Among the top most common chronic conditions in adolescents, obesity and eating disorders rank in the top 3. Data from the National Health and Nutrition Examination Survey (NHANES) show that between 2011 and 2012, 34.5% of adolescents aged 12 to 19 years were overweight or obese. The prevalence of eating disorders, which typically begin during adolescence, is highest among adolescent girls and growing among male and minority adolescents. It is estimated that adolescent females have a lifetime prevalence of anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder of 0.3%, 0.9%, and 1.6%, respectively.1
The need to more effectively address these chronic conditions in adolescents is underscored by the associated physical and psychosocial morbidity of these conditions that often extend into adulthood. If not adequately addressed, overweight and obese adolescents are at increased risk of developing a host of difficult-to-manage physical morbidities in adulthood, such as adult diabetes, coronary artery disease, fatty liver disease, and bone and joint problems, as well as enduring ongoing struggles with psychosocial difficulties such as depression.1
In recognition of the need to help pediatricians address some of the key issues about these conditions, the American Academy of Pediatrics (AAP) published clinical guidance in 2010 on identifying and managing eating disorders in children and adolescents,2 and in 2015 published guidance on the role of the pediatrician in the primary prevention of obesity.3
In a more recent publication, the AAP pulls together these 2 conditions to show the interaction between them and to highlight that an eating disorder in adolescence often begins when an adolescent is trying to lose weight or become more healthy. The 2016 published clinical report titled “Preventing obesity and eating disorders in adolescents” is meant to complement the prior clinical reports and provides pediatricians with tools to identify behaviors that predispose adolescents to both obesity and eating disorders.1
Lead author of the report, Neville H. Golden, MD, chief, Division of Adolescent Medicine, and Marron and Mary Elizabeth Kendrick Professor in Pediatrics, Stanford University, Palo Alto, California, highlights that the report “alerts the pediatrician to the increasing number of young people who were previously overweight or obese and who develop an eating disorder while trying to become healthy.”
The name given the condition for adolescents who develop an eating disorder while trying to lose weight is known as “atypical anorexia nervosa,” according to Golden, who says that adolescents who develop this type of eating disorder while trying to lose weight suffer from medical and psychological complications that are very similar to those associated with patients with more classical AN.
This article provides a brief summary of key findings of the AAP clinical report to provide a quick guide for pediatricians on how to identify behaviors that place adolescents at increased risk of becoming obese or developing an eating disorder. The report highlights that some behaviors, such as dieting, can lead to both obesity and eating disorders, while other behaviors, such as family meals, can protect against the development of either disorder, says Golden.
Importantly, the clinical report provides pediatricians with guidance about how to talk to children and adolescents about obesity prevention and eating disorders, underscoring the critical importance of giving these young people the right messages about healthy and effective weight loss.