Dr. GoldenMany eating disorders (EDs) programs have noted a marked increase in the number of teens who previously were obese or overweight presenting with frank eating disorders. In their attempt to lose weight, these adolescents may have resorted to unhealthy and unsustainable methods such as skipping meals or using diet pills or laxatives.
Even though their weight now is in the normal range, these individuals have medical and psychologic findings similar to those with classic anorexia nervosa. They may present to the pediatrician with severe bradycardia or orthostasis, signs of medical instability.
A new AAP clinical report addresses the interaction between obesity prevention and EDs in teenagers. It also provides pediatricians with evidence-informed tools to identify behaviors that predispose to both obesity and EDs and guidance on messaging.
The report Preventing Obesity and Eating Disorders in Adolescents, from the AAP Committee on Nutrition, Committee on Adolescence and Section on Obesity, is available at http://pediatrics.aappublications.org/content/early/2016/08/18/peds.2016-1649 and will be published in the September issue of Pediatrics.
Behaviors linked to weight problems
While most adolescents who develop an eating disorder were not previously overweight, some teens may develop an eating disorder as they try to lose weight.
Research has shown that certain behaviors such as dieting, weight talk and weight teasing predispose to both obesity and EDs in teens, while frequent family meals are protective of both conditions.
Research has shown that frequent family meals protect against obesity and eating disorders in teens. A new AAP clinical report recommends that families eat together as a way to model healthy food choices.
Dieting, defined as caloric restriction with the goal of weight loss, was associated with a twofold increased risk of becoming overweight and a 1.5-fold increased risk of binge eating five years later in a large prospective study of healthy teens (Neumark-Sztainer DR, et al. Am J Prev Med. 2007;33:359-369).
Another study found that normal weight girls who dieted in ninth grade were three times more likely to be overweight in 12th grade compared with non-dieters (Stice E, et al. J Consult Clin Psychol. 1999;67:967-974).
Weight talk, or comments made by family members about their own weight or to the child to encourage weight loss, has been linked to both overweight and EDs. Teasing children about their weight also has been associated with the development of overweight, binge eating and extreme weight-control behaviors in girls and overweight status in boys.
Body dissatisfaction is a known risk factor for both obesity and EDs. Adolescents who are more satisfied with their bodies report parental and peer attitudes that encourage healthful eating and exercise to be fit, rather than dieting.
Recommendations
Obesity prevention messaging, if done correctly, should not predispose to EDs in teens. The clinical report recommends that pediatricians do the following to prevent weight-related problems:
- Discourage dieting, skipping of meals or use of diet pills to lose weight. The focus should be on a healthy lifestyle rather than on weight.
- Encourage more frequent family meals, which provide an opportunity to model healthy food choices and provide time for teenagers and parents to interact.
- Promote a positive body image among adolescents. Body dissatisfaction should not be used as a reason to lose weight.
- Encourage families not to talk about weight but rather to talk about healthy eating and being active to stay healthy.
- Carefully monitor weight loss in an adolescent who is obese or overweight to ensure the teen does not develop the medical complications of semi-starvation.
Dr. Golden is lead author of the clinical report and a member of the AAP Committee on Nutrition.
