Early childhood intervention crucial for treating rising eating disorders

Early intervention can significantly improve long-term health outcomes for eating disorders, which have one of the highest mortality rates of any mental health condition.

Still, these conditions have been on the rise ever since the COVID-19 pandemic. And disordered eating behaviors often go undetected and are heavily underreported.

Significant training gaps remain for recognizing eating disorders in behavioral health settings. Eating disorder care is an incredibly rare subspecialty, meaning not many providers know how to spot associated problematic behaviors."

Sohyun Han, PhD, clinical psychologist, Eating Disorders Program, Children's Hospital Los Angeles

Dr. Han shares what behavioral health practitioners should know about indicators of illness, the benefits of early intervention, and gold standard treatment models CHLA is applying today.

Treating eating disorders in childhood is imperative

"Eating disorders, especially anorexia, often become entrenched by adulthood, with research showing poorer prognoses for both recovery and overall physical health," says Dr. Han.

The most effective interventions for eating disorders occur in childhood and adolescence, while the patient still has the support of their family.

At CHLA, practitioners use an interdisciplinary medical and mental health approach called Family-Based Treatment (FBT).

Family members are the primary resource for recovery

As the gold standard for pediatric eating disorders, FBT recognizes that most patients feel ambivalent about getting better. That's why family involvement is essential.

While many behavioral health interventions focus on individual therapy, medical and mental health practitioners guide the parent-sometimes the whole family-to oversee the child's recovery during FBT.

As an outpatient treatment, FBT offers a structured path to recovery while allowing patients to engage in as much of their normal routine as possible. Therapy sessions may even include a family meal where the therapist is present, coaching parents to manage resistance from the child.

Patients are often encouraged to continue any existing psychotherapy in parallel, and specialists collaborate with pediatric endocrinologists to help manage medical complications or comorbidities.

What signs to pay attention to-and when to refer

Dr. Han notes that accurately diagnosing a patient's eating disorder often requires taking a comprehensive clinical history, sometimes piecing together five or more years of weight changes and eating patterns.

"This is almost always a multidisciplinary effort between medical and psychological care teams," Dr. Han says.

Recognizing early signs can be difficult, but behavioral health practitioners should watch for several indicators, including:

• Increasingly rigid food rules, strict calorie or macronutrient tracking, or "clean eating"
• Skipping meals, often saying they are not hungry or their stomach hurts
• Avoiding social situations that involve food
• Anxiety, distress, or conflict around daily meals
• Secretive eating behaviors or reluctance to discuss eating habits
• Excessive exercise
• Visible weight loss or weight gain in a short period of time
• Significant concern about the way they look

Dr. Han acknowledges that sometimes, patients are hesitant to share these behaviors with anyone-including their therapist. That's where listening for insights and observations from parents can make a difference.

"I would take parent concerns incredibly seriously," Dr. Han says. "Even if you're not sure a patient's behaviors meet the threshold for an eating disorder, it's worth investigating further and asking the patient to obtain a medical evaluation from their pediatrician."