Childhood obesity is on the rise, including binge eating issues with children and adolescents. Binge eating disorder is the most common form of eating disorder among adolescents. An important aspect of binge eating is the youth’s experience with loss of control eating, which is likely a maladaptive coping mechanism for self-regulation. Loss of control eating has been linked to emotional stress, anxiety, mood disorders and low self-esteem. Diagnosing eating disorders in youth can be challenging. Pediatricians, nurse practitioners and family medicine providers may have difficulty diagnosing eating disorders in youth. Children and adolescents often try to minimize or hide their loss of control or binge eating episodes. Also, a child or adolescent’s growth spurt may make it difficult to determine the difference between binge eating episodes and increased eating associated with developmentally appropriate growth.
Screening can be done in the primary care office and is recommended by the American Academy of Pediatrics to be completed annually. Common risk factors associated with eating disorders include family history, trauma and family stress, bullying, traits of perfectionism, and social weight stigma -especially for adolescents who participate in activities that promote thinness. Additionally, obesity in childhood is linked to disordered eating. Adolescents with a history of obesity are at a higher risk of developing an eating disorder. Research has found that binge eating is prevalent in approximately 25% of youth who are overweight or obese. The SCOFF is a free, five question measure that can assist identifying patients with eating disorders. The questions can be administered verbally or in writing. A positive response to two or more indicates that a patient needs a more comprehensive assessment.
Given the association between mental health issues and disordered eating, screening for mental health issues may be beneficial to determine underlying conditions. The Illinois DocAssist website has information about free mental health screening tools that can be used in primary care.
Disordered eating, including binge eating, can be chronic and long-lasting. Some children may not meet the full criteria for an eating disorder, but suffer negative outcomes associated with binge eating including body dissatisfaction and additional psychosocial stressors. One key to successful outcomes is early identification and intervention. Bright Futures has tips for prevention with children and adolescents that include:
- Promote self esteem
- Educate throughout development about weight, nutrition and body changes
- Identify parents with excessive concern or rigid control of their child’s eating and physical activity
- For overweight patients avoid critical statements and support gradual weight loss
Treatment for eating disorders requires a team approach that typically includes the primary care provider, individual therapist, family therapist, nutritionist, and often a child and adolescent psychiatrist. The parents are an integral part of the treatment team. More information for families can be found at the National Eating Disorders Association.
The first step in treatment is to address any medical complications and ensure stability. As binge eating is a behavior, cognitive behavioral treatment is essential when working with the youth and their family. Including the patient’s family is necessary for positive outcomes. Specialized services related to eating disorders may be difficult to locate given the patient’s insurance coverage and community access to support services. The Academy for Eating Disorders has developed a guide for clinicians to assist patients and their families navigating the insurance process.
Identification, evaluation and treatment of eating disorders can be complex. Calling Illinois DocAssist to speak with an expert child and adolescent psychiatrist can be helpful to receive support for any step in the process.
De Giuseppe R, Di Napoli I, Porri D and Cena H. (2019) Pediatric Obesity and Eating Disorders Symptoms: The Role of Multidisciplinary Treatment. A Systematic Review. Pediatris 7: 123.
Gossens L, Van Malderen E, Van Durme K, and Braet C. (2016). Loss of Control Eating in Adolescents: Associations with Adaptive and Maladaptive Emotion Regulation Strategies. Eating Behaviors: 22 156-136.
Rosen D, and The Committee on Adolescence (2010). Clinical Report-Identification and Management of Eating Disorders in Children and Adolescents. www.pediatrics.org\cgi\doi\10.1542\peds.2010.2821.
Zullig K, Matthews-Ewald M, and Valois R. (2015) Weight Perceptions, Disordered Eating Behaviors, and Emotional Self-efficacy Among High School Adolescents. Eating Behaviors 21 (2016) 1-6.