Health Matters

Eating Disorders Often Missed in Overweight Teens

Nov. 5, 2013
If your child is overweight, you know the pressure that’s put on getting that excess weight off. So when kids work hard, exercising and cutting out empty calories, you have to applaud that effort. But how do you know when getting healthy crosses the line into unhealthy? When does healthy eating become disordered eating?
three teenagers
About half of adolescents with eating disorders are or have been overweight. Because of that extra weight, it takes them longer to get diagnosed. As a result, they are often sicker when they finally get treatment. 
A paper published recently in Pediatrics chronicles the journey to treatment for two young people whose parents knew something was wrong long before their health care providers did. Parents are the frontline for recognizing signs of eating disorders in young people. They are also critical partners in helping their children reach recovery. 
Adolescent medicine specialist Dr. Shellie Yussman shares these tips to help parents recognize the difference between healthy weight loss and an eating disorder:
  • Be sure your child gets annual check-ups, including BMI, to track rapid changes.
kid on scale with doctor
  • Watch for dramatic weight loss. Dieting, even for overweight young people, should never be the focus. Health and well-being should be their goal. It’s a good idea to seek your child’s doctor’s input as you plan a healthier path for your family’s eating and exercising.
  • Be aware. Don’t assume you will be able to see that your child has an eating disorder. People with eating disorders can be very effective at hiding their weight loss and unhealthy behaviors. And only a small percentage with eating disorders looks abnormally thin.
  • Listen for preoccupations about food, fat, and weight. People with disordered eating place an unhealthy emphasis on the importance of body size and shape, often negatively comparing themselves to peers—sometimes to the point of socially withdrawing from family and friends.
  • Take note of new unusual behaviors around food. Does your child now watch TV cooking shows, check out recipe books from the library, make elaborate meals for family and friends, but not take more than a taste? Does she now refuse to eat in front of others? Will she no longer eat what the rest of the family eats? These could be signs of food dominating her life and guilt about eating.
  • Watch for signs of purging which most often takes the form of vomiting. However, other forms of purging are often missed, such as abuse of laxatives, enemas, insulin, and excessive exercise. These behaviors can be dangerous and deadly.
  • Don’t stereotype who has eating disorders. Children as young as 9 or 10, males, and people who are overweight can all develop eating disorders.
  • Always talk with your child’s provider if you have concerns, but if you need an extra incentive to make the call, take this eating disorder screening from the National Eating Disorders Association (NEDA).
Shellie Yussman MD MPH
Susan “Shellie” Yussman, M.D., M.P.H., is an associate professor of Pediatrics at Golisano Children’s Hospital at the University of Rochester Medical Center, specializing in adolescent medicine and eating disorders. She sees patients in the Child and Adolescent Eating Disorders Program and the Adolescent and Young Adult Medical Clinic.