Eating Disorders | Texas Health Steps

Many people with eating disorders look healthy yet may be extremely ill.
Academy for Eating Disorders, 2022

Eating Disorders: The Question of Weight

Three adolescents are in your office today for their Texas Health Steps preventive medical checkups. As part of the checkups, you will measure the patients’ height and weight and determine their BMI, as required by the Texas Health Steps Periodicity Schedule. This information, along with updating the patient history, may be a key factor in your decision whether to assess for eating disorders, which are the third most common chronic condition among adolescents.

Good To Know

A BMI calculator for youth is available from the Centers for Disease Control and Prevention. The weight status categories and corresponding percentiles shown below were based on expert committee opinions.

Weight Status Category	Percentile Range
Underweight	Less than the 5^th percentile
Healthy Weight	5^th percentile to less than the 85^th percentile
Overweight	85^th to less than the 95^th percentile
Obesity	Equal to or greater than the 95^th percentile

Patient histories and current BMIs:

Elaina

15 years

Elaina has maintained the same weight since her last checkup. Her BMI is 22, which places her near the 70th percentile (healthy weight) for her age.

Min

16 years

Min has lost 15 pounds since her last checkup. Her BMI this year is 18, which places her near the 16th percentile (healthy weight) for her age.

Raphael

17 years

Raphael is new to your practice and a comprehensive health history has not yet been completed. His BMI of 27 places him in the 93rd percentile (overweight) for his age.

Based on this information, which of these adolescents should be assessed for a possible eating disorder?

Elaina

This answer is correct but incomplete.

All three adolescents should be assessed for possible eating disorders regardless of their weight, BMI or body size.

Min

This answer is correct but incomplete.

All three adolescents should be assessed for possible eating disorders regardless of their weight, BMI or body size.

Raphael

This answer is correct but incomplete.

All three adolescents should be assessed for possible eating disorders regardless of their weight, BMI or body size.

All of Them

This answer is correct.

All three adolescents should be assessed for possible eating disorders regardless of their weight, BMI or body size.

Individuals of all shapes and sizes can have an eating disorder. Health care providers are encouraged to avoid making assumptions based on an individual’s appearance and to look carefully for warning signs and other physical symptoms at every preventive medical checkup. Screening tools are available to help diagnose eating disorders. Tools are also available to address weight stigma in the office and provide guidance about adopting weight-neutral language that encourages patients to seek help for disordered eating.

Why It Matters

“Pediatricians are in a unique position to detect eating disorders early and interrupt their progression” (AAP, 2021) by routinely assessing patients, identifying at-risk behaviors and consistently focusing on healthy lifestyle rather than weight.

References

Academy for Eating Disorders. (2022). Nine Truths about Eating Disorders.

American Academy of Pediatrics. (2021). Clinical Report: Identification and Management of Eating Disorders in Children and Adolescents. Pediatrics, 147(1):e2020040279.

American Academy of Pediatrics. (2016). Clinical Report: Preventing Obesity and Eating Disorders in Adolescents. Pediatrics; 138(3).

Centers for Disease Control and Prevention. (2021). BMI percentile calculator for child and teen.