Behavioural eating disorders

Eating disorders are serious mental health disorders characterized by morbid preoccupation with weight and shape, manifest through distorted or chaotic eating. Planned changes to diagnostic criteria will broaden the definition of feeding and eating disorders to include presentations characterized by restricted food intake not associated with weight and shape concerns. Anorexia nervosa (AN), bulimia nervosa (BN) and partial syndromes are relatively common, and early intervention is advisable. Aetiology is multifactorial, with high heritability. Prognosis overall is good but treatment can be long and intensive, significantly impacting families. Essential aspects of management are an integrated multidisciplinary approach, working collaboratively with families and young people when possible. Psychological interventions focus on the eating disorder, supported by medical monitoring and dietetic guidance. Although working with families is the backbone of treatment for AN, young people also need opportunities for confidential discussion. The role of inpatient treatment is evolving. For BN, family or individual approaches may be equally effective. Paediatric expertise is of particular value in the assessment and management of acute malnutrition and complications secondary to disordered eating behaviours, in the early stages of re-feeding, and in the monitoring and management of long-term complications such as growth retardation, pubertal delay and osteopenia.