)

Anstine, D., & Grinenko, D. (2000). Rapid screening for disordered eating in college-aged females in the primary care setting. Journal of Adolescent Health, 26(5), 338-342.

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