ABSTRACT. Background. Eating disorders in children and adolescents remain a serious cause of morbidity and mortality in children, adolescents, and young adults. The working knowledge of pathophysiology, recognition, and management of eating disorders continues to evolve as research in this field continues.Objectives. This article builds on previous background and position papers outlining issues relevant to the care of the adolescent patient with an eating disorder.Methods. The eating disorder special interest group from the Society for Adolescent Medicine recognized the need to update the state of the art published guidelines for the care of the adolescent patient with an eating disorder. This article was a multidisciplinary, group effort to summarize the current knowledge of best practice in the field.Results. This article summarizes newer findings on pathogenesis and etiology, prevention and screening, risk factors, nutritional issues, care from the primary care clinician's perspective, appropriate use of a multidisciplinary team, and issues of managed care and reimbursement.Conclusions. Primary prevention combined with early recognition and treatment helps decrease morbidity and mortality in adolescents with eating disorders. Pediatrics 2003;111:e98 -e108. URL: http://www. pediatrics.org/cgi/content/full/111/1/e98; adolescent, child, eating disorder, anorexia nervosa, bulimia nervosa.ABBREVIATIONS. AN, anorexia nervosa; BN, bulimia nervosa; ED-NOS, Eating disorder-not otherwise specified; BMI, body mass index. E ating disorders in children and adolescents continue to be a serious problem and may result in premature death or life-long medical and psychosocial morbidity. In 1995, the Journal of Adolescent Health published background and position papers outlining relevant issues in the care of the adolescent with an eating disorder. 1 This article provides an update on the state of the art for the child and adolescent with an eating disorder. Topics covered are pathogenesis and etiology, prevention and screening, risk factors, nutritional issues, aspects of care from a primary care clinician's perspective and goals for a multidisciplinary team, care in the inpatient and outpatient settings, use of clinical pathways, and issues of managed care and proper reimbursement.
PATHOGENESIS AND ETIOLOGY OF EATING DISORDERSDespite increasing awareness of the major eating disorders, a specific etiology for the pathogenesis of anorexia nervosa (AN) and bulimia nervosa (BN) remains unclear. Rather than single factor causal theories, eating disorders are now viewed as multifactorial disorders with the symptom pattern representing a final common pathway. 2 Interest has focused variously on the contribution of environmental and social factors, psychological predisposition, and biological vulnerability, with recent familial aggregation studies renewing interest in the contribution of genetic predisposition.Dieting continues to be a common entry point in both syndromes, with the greatest risk being the group of severe dieters. 3 ...
