Pediatric Care & Eating Disorders: A Pediatrician’s Role in Early Intervention
The Trouble with Diagnosing Eating Disorders
Eating disorders are a type of mental health condition that affects someone’s eating behaviors and their thoughts about food, body weight, and body shape. 9% of Americans will experience an eating disorder at some point in their life, and women are twice as likely as men to be diagnosed with one. These conditions often begin in adolescence, with about 6-8% of teens having an eating disorder. The actual number of cases may be much higher, because eating disorders are notoriously difficult to diagnose.
Part of the difficulty with diagnosing eating disorders is that many physicians and parents have an idea of what someone with an eating disorder looks like, but these conditions don’t have a “look”. For example, they might assume that a person living with an eating disorder is very thin based on how the media portrays them, but less than 6% of those with eating disorders are clinically underweight. People of any size can live with an eating disorder.
Another struggle with proper diagnosis is that a large percentage of individuals with milder eating disorders who don’t meet all of the strict diagnostic criteria. They still experience the consequences of an eating disorder but won’t be able to access treatment for their condition without a formal diagnosis. To make sure they can still receive coverage, OFSED (“Other Specified Feeding & Eating Disorder”) and UFED (“Unspecified Feeding & Eating Disorder”) are now listed among the different types of eating disorders. Both have less specific diagnostic criteria which include the symptoms that those with milder eating disorders experience.
Types of Recognized Eating Disorders
Besides OFSED and UFED, there are 6 other eating disorders recognized by the scientific community: anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant-restrictive food intake disorder (ARFID), pica, and rumination.
| Anorexia Nervosa | People with anorexia severely restrict their eating, usually based on fear of gaining weight. Not everyone with anorexia nervosa is dangerously underweight; there is an atypical anorexia differential diagnosis under OFSED. |
| Bulimia Nervosa | Those with bulimia regularly overeat during a “binge” and then engage in compensatory behaviors that “compensate” for the overeating. These behaviors may include vomiting, using laxatives, fasting, or exercising excessively. |
| Binge Eating Disorder | Like with bulimia, individuals with binge eating disorder (BED) overeat during regular “binges”, but do not experience compensatory behaviors after. |
| Avoidant-Restrictive Food Intake Disorder (ARFID) | Individuals with ARFID severely limit their diet by only eating certain kinds of food. It’s beyond picky eating, often excluding entire food groups, and is often attributed to sensory or fear-based concerns. |
| Other Specified Feeding & Eating Disorder (OFSED) | This diagnosis covers a broad range of eating disorders that are varieties of anorexia, bulimia, and binge eating disorder. These include atypical anorexia nervosa, purging disorder, and night eating syndrome. |
| Unspecified Feeding & Eating Disorder (UFED) | This diagnosis is given when someone is dealing with the psychological and/or physical symptoms of an eating disorder, but they don’t meet specific criteria for another diagnosis. |
| Rumination | Those with rumination repeatedly regurgitate food they have recently eaten, then spit it out, rechew it, or swallow it. |
| Pica | People with pica eat substances that are not food and do not carry no nutritional value, such as chalk, soap, paint chips, and clay. |
Source: PsychCentral
Eating disorders, especially anorexia nervosa, have the highest mortality rates of any mental illnesses. Because of the danger they pose, early identification, intervention, and treatment is critical – which is where pediatricians come in.
Your Role in Eating Disorder Early Intervention as a Pediatrician
Pediatricians are in a unique position to identify eating disorders in children, teens, and adolescents, as well as intervene before they progress further. Annual wellness visits and examinations are excellent opportunities to screen for eating disorders, and there are a few steps to doing this successfully.
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Start by Implementing Universal Screening
We’ve already demonstrated how eating disorders don’t have one “look”, along with some of the many other reasons that they are so difficult to identify. For this reason, the American Academy of Pediatrics (AAP) recommends universal eating disorder screening for preteens and adolescents as part of their regular wellness visits. They also state that any reports from the parent or your patient about dieting, body image dissatisfaction, experiences of weight-based stigma, or changes in eating or exercise patterns invite further exploration. Trust your gut; it’s better to play it safe and screen too many patients than miss someone who really needs it!
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Know What Screening Questions to Ask
If you’re trying to do a surface-level check for eating disorder symptoms and behaviors, AAP provides this list of screening questions to add to your wellness visit routine. If you need more in-depth screening tools, the VMAP Guidebook includes the EAT-26 questionnaire and scoring metric.
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Be Prepared to Intervene & Connect Patient to Resources
After you’ve gotten a positive screen for eating disorder behaviors, it’s time to intervene and connect your pediatric patient and their family with resources and treatment options. If you’re not sure what direction to go in, call the VMAP Line! This will connect you to two free sources of support for your patient:
Mental Health/Psychiatric Consultation
Free same-day consultation regarding your patient’s case with experts like child/adolescent psychiatrists, developmental pediatricians, and licensed mental health professionals.
Care Navigation
Care navigators that help your pediatric patients connect with local mental health resources and referrals.
We have also designed this handout for you to print and share with your patients and their families. It helps explain treatment options and lists hotlines, helplines, and support groups for more immediate support.
We hope this article has helped you learn more about your role in early intervention with pediatric eating disorders. If at any point you need additional support with a patient’s case, don’t hesitate to call the VMAP Line and get the assistance you need!
