- Eating disorders not only cause individual distress, but also increase the burden on healthcare, costing the United States economy approximately $65 billion a year.
- Early intervention is essential to reduce the potential harm to young people, but researchers have limited information on how disordered eating begins and how it changes before a child reaches puberty.
- A new study of almost 12,000 9- and 10-year-olds provides some indication about disordered eating behaviors in this age group.
- Researchers looked at how age, sex, weight, and stage of puberty related to disordered eating behaviors such as compensatory actions, binge eating, or vomiting to reduce weight.
Eating disorders often begin in adolescence. They affect more than 28 million people in the U.S., and the prevalence of disordered eating behaviors is even greater.
Unfortunately, research suggests that eating disorders increased globally during the COVID-19 pandemic, due to the unprecedented additional stressors that people have experienced.
Teenagers, in particular, were affected. However, data on disordered eating behaviors in children younger than 12 years are limited.
In this research, whose findings appear in JAMA Pediatrics, the study team used data from 11,878 children, ages 9 to 10, collected between 2016 and 2018 through the Adolescent Brain Cognitive Development study, funded by the National Institutes of Health.
Instead of studying fully fledged eating disorders, the researchers analyzed disordered eating behaviors.
What is disordered eating?
The term disordered eating describes a range of irregular eating habits and behaviors that may or may not require a diagnosis of a specific eating disorder.
Eating disorders, such as anorexia nervosa or bulimia nervosa, are diagnosed according to a strict set of criteria defined by the American Psychiatric Association. On its own, disordered eating does not constitute a medical diagnosis.
The Academy of Nutrition and Dietetics lists the symptoms of disordered eating behaviors, including:
- frequent dieting, anxiety associated with specific foods, or meal skipping
- chronic weight changes
- feelings of guilt and shame associated with eating
- preoccupation with food, weight, and body image that negatively impacts quality of life
- a feeling of loss of control around food, including compulsive eating
- using exercise, food restriction, fasting, or purging to “make up for bad foods.”
What did this study find?
The researchers studied binge eating, vomiting to control weight, and other behaviors — such as exercising or restricting calories — intended to prevent weight gain.
Five percent of children in the study had engaged in binge eating, while 2.5% had taken measures to avoid gaining weight.
The researchers found that boys and girls were equally likely to engage in disordered eating, going against common assumptions. Therefore, boys face a similar risk to girls.
The analysis also revealed that children with higher body mass indexes (BMIs), as well as those further along in puberty, faced a higher risk.
The study’s lead author, Dr. Stuart Murray, Della Martin associate professor of psychiatry and the behavioral sciences at the Keck School of Medicine of the University of Southern California, Los Angeles, spoke to Medical News Today about the key findings of this research.
“It’s important for parents/guardians to be aware that disordered eating can impact boys, as well as girls. Parents and healthcare providers often follow the stereotype that eating disorders don’t apply to boys. This stigma can make it even harder for boys to talk about their symptoms and feelings about their body, so for parents, being vigilant to the signs of observable disordered eating behaviors is critical in helping boys.”
– Dr. Stuart Murray
The researchers stated that children with higher BMIs were more likely to engage in all of the disordered eating behaviors studied in this research: binge eating, vomiting, and taking other actions to avoid weight gain.
Dr. Murray added that “these data suggest that children — both boys and girls — who experience puberty earlier than their peers, may be vulnerable to disordered eating behaviors.”
“Early development, and the physical growth that this entails, may portend feelings of ‘being bigger’ than peers, which in turn can drive engagement in disordered eating behaviors,” he hypothesized.
Parents should therefore pay special attention to possible disordered eating in children with higher BMIs. The research did not conclude that disordered eating causes obesity, but aspects of disordered eating, such as binge eating, are linked to weight gain.
Dr. Sulman Aziz Mirza, board certified in psychiatry, child and adolescent psychiatry, and addiction medicine, who was not involved in this research, told MNT that these findings are similar to what is seen in his practice as a child and adolescent psychiatrist.
Dr. Mirza explained that “eating disorders and disordered eating behaviors usually start to emerge in this age range.”
“We know that early puberty, especially in girls and furthermore in Black/ Latino girls, can result in very apparent body/ weight changes, which can lead to some of these behaviors,” he added.
Study limitations
There were limitations to this research. First, the study relied on parents providing reports, meaning that some information may not have been collected.
Second, there is a relatively low prevalence of disordered eating behaviors overall, so it may not be possible to identify small, yet meaningful insights from this research. A larger sample size may be required in future studies.
Dr. Caz Nahman, a consultant child and adolescent psychiatrist at Oxford Health, who was also not involved in this research, agreed with the limitations highlighted by the authors.
Dr. Nahman told MNT that although these data are relatively old — collected between 2016 and 2018 — the results do clinically match what specialists observe in practice:
“There has been a significant increase in presentations of ‘atypical anorexia nervosa.’ Patients present with significant body image concerns, mental and physical health consequences of restricted eating and rapid weight loss, distress, preoccupation with shape, weight, and thoughts about food, in young people and adults who are in a healthy weight or even an above average weight range.”
On review, Dr. Mirza felt that the age range studied was low: “While 9-10 is not too young to have disordered eating behaviors, additional age groups could have been studied too. For example, ages 11-12 years, 13-14 years. It would have also been useful to compare pubertal maturation, as 9-10 years is considered early for puberty.”
“More so than ages, I think pubertal maturation is a more appropriate variable to compare,” he pointed out.
Early intervention is key
Dr. Murray explained that “educating parents to [recognize] the signs of disordered eating behaviors in children is critical.”
“For instance,” he said, “it can be challenging to separate a binge eating episode from normal growth-spurt-related eating. Similarly, educating parents on how to talk to their children about body image, particularly among those who develop earlier than their peers, is essential.”
The research highlights the need for increased educational efforts for both parents and physicians and, perhaps, educators too.
Dr. Nahman agreed that these findings shine a light on the need for timelier and more precise prevention efforts:
“We need to develop significantly better interventions around being overweight/obesity, as dietary restrictions don’t seem to work that well and have such potential to harm. But above all, we need preventative work around body image and self-esteem and more research in this area.”
The study’s results can help to improve eating disorder prevention by highlighting who is most at risk. Increased screening may improve prevention.
For example, pediatricians and middle schools may choose to increase monitoring of children with high BMIs and children who begin puberty before their peers.
Dr. Murray advised parents to look at the National Eating Disorders Association website, as they provide educational materials on this topic.
As a starting point, parents, physicians, and educators must understand that boys face a similar risk to girls when it comes to disordered eating.
More research is needed on this important topic. However, by helping to improve awareness, disordered eating can be tackled in both boys and girls, with the aim of improving outcomes for all.
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