Eating Disorders in the Pediatric Patient

Obesity is a nutritional problem that involves an increase in body weight and accumulation of excess fat, relative to lean body mass.

On the other hand, eating disorders are mental health disorders characterized by abnormal eating patterns that can negatively impact physical and mental health.

The two most common types are anorexia nervosa, which is a condition characterized by behaviors to prevent weight gain, like restricting the intake of food; and bulimia nervosa, which involves periods of binge eating followed by weight loss techniques like taking laxatives, diuretics, self-induced vomiting, or over-exercising.

Now, the causes of obesity and eating disorders are likely multifactorial, involving genetic, neurochemical, and sociocultural factors.

So, a family history of obesity or eating disorders increases the risk of developing these problems. As far as neurochemical factors go, obesity is associated with alterations in hypothalamic function and regulation of feelings of hunger and satiety, or the feeling of being full after eating.

Likewise, eating disorders are thought to be related to changes in brain function that regulate motivation, self-control, and reward, which can impact food intake.

Regarding sociocultural factors, pressure to lose weight, to have a socially defined body type, and partaking in activities that emphasize leanness, like modeling, ballet, gymnastics, and running, can increase the risk for eating disorders.

Obesity risk is increased in those who are sedentary and have limited access to healthy food options, most often due to low socioeconomic status or other environmental factors, like communities located in food deserts, or areas with limited access to fresh, quality food.

Now, obesity and eating disorders manifest as changes to the patient’s body mass index, or BMI, which is calculated based on their height and weight.

Generally, pediatric patients who are obese will have a BMI greater than or equal to the 95th percentile for their age and sex.

Other findings may include stretch marks on the skin and swollen or painful joints due to pressure from increased weight.

On the other hand, patients with anorexia nervosa usually present with a low BMI due to severe weight loss. Other common findings include a lack of a menstrual period, dry skin, brittle nails, thin hair, and muscle wasting.

Unlike anorexia nervosa, the BMI of patients with bulimia nervosa can be normal or elevated. Additionally, repeated vomiting can lead to erosion of dental enamel and formation of calluses on the knuckles, known as Russell’s sign, which can form when patients use their hand to induce vomiting.

Prolonged eating restriction or purging can lead to dehydration and depletion of electrolytes, like potassium, resulting in muscle weakness and even cardiac dysrhythmias.

Alright so, diagnosis of obesity and eating disorders begins with a history and physical examination, including anthropometric measurements like height, weight, and BMI.

Secondary causes of weight loss, like type 1 diabetes mellitus, and weight gain, like Cushing syndrome, should also be ruled out.

Okay, so treatment of obesity and eating disorders involves a multidisciplinary approach involving nonpharmacologic and pharmacologic measures.

Psychotherapy, like cognitive behavioral therapy, can be used to promote healthy eating patterns, form a new relationship around food, and support the patient during recovery.

For obesity, healthy dietary changes such as limiting sugary drinks, increasing intake of fruits and vegetables, and eating smaller portions are part of the treatment plan.

Additionally, patients with obesity should limit screen time and participate in physical activity several times per week.

For some patients, orlistat, a lipase inhibitor that limits absorption of dietary fat, may be prescribed. Bariatric surgery, a procedure that modifies the digestive system, can be used for certain adolescents who are severely obese.

Now, treatment for patients with eating disorders is focused on preventing complications of malnutrition and promoting weight gain.

While there are no medications specifically for eating disorders, medications used to treat related psychological conditions, like depression and anxiety, can be prescribed.

Okay, so if your patient is diagnosed with obesity, work with them to create a realistic plan that incorporates lifestyle modifications and environmental changes.

You’ll also provide nutrition education and monitor their progress toward their weight loss goal. For patients with anorexia nervosa or bulimia nervosa, you’ll monitor for complications associated with malnutrition, including anemia, fluid and electrolyte imbalances, and cardiac dysrhythmias.

And you’ll collaborate with the pediatric dietitian, and initiate enteral or parenteral feedings, as ordered. Lastly, for all patients with obesity or an eating disorder, be sure to offer them psychologic support and reassurance, and work with a therapist to provide individual and family-based counseling and behavioral therapy.

Alright, as a quick recap… Obesity is a nutritional problem that involves an increase in body weight and accumulation of excess fat, relative to lean body mass; whereas, eating disorders, like anorexia nervosa and bulimia nervosa, are mental health disorders characterized by abnormal eating patterns that can negatively impact physical and mental health.

The exact causes of obesity and eating disorders are likely multifactorial, involving genetic, neurochemical, and sociocultural factors.

Treatment involves a multidisciplinary approach involving nonpharmacologic and pharmacologic measures. Nursing care includes monitoring for complications, providing nutritional therapy, and offering psychological support.