Family treatment needed for eating disorders of youth

Abstract

When the American Academy of Pediatrics (AAP) released its clinical report “Identification and Management of Eating Disorders in Children and Adolescents” in the Jan. 2021 issue of Pediatrics, most families were preoccupied, as they still are, with COVID‐19. Providers who treat substance use disorder (SUD) are very familiar with the importance of family treatment, and eating disorders, which often cross over as comorbid, are no exception to the rule: involve the whole family. It's important to note that like SUD, eating disorders affect all races and genders. “For too long, eating disorders were considered a disease that afflicted mostly affluent white teenage girls,” said Laurie L. Hornberger, M.D., M.P.H., F.A.A.P., lead author of the report, written by the AAP Committee on Adolescence. “We know today that girls and boys of all ages, income levels and racial and ethnic groups may be struggling with eating disorders,” she said. “Our hope is to help counter the stigma they may experience and provide an environment for open nonjudgmental conversations.” Anorexia is a life‐threatening condition, and one of its signs is the inability to acknowledge the problem and its seriousness. One of the most promising approaches to treatment is a method that puts parents in charge of refeeding their child, with education, therapy, and support provided by a specially trained team. Some teenagers stuff themselves with food and then force themselves to vomit. Called “bingeing and purging,” the practice, if it continues for 3 months, results in a diagnosis of bulimia. But again, it's not simple. About half of all anorexics have episodes of bulimia at some time. Just like the young person who starves him or herself and wants to be thin, “the bulimic is dissatisfied with [his or her] body and obsessed with slimming down,” according to the AAP. The condition is accompanied by guilt and shame. Some girls take laxatives. They often have binges in secret. Like bulimia nervosa, people who are binge eaters consume enormous quantities of food in a short amount of time, then regret having done so. However, unlike bulimics, they do not purge themselves afterward, or fast, or exercise, or attempt in any way to compensate for the thousands of calories they've just ingested. This is why one in three teens who seek treatment for their weight are compulsive overeaters. Family‐based treatment (FBT) has emerged as the first‐line treatment for pediatric eating disorders, according to the AAP. It's effective and removes the guilt and shame which are so destructive in and of themselves. “Rather than dwelling on possible causes of the eating disorder, FBT is focused on recovery from the disease,” according to the AAP. An adaption of FBT is parent‐focused therapy, in which the clinician meets only with the parents. The patient has brief visits with a nurse for weight and acute mental health assessment but does not see the therapist. For all forms of eating disorders, families should not let shame intrude. Giving the child “agency” while at the same time making sure he or she is nutritionally safe is the parents' role. But even in the absence of a clinical diagnosis, it's a good idea to establish healthy habits rather than to focus on weight and dieting, according to the AAP. In a child who is developing or has an eating disorder, recommendations include more frequent family meals, discouraging weight talk in the home, closely monitoring weight loss in patients who are advised to lose weight, and promoting a healthy body image. This is reminiscent of much treatment for SUDs, in which focusing on the substance itself results in shame and does not reduce consumption or result in recovery. For the AAP report, go to Identification and Management of Eating Disorders in Children and Adolescents.