Eating Disorders

85 Eating Disorders



Levon H. Utidjian, Sara B. Kinsman


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.)


Bulimia Nervosa Diagnostic Criteria



A Recurrent episodes of binge eating, characterized by both:
1 Eating, in a discrete period of time (e.g., a 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances

2 A sense of lack of control over eating during the episode

B Recurrent inappropriate compensatory behavior to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or enemas; fasting; or excessive exercise

C Binge eating and inappropriate compensatory behaviors both occuring, on average, at least twice a week for 3 months

D Self-evaluation is unduly influenced by body shape and weight

E The disturbance does not occur exclusively during episodes of anorexia nervosa

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



Clinical Presentation


Pediatricians may be alerted to the early stages of an eating disorder during their evaluations at the patient’s routine and acute visits. Weight loss or failure to gain weight may be an initial finding. Vital signs may also reveal bradycardia, a lower blood pressure, or hypothermia compared with previous visits. A patient with anorexia nervosa may present with thinning of scalp hair, lanugo or fine hair growth on the extremities, dry skin, acrocyanosis, and bruising or calluses related to overexercising. Bulimia nervosa may be considered if the pediatrician notes scarring or abrasions in the back of the mouth, parotid gland hypertrophy, dental enamel erosions, or calluses on the dorsum of the fingers known as Russell’s sign, which result from self-induced vomiting. Some of the symptoms of patients with bulimia nervosa are summarized in Figure 85-1.


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Figure 85-1 Signs and symptoms of bulimia nervosa.

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Jun 19, 2016 | Posted by in PEDIATRICS | Comments Off on Eating Disorders

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