Perspective from Sydney M. Hartman-Munick, MD
Fact checked byCarol L. DiBerardino, MLA, ELS
A systematic review and meta-analysis of 32 studies found that 22% of children and adolescents exhibit disordered eating, according to findings published in JAMA Pediatrics.
Recent studies have shown that eating disorder admissions for pediatric patients increased at points in the United States during the COVID-19 pandemic.
Data derived from López-Gil JF, et al. JAMA Pediatr. 2023;doi:10.1001/jamapediatrics.2022.5848.
“Because some children and adolescents with eating disorders may hide the core symptoms of the illness and delay seeking specialized care due to feelings of shame or stigmatization, it is reasonable to consider that eating disorders are underdiagnosed and undertreated,” the authors of the new study wrote.
The authors also clarified the differences between eating disorders and disordered eating behaviors.
“Although these symptoms predict outcomes related to eating disorders and obesity in adolescents 5 years later, it is important to distinguish disordered eating from eating disorders,” they wrote. “The term disordered eating is often used to describe and identify some of the different eating behaviors that do not necessarily meet the diagnostic criteria for an eating disorder and, therefore, cannot be classified as eating disorders per se.”
The authors examined eligible studies of children and adolescents aged 6 to 18 years that used the Sick, Control, One, Fat, Food, which consists of five yes-or-no questions regarding eating behaviors and attitude toward food and weight loss. The 32 studies included 63,181 participants from 16 countries.
According to the review, the overall proportion of children and adolescents with disordered eating was 22.36% (95% CI, 18.84%-26.09%). Additionally, the proportion was more elevated among girls, (30.03%; 95% CI, 25.61%-34.65%) than boys (16.98%; 95% CI, 13.46%-20.81%).
“These high figures are concerning from a public health perspective and highlight the need to implement strategies for preventing eating disorders,” they wrote.
Sydney M. Hartman-Munick, MD
This review adds an important perspective to our knowledge about disordered eating behaviors in adolescents from a global perspective because we know that disordered eating behaviors are a red flag for the development of an eating disorder further down the line. The overall prevalence of disordered eating behaviors noted by this meta-analysis is incredibly high at 22%. Although the prevalence was found to be higher for girls than for boys in this study, it’s important to note that the prevalence for boys was still very high at almost 17%, which drives home the need to screen boys for these behaviors.
The association between disordered eating behaviors and elevated BMI is unfortunately not surprising, given what we know about societal and medical anti-fat bias and weight-based discrimination. This fits with what I see clinically — teens with higher weights who have been told that they need to lose weight by a well-intentioned provider, then take dangerous measures to do so. Eating disorder prevention is an important field of ongoing study, and there is still so much we don’t know about how to prevent the development of eating disorders in teens. The results from this review help push the field further by driving home how prevalent these problematic behaviors really are among teens around the world.
Sydney M. Hartman-Munick, MD
Assistant professor of pediatricsUMass Chan Medical SchoolWorcester, Massachusetts
Disclosures: Hartman-Munick reports receiving a grant from the Maternal and Child Health Bureau for her research.