Yasmine Deol, MD

Food is essential for life, yet our relationship with it can be complex and personal. Many factors influence how we interact with food and how it shapes our overall well-being. A positive relationship fosters a healthy lifestyle however a negative relationship can lead to poor nutrition and mental well-being. Disordered eating encompasses behaviors that interfere with daily functioning, growth, and development. These patterns start subtly, perhaps as an intent to “eat healthier” or “lose a few pounds.” However, there’s a delicate line and these behaviors can escalate quickly from health-conscious choices to disordered behaviors. These can be influenced by psychosocial factors, including trauma, family stress, and the misconception of equating thinness with worth.

Why Early Attention to Disordered Eating Matters

Eating disorders are among the most lethal mental health conditions, with severe repercussions for both individuals and their loved ones. Just as chest pain raises red flags in a clinician’s mind, disordered eating patterns require close monitoring. While not all disordered behaviors evolve into full-fledged eating disorders, persistent patterns can potentially meet the DSM criteria for severe conditions like anorexia nervosa, bulimia nervosa, or Avoidant/Restrictive Food Intake Disorder (ARFID). 

Identifying Disordered Eating Patterns in Children and Adolescents

The American Academy of Pediatrics emphasizes the importance of screening for eating disorders during annual visits and sports physicals. All preteens and adolescents should routinely be assessed for eating habits, weight concerns, and body image issues. Screening tools such as the SCOFF questionnaire, Eating Disorder Screen for Primary Care (EDS-PC/ESP), and Adolescent Binge Eating questionnaire may help identify early symptoms even though these tools are more validated for adults.

A comprehensive assessment that includes medical, nutritional, and psychiatric history should be done if there are any warning signs of disordered eating. Some early warning signs include:

General 

• Weakness, fatigue, and reduced energy 
• Presyncope or syncope episodes 
• Preoccupation with weight and appearance 
• Rigid “healthy” or “clean” diet plans 
• Secrecy around food choices and eating behaviors 
• Rigid exercise routines

Physical 

• Serial weight, height, and BMI on growth chart- notice any fluctuations or inability to meet age-appropriate standards
• GI complaints (eg- constipation, abdominal pain, nausea, frequent heartburn)
• Cardiorespiratory signs- heart palpitations, bradycardia at rest, dyspnea, edema 
• Endocrine signs- Menstrual irregularities, bone fractures, hypoglycemia signs 
• Dermatological- lanugo, hair loss, brittle hair and nails, scars on the back of hand, brittle hair and nails 
• Neurological- seizures 

Psychological or Behavioral

• Depressive or anxiety symptoms 
• Mood swings
• Memory loss 
• Insomnia 
• Substance Use 

Case Example:

Jack, a 15-year-old soccer player, visits his pediatrician for a sports physical. His mother mentions his newfound focus on fitness. Jack explains he’s trying to “get lean” for his sport, by avoiding carbs and foods he considers “unhealthy.” He often skips snacks, even when he’s hungry, to maintain control over his weight. The pediatrician noticed that Jack’s BMI had dropped slightly, and his pulse is a bit slower than expected. When asked, Jack admits he feels anxious about breaking his “food rules,” such as avoiding sugars or fats. His mother also shares that he sometimes eats separately to stick to his strict diet.

Recognizing signs of a possible disordered eating pattern, the pediatrician educates Jack on the importance of balanced nutrition for his growth and athletic performance. She recommends a dietitian who works with young athletes and schedules a follow-up to monitor his health and support more flexible eating habits.

Jack’s dedication to fitness appears positive but reveals deeper issues with restrictive behaviors and rigid food rules. This case highlights the need to explore seemingly healthy goals, like fitness, when they lead to inflexible routines or anxiety around food.

Pediatricians play a crucial role in identifying early signs of disordered eating. Early intervention can significantly alter its course. These behaviors rarely stem from conscious choice but rather from a need for control or perfectionism under stress. Promoting self-acceptance and healthy coping strategies is key to prevention and recovery.

Author Profile:

Yasmine Deol, MD 
Child & Adolescent and Adult Psychiatrist
Secretary, New Jersey Council of Child and Adolescent Psychiatry

References

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2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. DSM-5-TR. American Psychiatric Association Publishing; 2022. doi:10.1176/appi.books.9780890425787
3. Eating Disorders: A Guide to Medical Care- AED Report 2021. Academy for Eating Disorders
4. Hornberger LL, Lane MA, THE COMMITTEE ON ADOLESCENCE, et al. Identification and Management of Eating Disorders in Children and Adolescents. Pediatrics. 2021;147(1):e2020040279. doi:10.1542/peds.2020-040279
5. US Preventive Services Task Force. Screening for Eating Disorders in Adolescents and Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2022;327(11):1061-1067. doi:10.1001/jama.2022.1806