Introduction

Eating disorders (EDs) are mental health issues in which someone uses food to cope with emotions and situations. Unhealthy eating habits may include overeating or undereating, as well as becoming obsessed about self-image. The most common eating disorders are anorexia nervosa, bulimia, binge eating disorder (BED), avoidant/restrictive food intake disorder (ARFID), and other specified feeding or eating disorders (OSFED). Anyone can develop an eating disorder, but teenagers and young adults are particularly affected. However, most people who suffer from an eating issue may recover with proper therapy.¹ 

In 2023, the prevalence of all EDs was more common in teenagers aged 17 to 19 than in those aged 11 to 16, being 4 times greater in teenagers assigned female at birth (AFAB) than those assigned male at birth (AMAB). It is crucial to increase awareness of these eating disorders among teenagers and their parents to provide early treatment and more empathy that can help reduce the stigma that is often associated with such disorders.

Understanding teenage eating disorders

EDs may affect people of different ages, ethnicities, body weights, and genders. They often manifest in teenagers or young adults, although they can also develop in childhood or later in life. Teenagers who suffer from tough life events or emotions that they can not cope with usually misuse eating to cope with what they suffer from. 

Therefore, it is important to address the feelings behind these disorders rather than the food. Moreover, these disorders are often overlapping, which means that someone could be diagnosed with a disorder in the beginning and then move into another diagnosis when their symptoms change.

Factors contributing to teenage eating disorders

The importance of knowing the risk factors reflects in the prevention of EDs and discovering cases earlier, thus leading to better outcomes and support. Eating disorder risk factors are categorised into biological, psychosocial, and physiological factors. Here’s a link to a table with all the risk factors and the related eating disorders that are caused by them. Generally, dieting at severe levels was found to be a major risk for developing EDs, especially in teenage girls. Moreover, anorexia nervosa and bulimia nervosa are linked to perfectionism and low self-esteem.²

When taking a deeper look into these risk factors, you can conclude that most eating disorders have a psychosocial background such as parents having a perception that their child is overweight,  which in turn is reflected in their child’s psychological state and affects their emotions. 

Additionally, in EDs like anorexia nervosa, bulimia nervosa, and binge eating, children feel the urge (impulsiveness) to eat without being in control of themselves. There is significant evidence indicating genetic risk in the development of EDs, with the risk of developing anorexia nervosa being the highest.³

Identifying signs and symptoms

Anorexia nervosa 

This is one of the most common EDs in teenagers, where the affected person always sees themselves as overweight. Therefore, they avoid food and engage in severe exercise, thus leading to physiological changes to the body's electrolytes and hormones such as a decrease in potassium level, which affects the heart and blood pressure. Additionally, when these individuals try to lose weight by taking laxatives, this results in more disturbance in their body electrolytes which can be fatal.²

The following are the signs and symptoms of anorexia nervosa:

• Severely restricted diet
• Low body mass index or underweight
• Delayed puberty, disturbed menses, or infertility
• Decreased blood pressure and slow pulse
• Mild anaemia and wasted muscles, causing weakness and feeling tired all the time

Bulimia nervosa 

It is somehow similar to anorexia nervosa; however, the affected individual would weigh more than in anorexia. A very distinguishing point is that in bulimia nervosa, the person eats excessively and then forces themselves to vomit or overuse laxatives.²

Bulimia nervosa signs and symptoms include:

• Sore throat and inflammation
• Reflux disorder due to repeated vomiting
• Decayed tooth enamel and increased sensitivity as a result of exposure to stomach acidity
• Electrolyte disturbances such as low sodium or potassium, which might affect the heart

Binge eating disorder (BED)

When talking about BED, we should mention that it is closely related to individuals severely under stress, where they compensate by eating food in large amounts and then feeling guilty about it. However, it is not followed by episodes of vomiting and the affected person would not exercise to decrease weight.²

Its symptoms include the following:

• Eating large amounts of food even when not hungry, until full
• Feeling guilty, ashamed, and distressed about eating
• Repeated trials of losing weight without weight loss

Other EDs 

These include disorders such as avoidant restrictive food intake disorder (ARFID) which are common among children.² Many children have periods of fussy eating, but a kid with ARFID does not consume enough calories to grow and develop appropriately, and an adult with ARFID does not consume enough calories to sustain basic bodily functions. Symptoms include the following:

• Decreased appetite or interest in eating
• Drastic weight loss
• Picky eating that worsens with time, avoiding foods with an unpleasant colour, taste, texture, or odour
• Upset stomach, abdominal discomfort, or other gastrointestinal disorders with no recognised cause.

Prevention and intervention strategies

A recent study of ED patients found that there is an average delay of 5.28 years between symptom onset and treatment seeking.⁴ One element is thought to contribute to this delay which is health professionals' lack of understanding of indications of disordered eating habits, meaning that EDs frequently go undiagnosed by treating doctors. Another element is the stigma that is attached to such disorders in addition to the inadequacy of parents' knowledge of these disorders.

Several prevention strategies can be implemented to hinder the prevalence of EDs, as listed below: 

• Universal prevention programs in schools, aiming at educating students on various EDs, building self-esteem, promoting positive body image and encouraging healthy eating habits
• Selective prevention programs for children and teenagers who are at risk of developing EDs, by providing education on the effects of extreme dieting, providing information on healthy balanced dieting, and reducing the relevance of appearance and weight in determining one's success, pleasure, and self-worth
• Indicated prevention for children and teenagers who have symptoms of EDs but do not meet diagnostic criteria, similar to those described above under selective prevention programs. 

However, recommended therapies can also help someone with an eating disorder learn how to eat normally and maintain a healthy weight. At this stage, therapies aim at reducing the signs and symptoms of EDs.     

Treatment options

Whether you start with your primary care physician or a mental health professional, you will most likely benefit from a referral to a team of eating disorder specialists.^6,7 Members of the treatment team might include the following people: 

• A dietitian for meal planning and food education
• A psychiatrist to offer psychotherapy plans such as cognitive behavioural therapy (focused or in a group) or family-based therapy to provide you with the help needed ⁹
• Medical or dental specialists to treat the physical complications or dental problems that happened as a result of your eating disorder

The treatment journey is mostly started at home with ongoing appointments with the treatment team. However, you may need to be hospitalised if your general health is greatly affected or you have life-threatening physical health problems.⁸ Listed below are some of the reasons for hospitalisation:

• Electrolyte disturbances such as decreased potassium or sodium levels
• Abnormal heartbeats reflected in abnormal electrocardiogram (ECG) readings
• Changes in pulse and blood pressure
• Very low body mass index
• Presence of suicidal thoughts or suicidal attempts

Medications cannot treat an eating disorder. They work best when paired with psychiatric treatment. In children and teenagers, antidepressants and antipsychotics are not commonly used to treat EDs characterised by binge eating or bulimia nervosa; however, they could be given for anorexia nervosa at low body weights. They decrease the anxiety or sadness that might be the root of the disorder. Moreover, you may also require drugs to treat physical health issues caused by your eating disorder.⁵

Last but not least, check-ups are important to ensure ongoing support and to monitor the progress of improvement or change plans according to the response.^7,8

Advice for parents of teenagers diagnosed with eating disorders

• Talk to your children about their eating disorder. If they resist, keep trying as they might feel insecure or afraid to talk about it
• After they talk and when  they are in treatment, try to prepare their meal plans together
• All the family should try to be involved in your child’s treatment by staying positive and encouraging as well as trying not to focus too much on food and enjoying conversations during mealtime
• Increase your knowledge about EDs
• Be a role model by implementing a balanced diet as your lifestyle
• Get help yourself, and try to be involved in group sessions that might support you along with similar families that have children with EDs. Services for  people with eating disorders can be found here         

Summary

EDs in teenagers can be stressful to both them and their carers. Common eating disorders include anorexia nervosa, bulimia, BED, ARFID, and OSFED. Teenagers and young adults are particularly vulnerable, with EDs being more frequent in those aged 17 to 19. 

Severe dieting, perfectionism, low self-esteem, and genetic predisposition increase the incidence of teenage eating disorders. 

Prevention options include school-wide prevention programmes, selective prevention for children and teenagers at risk of developing EDs, and recommended prevention for children and teens who have symptoms but do not satisfy diagnostic criteria. 

Food planning by dietitians, psychotherapy plans, and consultations with medical or dental professionals are among the available treatment choices. The treatment process normally begins at home with continuous consultations, although hospitalisation may be necessary if the individual's overall health is severely impacted if they have life-threatening physical health concerns.

Knowing that your child has an eating issue may be heartbreaking and overwhelming. However, parents can help their children begin to heal, even if they are not yet fully prepared. Learning the facts, addressing their experiences, and supporting them to seek care can help a youngster heal.