Eating disorders in kids: A global health emergency

An elevated proportion of children and adolescents around the world, particularly girls or those with high BMI, experience disordered eating as shown in a meta-analysis of 32 studies from 16 countries.

The overall proportion of children and adolescents with disordered eating was 22.36 percent (p<0.001).

Girls were significantly more likely to report disordered eating than boys (30.03 percent vs 16.98 percent; p<0.001). Disordered eating became more elevated with increasing age and BMI (p<0.001).

“This is concerning from a public health perspective,” said the researchers led by Dr José Francisco López-Gil from the University of Castilla-La Mancha, Ciudad Real, Spain. “Our findings can inform intervention priorities for disordered eating.”

Disordered eating, if undetected and untreated, can lead to eating disorders, with harmful consequences. “Eating disorders are a global public health problem we must not ignore,” he emphasized. “People with these conditions die 10–20 years younger than the general population.” [World Psychiatry 2014;13:153-160]

Eating disorders are psychiatric disorders characterized by abnormal eating or weight control behaviours. These include anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorders not otherwise specified.

First to assess disordered eating comprehensively

López-Gil and colleagues systematically searched four databases (PubMed, Scopus, Web of Science, and the Cochrane Library) from January 1999 to November 2022 for the analysis – the first to comprehensively examined the overall proportion of children and adolescents with disordered eating in terms of gender, mean age, and BMI. [JAMA Pediatr 2023;177:363-372]

A total of 63,181 children and adolescents were included. Of this number, 14,856 (22.36 percent) were identified as having disordered eating as assessed by the SCOFF* questionnaire, a five-question screening tool for detecting eating disorders.

Questions were (1) Do you make yourself sick because you feel uncomfortably full? (2) Do you worry you have lost control over how much you eat? (3) Have you recently lost more than 1 stone in a 3-month period? (4) Do you believe yourself to be fat when others say you are too thin? (5) Would you say that food dominates your life?

Two or more “yes” answers suggest a positive screen, which denotes suspicion of an eating disorder.

“Not all children and adolescents who reported disordered eating behaviours – for example, selective eating – will necessarily be diagnosed with an eating disorder,” explained López-Gil. “However, disordered eating in childhood or adolescence should be closely evaluated as it may predict outcomes associated with eating disorders in early adulthood.”

For this reason, the findings of a high proportion of children and adolescents with disordered breathing are “worrisome and call for urgent action” to address the situation, he pointed out.

Many are not seeking help

A study in Brazil that assessed risky behaviours and predisposing factors among young people showed that the likelihood of experiencing eating disorders was higher among young people who had an intense fear of gaining weight. This was also the case for teenagers who experienced compulsive eating episodes or used laxatives. Yet most of them did not seek professional help. [Mundo da Saúde 2020,44:229-237, e1592019]

318 deaths in 2019

The prevalence of eating disorders in young people has markedly increased in recent years. In 2019 alone, eating disorders accounted for 318 deaths worldwide and are among the most life-threatening of all mental disorders. [Lancet Psychiatry 2022;9:137-15]

Most cases of eating disorders remain undetected, and hence untreated, as most affected individuals mask their symptoms and avoid seeking specialist care due to embarrassment, stigma, or ambivalence toward treatment.

The media is also partly to blame as content for children and adolescents very often portrays highly unrealistic appearances, including the glorification of sexualised thinness and the presence of weight biases.

For most adolescents, this plays on desperation, fuelling and influencing the perception of body image and the creation of aesthetic standards. This reinforces the idea that appearance is a core dimension of self-worth, pushing them to change their eating patterns drastically which could later result in undesirable outcomes.

Timely intervention is needed before this pattern of disordered thoughts – and eating – affects and ends – even more lives.

A problem not to be ignored

“Identifying the magnitude of disordered eating and its distribution in at-risk populations is crucial,” said the researchers.

Parents and healthcare professionals should be aware of the symptoms of disordered eating such as weight loss dieting, binge eating, self-induced vomiting, excessive exercise, and use of laxatives or diuretics without medical prescription, López-Gil said.