Pediatric Obesity Research Update | May 2022 Review

Each month, the OMA Pediatric Committee reviews a pediatric-focused obesity research update to help keep you up to date about the latest findings. This month’s update addresses pediatric obesity and mental health.

Restrictive Eating Disorders in Previously Overweight Adolescents and Young Adults

Article Summary

This study reviews the characteristics of patients with restrictive eating disorders who also suffer from obesity and overweight, what the research to date tells us, and what we have yet to learn. It brings to the surface the notion that “some patients with restrictive eating disorders are hiding in plain sight.” Read the full article.

Article Review

Patients who suffer from obesity or overweight are counseled on weight loss as well as the complications of their disease. As providers, we want them to achieve weight loss in a way that is safe and healthy. Studies suggest that patients with obesity and overweight are more likely to experience disordered eating to achieve their weight loss; however, it more often goes unrecognized as these patients are more likely to be applauded for their weight loss than criticized for it. Studies indicate that 20-35% of adolescents and young adults with restrictive eating disorders have overweight or obesity. Those with obesity and overweight are more likely to experience body dissatisfaction and concern about their weight than pre-morbid normal-weight adolescents and young adults, which increases their risk of engaging in restrictive disordered eating behaviors.

At diagnosis of their restrictive eating disorder, patients with overweight or obesity have experienced greater weight suppression than those who were normal weight prior to diagnosis. They are less likely to be hospitalized for their eating disorder, which is attributed to their higher weight at presentation. These findings call into question whether our focus should be on the degree of weight loss and not the presentation of weight when assessing a patient for a restrictive eating disorder.

Patients with restrictive eating disorders who also have overweight or obesity are at risk for the same systemic complications of the disorder as those with pre-morbid normal weight, including cardiovascular problems such as hypotension and bradycardia; gastrointestinal issues such as gastroparesis and constipation; hematologic anomalies such as pancytopenia; hormonal imbalances causing oligomenorrhea or amenorrhea; musculoskeletal effects such as decreased bone and muscle mass, and death.

There are few studies that address the treatment of such patients, making these cases difficult to manage based on well-defined evidence. These patients may still have overweight or obesity; thus, weight loss might still be warranted to prevent complications of their excess weight; however, this needs to be balanced against the need for some weight gain or maintenance to prevent complications of their disordered eating. Until more studies are published, and guidelines can be developed, it is important to encourage healthy weight loss and monitor for restrictive eating patterns in patients for whom weight loss is needed.

Additional Resources

Find more resources curated by OMA’s Pediatric Committee on our Pediatric Resources page. There you’ll find additional article reviews on various topics related to obesity as well as public resources for clinicians and families.