Contemporary Pediatrics
June 2017

Eating disorders can be difficult to diagnose and manage, and to make matters more complicated, a recent study reveals that just 20% of teenagers with eating disorders seek treatment from a medical professional.

The study collected data from a national sample of adolescents aged 13 to 18 years to identify how many met criteria for eating disorders. Conducted through interviews, the study surveyed sociodemographic data, characteristics of eating disorders, and mental health history and comorbidities.

A mere 20% of the teenagers with eating disorders in the study sample sought treatment, with girls being 2.2 times more likely to seek treatment than boys. Differences were also noted in likelihood to seek treatment based on eating disorder type. Adolescents with anorexia nervosa or bulimia nervosa were 2.4 and 1.9 times more likely, respectively, to receive treatment than adolescents with binge eating disorders.

There were few differences found in treatment seeking across socioeconomic divides, but teenagers with at least 1 parent with a college education were 1.8 times more likely to seek treatment than children of parents with no college education.

Researchers also found little difference in treatment-seeking behavior in relation to mental health history, but noted that adolescents who had in the past used mental health services for the treatment of emotional or behavioral problems were 1.7 times more likely to seek treatment for their eating disorder than those who hadn’t had previous experience with mental health services.

Treatment-seeking behaviors improve with age, the study notes, with adolescents aged 17 to 18 years being 4.4 times more likely than those aged 13 to 14 years to seek treatment for eating disorders.

Lauren Forrest, MA, a graduate assistant in the Department of Psychology at Miami University in Oxford, Ohio, and lead author of the study, says many teenagers don’t seek treatment for eating disorders even though many have had previous interactions with healthcare providers for emotional or behavioral problems.

Forrest says she was surprised at how seldom adolescents with eating disorders sought treatment. The study didn’t address why those individuals went without treatment, but Forrest says it’s something that she hopes will be on the radar of providers and parents.

“The findings highlighted how important it is to study individuals with eating disorders who have and have not sought treatment, so that we can be sure that the field’s knowledge about eating disorders isn’t based primarily on the subset of folks who are seeking treatment,” Forrest says. “Although this study didn’t assess what might have been preventing adolescents from seeking treatment for their eating disorders, the findings provide some ideas.”

One of these is the revelation in the study that girls were twice as likely to seek treatment for eating disorders as boys.

“Parents and healthcare professionals may be less likely to recognize eating disorders in boys—and boys may therefore be less likely to seek treatment—because of the misconception that eating disorders only affect girls,” Forrest says. “We know that eating disorders affect females and males, and while the female-to-male sex ratio among treatment-seeking samples is 10:1, data from community samples indicate that the sex ratio may be much smaller, such as 2-3:1. So it’s not that males aren’t developing eating disorders; males are less likely to seek treatment for their eating disorders.”

“Parents and healthcare professionals may be less likely to recognize eating disorders in boys and men because of differences in eating disorder symptoms. Eating disorders are often thought of as being marked by a desire for thinness, and this is often true for females,” Forrest says. “However, males appear to have stronger desires for muscularity and leanness as compared with thinness. Given this, parents or pediatricians may query adolescents or patients about desires for thinness but may not query about desires for muscularity or leanness, so certain symptoms may therefore be missed. Based on the study’s findings, the biggest ways parents and pediatricians may be able to help is to recognize that eating disorders affect a heterogeneous group of people, including girls and boys,” she says.

According to Eating Disorder Hope, 40% of teenaged girls have some type of eating disorder, and 91% try to control their weight through dieting. Ten million females and 1 million males struggle with eating disorders nationally across the lifespan, according to the organization. Additionally, 0.9% of women struggle with anorexia; 1.5% with bulimia; and 3.5% with binge eating in their lifetime. For men, an estimated 0.3% struggle with anorexia; 0.5% with bulimia; and 2% with binge-eating disorders.

Laura Roias, program director at Walden Behavioral Care in Waltham, Massachusetts, says teenagers are often hesitant to talk about eating disorders because of social stigmas.

“Eating disorders are highly stigmatized conditions in today’s culture. Some teenagers might feel ashamed or embarrassed if they suspect or recognize they have an eating disorder. Eating disorders also commonly develop as means to gain control or cope with certain emotions,” Roias says. “Drawing attention to it might leave them fearful this sense of control will be lost, particularly over eating behaviors and measures to control weight. Additionally, in a culture obsessed with weight and ‘healthy eating,’ other teens may fail to identify their eating behaviors as abnormal and are therefore unlikely to come forward seeking help.”

A positive influence is one of the best things a parent can offer to a child with an eating disorder, according to Roias. “One of the most helpful things a parent, friend, or community member can do is to be a role model. An adult who takes care of him/herself, eats in a balanced manner, refrains from degrading his/her body or the body of others, and abstains from discussing weight loss or diet tips has a profound impact on others,” she says. “Helping teenagers distinguish what are appropriate messages about food and weight from what are unhealthy or misleading messages is also important. Lastly, taking a nonjudgmental and supportive stance is critical when approaching an adolescent to talk about observed eating patterns or the possibility of seeking professional help.”

Forrest hopes the study will help healthcare providers keep in mind that eating disorders can strike any of their patients—male or female—and that eating disorders may present differently in each population. “With wider recognition that there’s not a ‘one-size-fits-all’ eating disorder presentation, we may all be able to better recognize and treat eating disorders,” she says.