Disordered eating is common in children and teens, creating health risks

24 February 2023 - 06:54
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Disordered eating behaviour includes binge eating unhealthy foods and self-induced vomiting to avoid gaining weight
Disordered eating behaviour includes binge eating unhealthy foods and self-induced vomiting to avoid gaining weight
Image: 123RF\lightwise

More than one in five children and teens have disordered eating patterns, the first global analysis of studies on this problem, including 63,000 participants in 32 studies from 16 countries, has found.  

Disordered eating is more common among girls, older adolescents and those with a higher body mass, the results show.

“These high figures are concerning from a public health perspective and highlight the need to implement strategies for preventing eating disorders,” said the corresponding authors, Dr Jose Francisco Lopez-Gil of Universidad de Castilla-La Mancha, Spain and Dr Hector Gutierrez-Espinoza, of Universidad de las Americas, Ecuador.

South African studies have demonstrated teenage girls in towns have “weight and shape concerns with body image issues and related dieting behaviour”, said eminent psychiatrist Prof Chris Szabo, who used to run the eating disorders unit at Tara Hospital in Johannesburg.

The Sick, Control, One, Fat, Food (SCOFF) questionnaire is the most widely used to screen for eating disorders. Two or more positive answers “denotes a suspicion of any eating disorder”.

(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 6,3kg in a three-month period?
(4) Do you believe yourself to be fat when others say you are too thin?
(5) Would you say food dominates your life?

The researchers who led the new meta-analysis report 14-million people experienced eating disorders, including almost 3-million children and adolescents, in 2019.

More than 17,000 years of life were lost from 1990 to 2019 because of eating disorders the authors noted, calling for urgent action to tackle this.

Disordered eating, with symptoms including “behaviours such as weight loss dieting, binge eating, self-induced vomiting, excessive exercise, and the use of laxatives or diuretics”,  can predict eating disorders and obesity later in life.

In mid- and high-income countries eating disorders have “markedly increased” in the last 50 years.

“Eating disorders are among the most life-threatening psychiatric problems, and people with these conditions die 10 to 20 years younger than the general population,” the researchers warned in their paper published in the journal JAMA Pediatrics this week.

Szabo, author of the book Eating Disorders, said: “Dieting is a major risk factor, influenced to some extent by societal values. (There is) an emphasis on physical appearance as a determinant of self-worth. Hence self-esteem issues also contribute to risk.”

Roughly one in six South African girls expressed attitudes and behaviours that “could indicate an eating disorder or risk for developing an eating disorder”, he said.

However, there are no studies in South Africa that measure how common “diagnosable eating disorders, specifically anorexia nervosa and bulimia nervosa” are among adolescents, Szabo reported.

Eating disorders can damage people’s health, daily functioning and cause “significant distress”, the experts warned.

Two new studies reveal social media use aggravates the threat of eating disorders among adolescents and young adults, and the Covid-19 pandemic worsened the problem.

The first revealed teens who cut their social media use by half felt better about themselves, building on earlier research with similar outcomes.

The second found after the Covid-19 pandemic eating disorders among adolescents increased significantly, among both inpatients and outpatients across 14 academic medicine sites in the US, compared to before its onset.

In general eating disorders are underdiagnosed and undertreated, with some children and teens hiding their symptoms because they feel shame or stigmatisation, delaying their access to care and treatment.

Szabo said eating disorders have been documented in South Africa since the 1970s but there is no scientific data on how common they are (prevalence).

Eating disorders are among the most life-threatening psychiatric problems
Journal JAMA pediatrics

“However, the advent of social media has certainly heightened issues of body image and no doubt contributed to such concerns through comparison with others, and scrutiny of self, with the emergence of body dissatisfaction,” he said.

Disordered eating behaviours among boys, “such as intensely engaging in muscle mass and weight gain with the goal of improving body image satisfaction”, are not detected, based on diagnostic criteria, researchers said.

Twelve years is the median age for the onset of eating disorders, such as anorexia nervosa, bulimia nervosa, and binge eating disorder, according to a US nationally representative sample of more than 10,000 adolescents.

Szabo said the finding in the latest review that 22% of children and adolescents have disordered eating was a cause of concern but must be “interpreted carefully” since selected symptoms did not amount to a full-blown condition of an eating disorder.

“Treating eating disorders is complex,” he said.

“Parental involvement is important, and one needs to consider that often the child or adolescent with an eating disorder is symptomatic of family issues.

“As much as the sufferer needs treatment, family issues also need to be addressed within that treatment.”


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