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Eating Disorders

Binge Eating Disorder

Binge eating can be a maladaptive coping mechanism in children and adolescents and has been linked to emotional stress, anxiety, mood disorders and low self-esteem.  Binge eating disorder is the most common form of eating disorder among adolescents.

Diagnosis in youth can be challenging because patients are likely to minimize or hide  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.

Common risk factors associated with binge 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. Patients 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.

Anorexia Nervosa

Anorexia usually emerges in middle childhood or adolescence.  These patients experience an intense fear of gaining weight, have a distorted perception of their body, and their weight or shape has a disproportionate influence on their self esteem. Children and adolescents with anorexia restrict calories and the types of foods eaten.  These youth may also exercise compulsively, or use laxatives.

Warning Signs:

  • Dramatic weight loss
  • Dresses in layers to hide weight loss or stay warm
  • Preoccupation with weight, food, calories, fat grams, and dieting
  • Frequently reports feeling “fat” despite weight loss
  • Complains of constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy
  • Enages in food rituals
  • Cooks meals for others without eating or avoids mealtimes
  • Excessive and rigid exercise regimen
  • Withdrawal from friends and activities
  • Stomach cramps or other gastrointestinal complaints
  • Difficulties concentrating
  • Dizziness or fainting
  • Menstrual irregularities
  • Injuries to top of finger joints associated with inducing vomiting
  • Enamel erosion, cavities, and tooth sensitivity
  • Dry skin or brittle nails
  • Thinning of hair on head, dry and brittle hair
  • Cavities, or discoloration of teeth, from vomiting
  • Muscle weakness

Bulimia Nervosa

Patients experiencing bulimia nervosa engage in episodes of binge eating for short periods of time.  Such episodes feel out of control for the patient.  When not binge eating, children and youth with bulimia will use compensatory behaviors such as restricting food intake and purging.

Warning Signs:

  • Weight loss, dieting, and controlling food
  • Disappearance of large amounts of food or empty food wrappers or containers
    Frequent trips to the bathroom after eating,
  • Signs and/or smells of vomiting
  • Uncomfortable or afraid of eating around others
  • Develops food rituals
  • Skips meals or takes small portions of food at regular meals
  • Steals or hoards food
  • Drinks excessive amounts of water or non-caloric beverages
  • Uses excessive amounts of mouthwash, mints, and gum
  • Hides body with baggy clothes
  • Maintains excessive, rigid exercise regimen
  • Discolored or stained teeth
  • Withdraws from friends and activities
  • Bloating from fluid retention
  • Extreme mood swings
  • Weight fluctuates up and down
  • Stomach cramps or gastrointestinal issues
  • Difficulty concentrating
  • Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)
  • Dizziness or fainting
  • Feeling cold all the time
  • Sleep problems
  • Injuries to finger joints from inducing vomiting
  • Dental problems
  • Dry skin or brittle nails
  • Muscle weakness
  • Menstrual irregularities
  • Poor wound healing
  • Impaired immune functioning

Screening for Eating Disorders

Screening can be done in the primary care office and is recommended by the American Academy of Pediatrics to be completed annually.

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 following mental health conditions have been associated with pediatric eating disorders:

  • Anxiety
  • Depression
  • Obsessive Compulsive Disorder
  • Substance Abuse
  • Trauma

Visit our webpage to learn more and access free evidence based screening tools for use in primary care.

Eating disorders in children and adolescents can be chronic and long-lasting. Some children may not meet the full criteria for an eating disorder, but suffer negative outcomes such as body dissatisfaction and psychosocial stressors. One key to successful outcomes is early identification and intervention.

Bright Futures provides a module on pediatric eating disorders and includes tips for working with children and adolescents:
• 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.

The first step in treatment is to address any medical complications and ensure stability. Patents may benefit from cognitive behavioral therapy to work on changing behaviors.  Including the patient’s family is necessary for positive outcomes. Specialized services related to eating disorders may be difficult to locate and is impacted by insurance coverage and community access to support services.

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.


The American Academy of Pediatrics updated their guidance on caring for children and adolescents in the primary care office in January 2021.

The Academy for Eating Disorders has developed a guide for clinicians to assist patients and their families navigating the insurance process when advocating for specialty care.

The National Eating Disorders Association (NEDA) is a non-profit organization that offfers assistance to patients and families experiencing eating disorders.  Their website offers information and resources for eating disorders.  NEDA also offers a helpline that patients and families can contact with questions or requests for assistance.