Red-Haired Girl

The Dilemma of Eating Disorders and Obesity in Teens

The intersection of obesity and eating disorders in teens requires urgent attention, write Hiba Jebeile and colleagues in a new paper. But attention is lacking. Policymakers talk much about childhood obesity. Beyond the talk though, health policies do little to offer help for the youth and families affected. Likewise, screening and care for youth with eating disorders is spotty at best. Worse yet, a false dichotomy often sets up these two problems in opposition. The false inference is that dealing with obesity necessarily makes eating disorders worse.

However, the analysis of Jebeile et al presents a very different set of facts.

A Culture of Unsupervised Dieting

We live in a culture that promotes unsupervised dieting by teens. Dieting to lose weight is common among adolescent girls. Arguably, obesity surveillance programs encourage it when they notify youth and families about excess weight, but offer no clinically effective help for dealing with it.

However, Jebeile points out that this is precisely where the risk for eating disorders is a concern:

“Unsupervised dieting to manage weight may exacerbate eating disorder risk, while structured and supervised weight management is likely to reduce eating disorder risk for most adolescents.”

Thus, she and her colleagues conclude:

“Based on current evidence, adolescents should not be encouraged to lose weight and diet on their own. Rather, when intervention is required, support and supervision from health professionals trained in obesity management should be provided.”

Heightened Concerns in the Pandemic

The American Academy of Pediatrics has released new guidance for screening to identify eating disorders. They are easy to miss, and appearances can be deceiving. Laurie Hornberger is lead author of this guidance. She says that this has become even more important during the pandemic.

“The lockdowns, the social isolation from not having school, not having activities, not having interactions with friends — it really appears to have a negative effect on kids with mental health issues including eating disorders. Pediatricians need to be especially vigilant these days.”

Tropes about the quarantine 15 are utterly unhelpful. Both obesity and eating disorders are very real health concerns. Casual, uninformed chatter and screening without offering real care probably does more harm than good.

This is yet another reason why we need better access to care for both obesity and eating disorders.

Click here for the paper by Jebeile et al and here for the new guidance from Hornberger et al.

Red-Haired Girl, painting by Moise Kisling / WikiArt

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January 18, 2021