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Eating Disorders in Adolescents

Eating disorders (EDs) are complex illnesses that have significant health on the physical, psychological and social health of adolescents and children. We have had an increasing number of teens and children presenting for care to the Eating Disorder Team, Adolescent Medicine Service over the recent years. Anorexia nervosa is the most common restrictive eating disorder presenting to the team.

EDs are serious illnesses that can present with changes in behaviors and attitudes surrounding food, eating, exercise, and weight and can have a significant impact on the physical and psychological health of the patient. They are most commonly known to impact young women, but in fact, can affect anyone of any age or gender. Individuals with eating disorders may not appear thin; individuals with healthy weight or who are overweight can also have eating disorders. Hence, it is important to be aware of the warning signs for an eating disorder.

There is no single cause of EDs - the reasons are complex and vary widely from individual to individual. It is important to remember that eating disorders are severe illnesses and the affected individual did not choose to have the illness. Similarly, it is important for family members to understand that they did not cause the illness and are not to be blamed.

Early detection and treatment provides the best chance of a complete recovery and return to a healthy adolescent life.

Warning Signs of an Eating Disorder

  • Changes in food preferences (e.g. refusing to eat certain ‘fatty’ or ‘bad’ foods, cutting out whole food groups such as meat or dairy, claiming to dislike foods previously enjoyed, a sudden concern with ‘healthy eating’, or replacing meals with fluids)
  • Development of rigid patterns around food selection, preparation and eating (e.g. cutting food into small pieces, eating very slowly or only eating at specific times of the day)
  • Avoidance of eating meals, especially when in a social setting (e.g. skipping meals by claiming they have already eaten or have developed an intolerance/allergy to particular foods)
  • Lying about amount or type of food consumed or evading questions about eating and weight
  • Behaviours focused on food (e.g. planning, buying, preparing and cooking meals for others but not actually consuming; interest in cookbooks, recipes and nutrition)
  • Dieting behaviours (e.g. fasting, counting calories/kilojoules, avoidance of food groups or types)
  • Binge eating (e.g. disappearance or hoarding of food)
  • vomiting or laxative use (e.g. taking trips to the bathroom during or immediately after meals)
  • Rigid ‘black and white’ thinking (e.g. labelling of food as either ‘good’ or ‘bad’)

  • Behaviours focused on body shape and weight (e.g. interest in weight-loss websites, books and magazines, or images of thin people)
  • Development of repetitive or obsessive behaviours relating to body shape and weight (e.g. body-checking such as pinching waist or wrists, repeated weighing of self, excessive time spent looking in mirrors)
  • Dressing in layers to hide weight loss or stay warm
  • Pre-occupation with food, body shape and weight despite being at a healthy weight
  • Extreme body dissatisfaction
  • Distorted body image (e.g. complaining of being/feeling/looking fat when a healthy weight or underweight)
  • Sensitivity to comments or criticism about exercise, food, body shape or weight

  • Social withdrawal or avoidance of previously enjoyed activities
  • Excessive, obsessive or ritualistic exercise patterns (e.g. exercising when injured or in bad weather, feeling compelled to perform a certain number of repetitions of exercises or experiencing distress if unable to exercise)
  • Secretive exercise

  • Weight loss or weight fluctuations
  • Feeling cold most of the time
  • Changes in or loss of menstrual periods
  • Swelling around the cheeks or jaw, calluses on knuckles, or damage to teeth from frequent vomiting
  • Fainting or dizzy spells
  • Difficulty in concentration
  • Bloating or constipaion

  • Heightened anxiety around meal times
  • Depression, anxiety or irritability
  • Low self-esteem (e.g. negative opinions of self, feelings of shame, guilt or self-loathing)