Child and Adolescent Eating Disorder
The Incidence and prevalence of eating disorder (Anorexia Nervosa, Bulimia Nervosa, Obesity, Eating disorder NOS) has increased over last few decades. Awareness about its negative effect on Physical health (Diabetes, Hypertension, gastrointestinal Symptoms, etc) and mental health (Low self esteem, anxiety, depression, etc) is critical. Early detection and treatment is extremely important to avoid complications.
Epidemiological study indicated that eating disorders has dramatically increased in Children and Adolescent since 1950s. During the past decade Obesity has been on the rise accompanied by further emphasis on dieting and weight loss among Children and Adolescents. Of particular concern is eating disorder impacting children progressively at younger age and increased number of hospital admissions.
Medium of communication spread of information made the world as global village bridging the gap between differences in cultural values. It has its positive and negative effects. Minority communities and males who were usually not affected, eating disorder trend is on the rise among this population group as well.
Causative factors are multifactorial gene and environment. Especially genetic predisposition make the children and adolescent vulnerable to disorder activated at puberty (hormonal changes, etc), resulting producing all the associated symptoms of self image issues, low self esteem, lack of confidence, anxiety and depression etc. This kind of Feelings usually at tender age, can affect personality development and further complicated by expectation achievement mismatch struggle.
- 0.5 % Adolescent girls meets the Criteria for Anorexia Nervosa
- 1% to 2% Bulimia Nervosa
- 5%-10% all cases of eating disorder are Male.
- Sub threshold cases of eating disorder are between 0.8% to 14% depending upon the Diagnostic criteria used
- Anorexia Nervosa
- Bulimia Nervosa
- Eating disorder NOS ( elective eating, Food Avoidance Emotional Behavior Disorder, etc)
Major Risk Factors
- Genes (Genetic predisposition seems be activated during puberty and there is strong evidence of genetic-Environment interaction)
- Environmental stress
- Jobs requiring lean body habitus (Dancer, gymnastics, running, wrestling, dance, modeling)
- Dieting is a risk factor for disordered eating
- Neuroendocrine Role of Leptin In blood
- Physical hyperactivity and weight loss has also occurred in Animal Model studies.
- Caloric Restriction coupled with stress can lead to Bing-Eating and Purging.
Signs and Symptoms
- Anorexia Nervosa: Restricting eating, excessive use of laxatives, Excessive exercise to lose weight when already underweight which is less than 85% expected body weight.
- Bulimia Nervosa: Uncontrollable eating for 2 hours when it is not needed after satiety
- Obesity: Mild , Moderate or severely Overweight
- AN Less than 85% Expected Body WT
- BN uncontrolled eating for 2 hour pass satiety
- Diagnostic Criteria focus on Weight loss, Attitude, Behavior and Amenorrhea
- Under 13 years usually have co morbid Depression, Obsessive-Compulsive disorder and Anxiety disorder Less focused on Binging
- Abnormal body image lead to host of mental health Issues,
- Low self esteem
- Poor School and work Performance
- Poor social relationship etc
- Electrolyte Imbalance leading to Mental status change
- ECG Changes QTC Prolongation, repolarization abnormalities, MI, etc
- Structural brain changes
- Low Bone Mineral density
- Growth Retardation
- Gastrointestinal Symptoms and skin changes
- Endocrinological problems
- Psychoeudcation in School and
- Pedriatitions Office about Healthy eating and appropriate exercise
- Cultural approach to weight, Dieting, and body Image
- Programs for preventing Eating pathologies
- Health Insurance coverage inclusion of eating disorders
Stabilization and nutritional Rehabilitation is Priority
- Family Based treatment approach
- Cognitive Behavior Therapy
- SSRI for Co morbid Depression-Anxiety
- Atypical Antipsychotics for Disordered thinking
- Early Detection
- Family Involvement
- Appropriate Follow up
- Key To Success