Today’s post is about eating disorders. It’s meant for families with someone already diagnosed. Maybe they’re starting to think about eating disorder recovery. So, before I go on: if you think you or your child has an eating disorder, please see your physician. If you’re not sure, please see your physician. In the meantime, The National Eating Disorders Association has a helpline and screening tool. And, if you’d rather not read about eating disorders, please skip this post.
For many, eating disorder recovery is a long process. For children and teens, family support can make a big difference. I chose this topic today hoping that families may learn information that will help them support someone with an eating disorder.
Much of the information in this post comes from the Pediatrics article from January 2021.
This post will review a few highlights that I don’t think get enough attention or that can be easily misunderstood. I’ll go over who is affected. I’ll also cover some oft-overlooked symptoms and share some resources for more information.
Which diagnoses are eating disorders?
The criteria for diagnosing eating disorders has changed in the past few years. Below is a list of diagnoses that all fall under the eating disorder umbrella. However, it’s beyond the scope of this article to define each one. One thing I’d like to make clear is that many diagnoses are life-threatening. All should be treated with care and sensitivity.
- Anorexia nervosa
- Bulimia nervosa
- Binge-eating disorder
- Avoidant/restrictive food intake disorder
- Other specified feeding or eating disorders
Why is a general pediatrician writing about eating disorders? Aren’t there specialists?
A multi-disciplinary team can see people with eating disorders. The team may include specialists in adolescent medicine, nutrition, and psychology. However, these children often see their pediatrician or family practice physician first. For teens, these initial primary care visits can include confidential time with just the physician. Ideally, these confidential conversations are followed by a joint conversation with the patient, parent, and physician all present.
I hope this post is something a parent can read after the appointment. Maybe their mind is still reeling. I’ve learned that many parents (and teens) have different perceptions of eating disorders. So, I’m putting this out there just to add a few extra pieces of information.
Obviously, this is not medical advice. Anything a child’s actual physician advises overrules anything written here. Of course.
Anyone can have an eating disorder.
Some used to think that eating disorders only happened to certain groups of people. This meant specific populations, ethnicities, or socioeconomic classes. We now know more. In reality, anyone can be affected, including all ethnic groups.
(I say this in case someone thinks their child doesn’t fit the expected “eating disorder stereotype.” The truth is there is no one “type” of person with eating disorders).
According to the Pediatrics article, a study of college students showed that transgender students had higher rates of eating disorder diagnoses (self-reported).
In another study, one third of children with type 1 diabetes engaged in behavior associated with eating disorders (including binge eating or excessive exercise). This can dramatically impact their diabetes control.
Eating disorders and eating disorder recovery can affect every organ system.
I’m not going to list all the parts of the human body and how eating disorders can affect every one of those parts. Everything from hair to heart to kidneys to bones. Here, I’ll highlight a few that may affect how we parent a child with an eating disorder.
Again, not every person with an eating disorder has every listed symptom. These are just possible complications. I will also note, that with proper treatment many are reversible.
Eating disorders affect cognition.
We now know that decision-making and thinking clearly are impacted by many eating disorders. It is literally part of the illness. Why does this matter? I’ve seen parents lovingly frustrated that their ill teen doesn’t “get it.” They think their child doesn’t seem to care enough or process what is happening. Or, the adolescent may not really understand what they need to do in order to recover. This lack of understanding is not just common cluelessness. It is actually a symptom of the disorder itself.
I hope knowing this can lead to more patience. I hope it also emphasizes that many teens need a lot of support early in their illness. They need their parents (for example) to help care for them as they heal.
Vague stomach discomfort can be part of an eating disorder.
Children and teens with restrictive eating (where they severely limit how much they eat), may feel vague bloating or nausea. This is because their gastrointestinal (GI) system has slowed down. It takes longer for food in their stomach to empty into the intestines.
I mention this because I’ve seen patients who say they just don’t feel like eating. And again, parents may think their teen is only trying to avoid eating.
Of course, every individual is different. For some children and teens, though, they really feel uncomfortable. The important point is that with regular eating (under the guidance of medical care), these uncomfortable symptoms can resolve. With eating, they begin to feel like eating.
Allow me to emphasize that last point. If someone has an eating disorder and is malnourished, they must follow their medical team’s advice as they heal and resume regular eating. There are dangerous complications (“refeeding syndrome”) if someone has been starving for a long time and is too-aggressively fed.
Eating disorders can affect growth and puberty.
Depending on the age of the child, an eating disorder can affect when the child goes through puberty. It can affect how tall they grow. I point this out as it’s one of the most physically noticeable complications. It can be a dramatic sign of how much someone’s body is affected.
Eating disorders may affect teeth.
This varies too, but teeth are often overlooked amidst everything else going on. Patients should continue regular dental care and consider informing the dentist about the diagnosis. (This is not only disorders that include vomiting).
Again, every organ system can be involved with eating disorders and eating disorder recovery.
As I mentioned, the list above is far from complete. Many of the complications are even more serious. Other more life-threatening complications are best discussed on an individual basis with each child’s physician.
The journey to recovery from an eating disorder varies.
Treatment depends on the person and on available resources. I want to share a few pieces of information for a parent to keep in mind as they navigate the long road of healing and treatment. (Again, these notes are for someone already diagnosed and following the advice of their medical care team).
Family Based Treatment
First, a “family based treatment” (FBT) approach is considered the first-line treatment. It’s not available everywhere. I mention it here in case those words floated around during an appointment. This approach, by definition, includes family members (parents, for example) as integral parts of the treatment team.
Residential Treatment Facilities
Second, the Pediatrics article reminds families (and providers) to be cautious if and when selecting any residential treatment facility. Many are for-profit. Many claims about how effective they are can be misleading. This link from The National Eating Disorders Association (NEDA) has some suggestions and questions to ask when evaluating treatment.
Paying for Treatment of Eating Disorders
Lastly, insurance coverage for eating disorders treatment varies a lot from state to state. It also varies from one insurance policy to another. I imagine it can feel overwhelming. NEDA also has information to may help navigate the intricacies.
If your child has already been diagnosed with an eating disorder, please continue to follow their team’s advice. It’s worth remembering that every part of the body may be affected by their illness, including cognition, the GI system, and teeth.
When navigating treatment options, The National Eating Disorders Association has excellent resources.