Eating disorders and obesity

by

Richard Kreipe, Sarah Welsh

• LAST REVIEWED: 30 March 2017
• LAST MODIFIED: 30 March 2017
• DOI: 10.1093/obo/9780199791231-0181

Introduction

Eating disorders include a variety of conditions in which unhealthy patterns of eating and weight control habits (excessive exercise, vomiting, or laxative abuse) can lead to significant medical, psychological, and social problems. Eating disorders typically are classified as mental disorders, although the vast majority of cases occur in white, adolescent females from middle- to upper-income families for whom the eating disorder represents an attempt to cope with normal developmental challenges of adolescence, such as puberty, autonomy, identity, and socialization. In addition, mounting evidence points to eating disorders as being “brain circuit disorders” that are heavily influenced by the internal and external biological, psychological, and social environmental factors related to the developmental process of childhood and adolescence. Thus, eating disorders may be framed more accurately as “developmental,” rather than “mental,” disorders. In unusual cases in which the onset of an eating disorder occurs in adulthood, struggles often still are grounded in issues related to autonomy, identity, and socialization that were unresolved during adolescence. Obesity, which is defined as the presence of an excessive amount of body fat and is usually determined by imperfect proxy measures of body weight corrected for height such as the body mass index (BMI), is not considered a mental health condition, although it can be both the cause and the result of mental health problems. As a relatively new phenomenon—arising in the last quarter of the 20th century—childhood obesity remains a very complex condition that is difficult to treat and represents a major public health threat worldwide. This article will cover the medical aspects of these conditions; however, for a broader, more sociocultural approach, please see the companion entries on Food and Body Image.

General Overviews

Both the United States and the United Kingdom have impressive standards and guidelines for the diagnosis and treatment of eating disorders. The Diagnostic and Statistical Manual of Mental Disorders DSM-IV Text Revision (American Psychiatric Association 2000) is published in the United States. The extensive, clinically oriented guidelines Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders is published in the United Kingdom (National Institute for Health and Care Excellence, UK 2004). In a pediatric serial publication that focuses on in-depth exploration of common problems, Rome 2012 provides an excellent, concise monograph on a wide range of issues related to diagnosis, management, and prevention of eating disorders in children and adolescents. Rosen and American Academy of Pediatrics Committee on Adolescence 2010 published official guidelines for the management of eating disorders in primary care. Canada tends to have a lower ratio of specialists to generalists; Findlay, et al. 2010 produced guidelines for community physicians rather than specialists, which were published through the Canadian Pediatric Society. Barlow and the Expert Committee 2007 was one of the first attempts to lay out guidelines for the prevention and treatment of obesity in children, and the monograph was written collaboratively with a number of US-based entities. Two other excellent overviews are in the literature. Although UK-based, Lakshman, et al. 2012 published an overview in the US publication Circulation, whereas Han, et al. 2010 is part of a US team that published in the UK publication The Lancet. The former is focused on early childhood obesity with an emphasis on prevention. The latter takes a broad-range global perspective on childhood obesity from a systems-based view, down to the individual/family level.

• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. 4th ed., text rev. Washington, DC: American Psychiatric Association, 2000.

  For the past four decades, the “gold standard” for the classification of psychiatric diagnoses into distinct clinical categories or entities, based on available scientific data or expert opinion in the absence of definitive studies. Concerns regarding lack of attention to specific issues of children are being addressed in the DSM-IV.

• American Psychiatric Association. “Treatment of Patients with Eating Disorders, Third Edition.” American Journal of Psychiatry 163, Suppl. 7 (July 2006): 4–54.

  A comprehensive review of the evidence of treatment methods for eating disorders and authoritative treatment guidelines for different forms of eating disorders, particularly anorexia, bulimia, and binge eating. It covers patients of all ages. Essential for practitioners and health-care professionals.

• Barlow, Sarah E., and the Expert Committee. “Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report.” Pediatrics 120, Suppl. 4 (2007): S164–S192.

  DOI: 10.1542/peds.2007-2329C

  Comprehensive summary of recommendations to prevent, assess, and treat child and adolescent overweight and obesity published by the American Academy of Pediatrics, representing a collaborative effort of fifteen professional organizations and nineteen experienced clinicians and scientists. Emphasis on staged, individualized approach and need for community-level interventions.

• Findlay, Sheri, Jorge Pinzon, Danielle Taddeo, Debra K. Katzman, and the Canadian Paediatric Society Adolescent Health Committee. “Family-Based Treatment of Children and Adolescents with Anorexia Nervosa: Guidelines for the Community Physician.” Paediatric and Child Health 15 (2010): 31–40.

  The Canadian Paediatric Society position paper emphasizing the importance of the community physician in recognizing and treating pediatric eating disorders using a family-based approach, in which medical visits occur regularly and parents receive feedback at every visit in a working partnership with the physician to determine action steps.

• Han, Joan C., Debbie A. Lawlor, and Sue Y. S. Kimm. “Childhood Obesity.” Lancet 375 (2010): 1737–1748.

  DOI: 10.1016/S0140-6736(10)60171-7

  Excellent synthesis of issues related to childhood obesity, with a global perspective. Comprehensively addresses the need for both population and family- and individual-level interventions. Also calls for high-quality multicenter trials with long-term follow-up studies.

• Lakshman, Rajalakshmi, Cathy E. Elks, and Ken K. Ong. “Childhood Obesity.” Circulation 126 (2012): 1770–1779.

  DOI: 10.1161/CIRCULATIONAHA.111.047738

  Comprehensive review of trends in childhood obesity, including genetic, nutritional and other risk factors, and preventative and treatment strategies, with emphasis on early-onset obesity in preschool children, which provides insights into the origins of childhood obesity and suggests potential interventions for early preventative approaches with long-lasting effects.

• National Institute for Health and Care Excellence, UK. Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa, and Related Eating Disorders. National Clinical Practice Guideline 9. Leicester, UK: British Psychological Society, 2004.

  Extensive, practical UK treatment and management guidelines for individuals over seven years old with eating disorders, including binge eating disorder. Available online are the Full Guideline (261 pp.), NICE Guideline (36 pp.), and Quick Reference Guide, available online (20 pp.).

• Rome, Ellen. “Eating Disorders in Children and Adolescents.” Current Problems in Pediatric and Adolescent Health Care 42.2 (2012): 28–44.

  DOI: 10.1016/j.cppeds.2011.08.003

  Comprehensive review of eating disorders in children and adolescents from one of the premier adolescent medicine specialists in the United States, addressing the unique challenges and approaches to the diagnosis and treatment of younger individuals, with practical information for providers who may not be familiar with the issues in this population.

• Rosen, David S., and American Academy of Pediatrics Committee on Adolescence. “Identification and Management of Eating Disorders in Children and Adolescents.” Pediatrics 126 (2010): 1240–1253.

  DOI: 10.1542/peds.2010-2821

  From the American Academy of Pediatrics, this report details the special needs of children and adolescents with eating disorders for primary health-care providers. Highlights emerging issues (e.g., earlier age of presentation, higher percentage of boys) and collaborative treatment models (family-based, day-treatment, and hospital-based).