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When chronic illness leads to eating disorders in young people

By Naveed Saleh, MD, MS ' Medically reviewed by Amanda Zeglis, DO, MBA '

Published June 27, 2022
Diseases that require patients to follow lifelong diets can warp a child’s relationship with food, which could result in disordered eating and eating disorders.

Disordered eating can impair a young person’s health-related quality of life and lower their psychosocial health.

To combat the risk of eating disorders, physicians should screen to combat negative body image and disordered eating early, and learn more about how to treat disordered eating.

Here’s a sad thought: Not every child can enjoy the occasional ice cream cone or candy bar with reckless abandon.

For those with type 1 diabetes or chronic gastrointestinal disease, diets have to be closely monitored.

Strict diets, however, can place young patients down a path that begins with altered perceptions about food and possibly ends with a life-altering eating disorder.

It’s important for physicians to be aware of these outcomes and work to optimally manage food perceptions.
Proposed mechanism

Authors of a review published in Advances in Nutrition hypothesized how treatment of diet-related chronic health conditions (DRCHCs) such as inflammatory bowel disease (IBD), type 1 diabetes mellitus (T1DM), cystic fibrosis (CF), and irritable bowel syndrome can eventually result in eating disorders.

These diseases require patients to follow a lifelong diet. The diets place pressure on kids that can result in destructive perceptions of food and body weight, as well as unhealthy eating habits.

Increased concern over body weight and diet in children with DRHCs compared with their healthy cohorts could then lead to disordered eating such as binging, purging, or extreme dieting, which could lead to eating disorders.

“Although it remains unclear whether the prevalence of eating disorders is higher in those with DRCHCs compared with the general population,” the authors wrote, “overall findings suggest that young people with DRCHCs may be at risk of endorsing disordered eating behaviors that may lead to diagnosis of an eating disorder and other health problems over the course of their treatment.”

In a review published in the International Journal of Eating Disorders, researchers found that diet-treated chronic illness was related to disordered eating as well as eating disorders.

Treating chronic illness with diet preceded disordered eating in diabetes, celiac disease, and GI disorders�"but not IBD.

The researchers found that disordered eating alongside unhealthy weight management increased the risk that children would experience poor clinical outcomes.
Repercussions

Results of a systematic review and meta-analysis published in PLOS ONE showed that disordered eating attitudes and behaviors predicted lower health-related quality of life (HRQOL) in children and teens compared with their healthy peers.

Similarly, disordered eating correlated with diminished psychosocial health.

The authors suggested that “health programs for promoting healthy eating and reducing disordered eating behaviors among school children and adolescents may help to enhance the HRQOL and overall health status of these individuals.”
What can be done

Authors of the review published in Advances in Nutrition mentioned interventions intended to curb the risk of eating disorders in children with DRHCs.

At routine visits, children can be screened early to combat negative body image and disordered eating. When identified, providers can intervene before harmful attitudes and behaviors change into eating disorders.

“Healthcare providers should be aware that young people with DRCHCs may be at risk of eating disorders, and carefully monitor psychological changes and the use of unhealthy weight control methods.”
�" Quick, et al.

Clinicians can also be better trained on how to detect and treat disordered eating. Previous research has demonstrated that physicians who treat T1DM, for instance, have limited training in eating disorder management.

The authors stressed that it’s imperative to develop effective intervention and screening tools. These could cease the progression to eating disorders and mitigate detrimental health outcomes in younger people with DRCHCs.

Authors of the review published in International Journal of Eating Disorders pointed out the conundrum that clinicians face. Diet-treated chronic illness needs young people to closely consider diet and weight, but doing so may increase the odds of disordered eating.

“Future research is needed to elucidate the mechanisms that transform standard treatment practices into pathological eating, including characteristics and behaviors of the child, parents/care providers, family, and treatment providers.”
�" Conviser, et al.

What this means for you

It’s tough when your younger patients have to deal with DRHCs. While their peers are enjoying sugary, salty, or high-calorie treats, kids with illnesses such as diabetes or CF cannot partake. This can lead to distorted perceptions of food, disordered eating or even eating disorders. As a physician, it’s important to screen them for disordered eating and remain informed of appropriate interventions to decrease the risk of future eating disorders.

https://www.mdlinx.com/article/when-chronic-illness-leads-to-eating-disorders-in-young-people/6rg4upMtkLWZpM7hSzmI2l

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Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!

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