Recognizing Eating Disorders in Youth: When Menstrual Dysfunction Is a Clue

The prevalence of eating disorders in adolescents has increased globally in the past decade, with as many as 87% of young people going undiagnosed and untreated, according to some estimates.

Often referred to as a “silent epidemic,” calls within the medical community urge providers to be aware of signs to support early intervention. Recently, the North American Society for Pediatric and Adolescent Gynecology (NASPAG) and the Federation Internationale de Gynecologie Infantile et Juvenile (FIGIJ) issued a joint advocacy statement calling special attention to eating disorders in adolescents and galvanizing the support of adolescent reproductive healthcare providers.

“Pediatricians and gynecologists who see children, adolescents and young adults are uniquely positioned to help facilitate early detection and intervention,” says Ellen Rome, MD, MPH, who leads the Center for Adolescent Medicine at Cleveland Clinic Children’s. She writes about this and recent advocacy statements from medical societies in an article published in the Journal of Pediatric & Adolescent Gynecology.

Prevention and early intervention

Prevention and early intervention for eating disorders are very important, Dr. Rome emphasizes, because they become much more challenging to treat as they progress and can affect every organ system, leading to a myriad of health problems.

They are also difficult to detect and can occur in any population. Dr. Rome notes, “Eating disorders come in all shapes and sizes and socioeconomic statuses.”

Symptoms can be elusive for providers, and even for the individual with the eating disorder. Clinical presentations differ depending on the type of eating disorder. For example, adolescent patients with atypical anorexia nervosa may present with normal or overweight status, unlike anorexia nervosa, which is characterized by weight loss below expected growth parameters or failure to grow.

Menses is a vital sign

Menses is a vital sign, and menstrual dysfunction can be a sign of physiologic stress associated with disordered eating. “Kids with disordered eating often come in with absent or irregular periods,” says Dr. Rome. “If you don’t think about it, you won’t recognize it.”

While formal diagnosis and treatment are outside the scope of practice for many pediatricians and gynecologists, the advocacy statement invites clinicians to get comfortable recognizing red flags and facilitating referral for treatment.

Remember to look at the growth chart

Growth charts can also be a clue for missing information, particularly for providers who are used to seeing adult patients.

“Remember to look at the growth charts; they tell us a story of wellness and illness. If a kid is crossing major percentiles, like going from the 75th percentile for weight to the 25th percentile and height is holding steady in the 50th percentile, that tells us a story, and we then get to play detective to figure out what’s behind that story,” she says.

Use compassionate messaging

She also says providers can help guide families through these discussions with compassion and be aware of their own weight bias, including potentially harmful messaging about losing weight.

“Messaging that focuses exclusively on losing weight for kids with elevated BMIs in the overweight or obese ranges may create more harm than good.” Instead, she says, encourage family-centered strategies that involve healthy activities and eating experiences, like family dinners.

She also advises motivational interviewing as a strategy to help facilitate next steps, including referral for treatment, ideally at a multidisciplinary center, and follow-up.

Though these conversations may be difficult, validating their experience and fears can lead to an open and honest conversation and help address the challenges more directly.