Treatment of Eating Disorders in Children, Adolescents, and Young Adults

Martin Fisher, MD* 1. *Chief, Division of Adolescent Medicine, Schneider Childrens Hospital, North Shore-Long Island Jewish Health System; Professor of Pediatrics, New York University School of Medicine, New York, NY After completing this article, readers should be able to: 1. Describe the demographics and pathogenesis of eating disorders. 2. Delineate the criteria for the diagnosis of anorexia and bulimia nervosa. 3. Detect the presence of an eating disorder and evaluate its severity. 4. Outline the medical complications of eating disorders. 5. Organize a treatment or referral plan for patients who have eating disorders. A 16-year-old girl who initially was underweight has been dieting and lost 20 pounds in the last 3 months. A 19-year-old girl has been sent home from college because she was found vomiting every night in her dormitory room. A 14-year-old boy has been exercising 3 hours a day and eliminated all fat from his diet to “increase my muscle mass and decrease my fat.” An 11-year-old girl has grown 2 inches but gained no weight since her last check-up 1 year ago. A 15-year-old girl is found to have empty boxes of laxatives hidden under her bed but denies they are hers. In January 2003, the American Academy of Pediatrics (AAP) published a policy statement entitled “Identifying and Treating Eating Disorders.” Written by the Committee on Adolescence, it outlined the roles of the pediatrician in the identification, evaluation, and management of eating disorders in children, adolescents, and young adults. The statement provided recommendations for treatment in outpatient, inpatient, and day programs and suggested roles for the pediatrician in the areas of prevention and advocacy. Also included were some specifics relevant to particular recommendations, but not a detailed overview of the topic. This article provides that overview and, together with the policy statement, offers a state-of-the-art review of the eating disorders anorexia nervosa and bulimia nervosa. Included in this review are discussions of diagnosis and demographics; pathogenesis and presentation; evaluation and complications; medical, nutritional, and psychological management; and prognosis and prevention. It …