Eating Disorders in Children and Adolescents: State of the Art Review

Kenisha Campbell · Rebecka Peebles

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Eating Disorders and Behaviors Nutrition, Health and Food Behavior Child Nutrition and Feeding Issues

Abstract

Despite their high prevalence, associated morbidity and mortality, and available treatment options, eating disorders (EDs) continue to be underdiagnosed by pediatric professionals. Many adolescents go untreated, do not recover, or reach only partial recovery. Higher rates of EDs are seen now in younger children, boys, and minority groups; EDs are increasingly recognized in patients with previous histories of obesity. Medical complications are common in both full and subthreshold EDs and affect every organ system. No single cause of EDs has emerged, although neurobiological and genetic predispositions are emerging as important. Recent treatment paradigms acknowledge that they are not caused by families or chosen by patients. EDs present differently in pediatric populations, and providers should have a high index of suspicion using new Diagnostic and Statistical Manual, 5th edition diagnostic criteria because early intervention can affect prognosis. Outpatient family-based treatment focused on weight restoration, reducing blame, and empowering caregivers has emerged as particularly effective; cognitive behavioral therapy, individual therapy, and higher levels of care may also be appropriate. Pharmacotherapy is useful in specific contexts. Full weight restoration is critical, often involves high-calorie diets, and must allow for continued growth and development; weight maintenance is typically inappropriate in pediatric populations. Physical, nutritional, behavioral, and psychological health are all metrics of a full recovery, and pediatric EDs have a good prognosis with appropriate care. ED prevention efforts should work toward aligning with families and understanding the impact of antiobesity efforts. Primary care providers can be key players in treatment success.

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References

2013Diagnostic and Statistical Manual of Mental Disorders 2013Diagnostic and Statistical Manual of Mental Disorders 2011Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders 2012Epidemiology of Eating Disorders: Incidence, Prevalence and Mortality Rates 2011Prevalence and Correlates of Eating Disorders in Adolescents 1995Mortality in anorexia nervosa 2011Dieting and Disordered Eating Behaviors from Adolescence to Young Adulthood: Findings from a 10-Year Longitudinal Study 1998A Controlled Family Study of Anorexia Nervosa and Bulimia Nervosa

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