Intersection between Eating Disorders and Obesity in Youth: Implications for Treatment

Eating disorders among children and adolescents occur in all body sizes and must be properly identified and treated across settings for optimal health outcomes. This review summarizes considerations for behavioral, pharmacological, and surgical obesity treatment and eating disorder risk.

Obesity and eating disorders share many common risk factors. Yet adolescents with obesity and eating disorders are underrepresented in research studies and often remain undiagnosed in medical practice despite presenting with more severe symptoms. There is evidence for reduction of subclinical disordered eating attitudes and behaviors in health behavior and lifestyle trials, with emerging evidence of reductions in subclinical disordered behaviors (i.e., loss of control eating) for patients who have undergone bariatric surgery. There is a paucity of eating disorder screening and monitoring data reported in pharmacological trials. Psychosocial outcomes, including subclinical eating disordered attitudes and behaviors, suicidality risk, and symptoms of depression and anxiety, should be continuously monitored prior to and throughout obesity treatment. There are several validated measures to detect symptoms of disordered eating among youth with higher weights. Early detection of eating disorder symptoms among obesity treatment-seeking youth is imperative to inform the course of comorbid treatment to occur simultaneously, sequentially, or within specialty care. Adolescents with obesity are at greater risk for engaging in disordered eating and related worsened mental and physical health outcomes compared to peers without obesity. It is vital to assess for eating disorder symptoms and presentation to inform timely treatment.