Adolescents are becoming more frequently affected by eating disorders, which are complicated illnesses. They have an incidence of up to 5 percent, which has significantly increased over the past three decades, and are the third most prevalent chronic illness among adolescent females. Anorexia nervosa, a form of the disorder in which food intake is severely restricted, and bulimia, a condition in which episodes of binge eating are followed by attempts to reduce the effects of overeating through vomiting, catharsis, exercise, or fasting, are the two main subgroups of the disorders that are recognised (bulimia nervosa). Both bulimia nervosa and anorexia nervosa can lead to considerable mortality as well as serious medical, psychological, and societal morbidity.
Despite the fact that adolescent eating disorders are the most common, papers in the scientific literature sometimes blend data from adolescent and adult samples or only focus on adult samples. When defining the diagnosis, course of treatment, or result of eating disorders, specific characteristics of teenagers and the developmental process of adolescence are frequently important factors to take into account. As a result, adolescents and adult eating disorder patients need to be treated differently and independently. This position statement, which expresses the agreement of many experts in adolescent medicine about the diagnosis and treatment of adolescents with eating disorders, tackles the important topics gleaned from the scientific literature.
DIAGNOSIS Teenagers may not fully fit the diagnostic criteria for eating disorders as outlined in DSM-IV (4). The application of those formal diagnostic criteria to adolescents is limited by the wide variation in the rate, timing, and magnitude of both height and weight gain during normal puberty; the absence of menstrual periods in early puberty along with the unpredictable nature of menses soon after menarche; and the lack of psychological awareness regarding abstract concepts (such as self-concept, motivation to lose weight, or affective states) due to normative cognitive development. Additionally, eating disorders may present at subclinical levels with clinical symptoms such pubertal delay, growth retardation, or the impairment of bone mineral acquisition.
In addition to excluding some adolescents with significantly abnormal eating attitudes and behaviours, such as those who regularly vomit or take laxatives but do not binge, the use of strict criteria may prevent the recognition of eating disorders in their early stages and subclinical form, which is necessary for primary or secondary prevention. Finally, even in the absence of formal criteria for an eating disorder, irregular eating behaviours may cause a considerable impairment in health. For all of these reasons, rather than relying solely on codified criteria, it is crucial to identify eating disorders in teenagers in the context of the numerous and varied characteristics of appropriate pubertal growth, adolescent development, and the eventual attainment of a healthy adulthood.
Position: Adolescent patients who engage in potentially harmful weight control methods and/or exhibit obsessive thoughts about food, weight, shape, or exercise should be evaluated for an eating disorder in clinical practise, not just those who match the predetermined diagnostic criteria. If the adolescent fails to achieve or maintain a healthy weight, height, body composition, or stage of sexual maturity for sex and age, eating disorders should be taken into consideration.
MEDICAL COMPLICATIONS Eating disorders have an adverse influence on every organ system. Although a patient’s physical signs and symptoms are mostly related to the methods of weight control used, the health care provider must take into account their frequency, intensity, and duration as well as the biological susceptibility provided by the patient’s sexual maturity. The majority of physical issues in teenagers with eating disorders seem to get better with nutritional therapy and eating disorder recovery, but some issues may be possibly irreversible. The long-term effects have yet to be clarified.
Growth retardation, if the disorder develops prior to the closure of the epiphyses, pubertal delay or arrest, and impaired acquisition of peak bone mass during the second decade of life, which increases the risk of osteoporosis in adulthood are medical complications in adolescents that may have an irreversible effect. These characteristics highlight the significance of medical management and continued observation by doctors who are familiar with typical teenage growth and development.
We support early intervention to prevent, reduce, or improve medical problems, some of which are life-threatening, just as we support early recognition of eating disorders through the use of broad developmentally appropriate criteria. Even if they do not strictly fit the definition of an eating disorder, adolescents who severely restrict their food intake, vomit, purge, or binge in any combination, with or without extreme weight loss, need to be treated.
Position: The barrier for intervention in adolescents should be lower than in adults because to the potential irreversible effects of an eating disorder on physical and emotional growth and development in adolescents, the danger of death, and the data indicating improved outcomes with early treatment. Until the adolescent exhibits a restoration to both physical and mental health, ongoing medical surveillance should continue.
NUTRITIONAL DISTURBANCES The intensity and persistence of disordered eating patterns are associated to nutritional abnormalities, which are a defining feature of eating disorders. Mineral, vitamin, and trace element abnormalities can happen but are typically not clinically identified. On the other hand, protein deprivation is particularly significant to pinpoint since these nutrients are essential for growth. Additionally, there is data suggesting that teenagers with eating disorders may be losing important tissue components, such as muscle mass, body fat, and bone mineral, during a time when these components should be dramatically increasing due to growth. The foundation of managing nutritional abnormalities in adolescents with eating disorders is a thorough and ongoing assessment of nutritional status.
Position: Teenagers with eating disorders should have their individual nutritional needs taken into account in the context of pubertal development and activity level during the evaluation and continuing therapy of nutritional abnormalities.
PSYCHOSOCIAL DISTURBANCES The adjustment to pubertal growth and completion of the developmental tasks required to become a healthy functional adult are both hampered by eating disorders that emerge in adolescence. At a time when families and peers should be offering an environment to encourage growth, social isolation and family issues start to appear.
Developmentally appropriate strategies should be used to address issues with self-concept, self-esteem, autonomy, separation from the family, the ability for intimacy, affective disorders (such as depression and anxiety), and substance misuse.
The presence of co-morbid mental diseases, such as anxiety, depression, dissociative, and behavioural disorders, should be assessed in all patients. The function of the family should be examined during both the evaluation and the treatment process because adolescents typically reside at home or interact with their families on a daily basis.
