Wednesday, February 24, 2021

The Changing Face of Eating Disorders

By Dr. Hina Talib, Adolescent Medicine Specialist, Children’s Hospital at Montefiore

In recognition of National Eating Disorders Awareness Week, which takes place February 22 – 28, it is important to raise awareness and share how eating disorders affect our community.

Typically, someone with an eating disorder was assumed to be a skinny teenage girl, usually white and affluent. Gone are those days. Those of us caring for teens now recognize eating disorders, which are a group of mental health conditions with potentially life-threatening consequences, in more diverse groups of teens. 

Paying attention to new or unusual eating habits is more important than ever, as the COVID-19 pandemic has made it more challenging to recognize who may be struggling with an eating disorder. And since the pandemic hit, fewer teens are coming in for their yearly check-ups. Here are five ways the face of eating disorders have changed over the last decade: First, younger teens and pre-teens are now facing eating disorders, including Anorexia Nervosa, which we used to think of more in older girls and adults. Pre-teens can actually have more rapid and drastic weight loss and have other mental health challenges like anxiety and depression. They are less likely to binge eat or force themselves to vomit, so, they may not look like a “typical” eating disorder, but they are still at risk. In fact, pre-teens can become very sick as a result of malnutrition from rapid weight loss. Fortunately, earlier treatment can lead to earlier recovery.

Another group we do not typically think about are boys, especially younger boys, who are often missed and have later diagnoses, when medical complications may arise. Doctors as well as families still don’t think of eating disorders in boys, who may be focused on body shape and muscles for sports, but are still struggling with troubling, disordered thoughts about food and their bodies. Student athletes of all genders should be screened at their yearly check-ups for eating disorders - another good reason not to skip sports physicals even during the pandemic.

Third, teens of color have historically not been given attention both in diagnosis and treatment of eating disorders, but studies in America now show that eating disorders are found in all races and ethnicities. It is important to do more to increase access for Hispanic and Black teens to skilled care, as well as to educate families and communities about eating disorders, as they might not be aware that eating disorder can affect non-white teens too.Fourth, teens who identify as LGTBQIA+ are actually at a higher risk, and teens who are transgender as well. Studies show that students in the sexual minority, including those who are lesbian, gay, or bisexual have more unhealthy eating and dieting than cisgender students. This is also true for young adults who may be attending college, as studies have shown similar risk in college students who identify as transgender.

Finally, teens who are not underweight and are actually overweight, may still have an eating disorder. These are challenging cases, as sometimes teens get a lot of praise for losing weight from doctors and families. This highlights the importance of discussing healthy eating and physical activity, and not solely focusing on a number on the scales.

It is important to recognize that teens of all ages, genders, races and even weights could potentially face an eating disorder. This awareness is the first step to identifying all teens who may be struggling with food, weight, and nutrition issues.

If you have concerns about your child having an eating disorder, please discuss with your pediatrician. At the Children’s Hospital at Montefiore - Division of Adolescent Medicine - we offer culturally competent and inclusive eating disorder treatment for all teens and families facing eating disorders. You can also contact the National Eating Disorder Association helpline at 800.931.2237, which has Spanish translation counselors as well. 

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