AAP Voices Blog

As physicians who are naturally concerned about the negative health effects that “excess” pounds can cause, we may reflexively praise a teen patient’s weight loss. But we should stop and think before we do, especially now.

Since my early years of medical school, I have been passionate about the care of patients with eating disorders. This goal led me to pursue a relatively unpopular fellowship among pediatricians: adolescent medicine. During this period of my training, I have gained the clinical knowledge and experience in caring for complex children and adults with eating disorders under the mentorship of experts in the field.

What I didn’t expect during my training was the extent of the need for eating disorder treatment services. When the pandemic caused widespread shutdowns in 2020, many of the medical and mental health providers who regularly care for patients with eating disorders got the sinking feeling that we were about to get busier.

Everyone was experiencing many of the things we know eating disorders thrive on: isolation, uncertainty, loss, and fear, to name a few.

For these reasons, it was not a surprise that after a short lull in patient intakes at the onset of the pandemic, our referrals increased, as did those of our colleagues across the country. The National Eating Disorders Association experienced an increase in calls for help, and the increase in patient volume has been documented numerous times in the newly emerging medical literature.

I’ve always been excited about education and outreach for providers who may interact with patients with eating disorders. Recently, my colleagues and I have seen more and more pediatricians reach out for advice on how to recognize eating disorders in their patients and get them the help they need.

“Despite the stereotypes in popular culture and media, people of any gender, race, socioeconomic status, or age can suffer from an eating disorder.”

While these diseases can be difficult to detect for both patients and families, here are some general principles that can be beneficial to keep in mind:

• Any deviation from someone’s growth trajectory should be an indication for further investigation into eating patterns. Each of us has weight bias, and many providers jump to praise someone when they lose weight, especially if they are on the higher end of their growth curve. While concern for obesity seems to dominate the public narrative, many of us are conditioned to react positively to weight loss. However, it’s important to gather information on how and why that weight loss occurred, as weight loss can be a symptom of an eating disorder or another underlying diagnosis that needs to be identified and addressed. Furthermore, a patient at any weight can suffer from medical complications of an eating disorder.
• While there can be signs of an eating disorder on a physician exam, vitals and laboratory workup do not tell the whole story. When gathering information about someone’s relationship with food and exploring the possibility of someone having an eating disorder, it’s important to remember that objective measures, such as vital signs and laboratory markers, are often normal. This is very common, as the human body is amazing at compensating for even severe malnutrition. It is important for providers and patients to know that the absence of vital sign or laboratory abnormalities does not indicate that an individual’s disease is not severe.
• Anyone can be affected. Despite the stereotypes in popular culture and media, people of any gender, race, socioeconomic status, or age can suffer from an eating disorder. It is imperative to recognize signs of an eating disorder in anyone.
• Use care with words and actions about weight or dieting. Dieting is a major risk factor for an individual developing an eating disorder. It can be helpful for important adults in a child’s life to model language that is weight-neutral and avoid overly focusing on caloric intake or weight loss.

There are a number of resources available to help pediatricians assist patients and families who are affected by eating disorders, such as the Medical Care Standards Guide as published by the Academy for Eating Disorders and the National Eating Disorder Association.

The pandemic has been an exceptionally stressful time for many adolescents. It’s important to be on the lookout for signs of eating disorders and negative body image and to speak sensitively to teens about healthy living, both physical and mental.

*The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.