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ABSTRACT: The hallmarks of an eating disorder are disturbed eating behaviors (eg, binge eating, compulsive eating, and purging), dissatisfaction
with body image, and medical or psychiatric comorbidities. Certain
factors such as dieting, parental weight-related teasing, and family meal
frequency influence the emergence of disordered eating. Depressive and
anxious symptoms also contribute to eating disorder pathology. Nutrition
and medical evaluation is of equal importance to psychological assessment. Routine screening of children and teens of varying sizes will increase
recognition of eating disorders and improve clinical skills and confidence.
Collaboration with additional providers early on is essential for effective
treatment of obese children.
DOMINIQUE R. WILLIAMS, MD
Childrens Hospital of
The Kings Daughters
DIAGNOSTIC CRITERIA
FOR EATING DISORDERS
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Morning anorexia
Increased appetite in the evening
Difficulty in falling asleep
Patients can have amnesia for night eating
DSM-IV-TR, Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision.
february 2012
In a smaller study, Eddy and colleagues6 investigated disordered eating and mental illness in children and
adolescents seeking treatment in the
Optimal Weight for Life pediatric
weight management program at Childrens Hospital Boston. Exclusion
criteria were psychotic disorders, developmental disorders with cognitive
impairment, and obesity-related disorders associated with mental retardation. After 18 months of recruiting,
122 participants met the inclusion criteria. Participants and their parents
received compensation for their time
and participation.
Researchers used multiple inter views, inventories, scales, and
questionnaires to evaluate patients
for eating disorders, mood and anxiety disorders, psychopathology, and
other risk factors. The results of the
questionnaires and statistical analysis revealed a positive association
between eating disorder pathology
and depressive and anxious symptoms (ie, depression, generalized
anxiety, and separation anxiety). A
teasing experience, thin-ideal internalization, and decreased per fectionism all increased the possibility
of an eating disorder, having an elevated negative af fect. Of special
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note, 10 patients (8.2%) met the criteria for an eating disorder while at
least one-third disclosed recent
binge eating. Researchers also suggested that over weight patients
with disordered eating or binge eating have a poorer prognosis for
treatment.
ASSESSMENTS FOR
OVERWEIGHT AND OBESITY
Adolescent girls
(n = 6022)
Adolescent boys
(n = 4518)
Purging
219 (3.6)
30 (0.7)
Binge eating
426 (7.1)
90 (2.0)
Obese or overweight
1019 (17.4)
1040 (24.6)
Weight concern
2.4 (1.1)
1.6 (0.8)
1.9 (0.7)
1.3 (0.5)
1.3 (0.6)
1.2 (0.6)
4.8 (2)
5.2 (1.7)
3.1 (0.8)
3.2 (0.8)
2316 (38.5)
719 (15.9)
Maternal dieting
4104 (68.2)
2746 (60.8)
Outcomes, No (%)
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Use
10 - 15 min
Completed by parent
10 min
Completed by parent, child
Age rangea
5 - 7 y
Time to administera
10 min
Completed by child
2. Do you ever feel that when you start eating you just cant stop?
3. Do you ever eat because you feel bad, sad, bored, or any other mood?
4. Do you ever want food as a reward for doing something?
5. Do you ever sneak or hide food?
6. How long have you been doing this?
7. Do you ever do anything to get rid of what you ate?
a
From The California Evidence-Based Clearinghouse for Child Welfare Web site. Available at: www.cebc4cw.org/assessment-tools.19
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14. Ozier AD, Henry BW; American Dietetic Association. Position of the American Dietetic
Association: nutrition intervention in the treatment
of eating disorders. J Am Diet Assoc. 2011;111:
1236-1241.
15. Marcus MD, Kalarchian MA. Binge eating in
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16. Rome ES, Ammerman S, Rosen DS, et al.
Children and adolescents with eating disorders: the
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17. Wadden TA, Volger S, Sarwer DB, et al. A twoyear randomized trial of obesity treatment in primary care practice [published online ahead of print
November 14, 2011]. N Engl J Med.
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overweight and obesity. Pediatrics. 2007;120:
S254-S288.
19. The California Evidence-Based Clearinghouse
for Child Welfare Web site. Screening and
Assesment Tools for Child Welfare. Available at:
www.cebc4cw.org/assessment-tools. Accessed
November 18, 2011.
20. Shapiro JR, Woolson SL, Hamer RM, et al.
Evaluating binge eating disorder in children: development of the childrens binge eating disorder scale
(C-BEDS). Int J Eat Disord. 2007;40:82-89.
www.dsm5.org/ProposedRevisions/Pages/Default.
aspx. Accessed November 13, 2011.
4. Decaluw V, Braet C. Assessment of eating disorder psychopathology in obese children and adolescents: interview versus self-report questionnaire.
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5. Desocio JE, Otoole JK, Nemirow SJ, et al.
Screening for childhood eating disorders in primary
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6. Eddy KT, Tanofsky-Kraff M, Thompson-Brenner
H, et al. Eating disorder pathology among overweight treatment-seeking youth: clinical correlates
and cross-sectional risk modeling. Behav Res Ther.
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7. Haines J, Kleinman KP, Rifas-Shiman SL, et al.
Examination of shared risk and protective factors
for overweight and disordered eating among
adolescents. Arch Pediatr Adolesc Med. 2010;164:
336-343.
8. Hamilton JD. Eating disorders in preadolescent
children. Nurse Pract. 2007;32:44-48.
9. Bean MK, Stewart K, Olbrisch ME. Obesity in
America: implications for clinical and health
psychologists. J Clin Psychol Med Settings. 2008;
15:214-224.
10. Haines J, Neumark-Sztainer D. Prevention
of obesity and eating disorders: a consideration of
shared risk factors. Health Educ Res. 2006;21:
770-782.
11. Tanofsky-Kraff M, Yanovski SZ. Eating disorder or disordered eating? Non-normative eating
patterns in obese individuals. Obes Res. 2004;12:
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12. Zametkin AJ, Zoon CK, Klein HW, Munson S.
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13. American Academy of Pediatrics. Policy Statement: identifying and treating eating disorders.
Pediatrics. 2003;111:204-214.
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