Don’t discount ED prevalence in boys

Although eating disorders are often strongly associated with young girls in popular culture, a new study cautions pediatricians to not overlook the prevalence of this disorders in boys.

In a research letter published in JAMA Pediatrics, researchers highlight data on eating disorder prevalence in children aged 9 to 10 years. The letter notes that prevalence of early-onset eating disorders has increased over the last several decades, with younger children developing these disorders with psychiatric comorbidity more often than adolescents. According to the research team, prevalence among girls aged 8 to 11 years was 0.3 percent compared to 0.1 percent in boys of the same age range according to previous studies. Researchers sought to break down that number further and report prevalence rates of specific disorders in the eating disorder spectrum, including anorexia nervosa, bulimia nervosa, and binge eating disorder.

The study used data from the 2016 and 2017 Adolescent Brain Cognitive Development (ABCD) study, polling more than 4500 children aged 9 to 10 years and at least 1 of their caregivers. The research team reported that it will follow this cohort for 10 years in the full study.

Results of the initial data collection are telling, though, revealing that within the entire database of more than 8 million children that overall prevalence of any eating disorder in this age group was 1.4 percent, with 0.1 percent having anorexia nervosa and 0.6 percent having binge eating disorder. The research team found that there were not significant differences in prevalence between genders when it comes to eating disorders overall, although prevalence of anorexia nervosa was somewhat higher in girls than in boys. Overall, the research team reports that 1.6 percent of boys and 1.1 percent of girls in the study had some type of eating disorder.

Katie Rozzell, a graduate researcher in the Body Image, Sexuality, and Health Lab at San Diego State University in California, led the study and says she hopes the findings will inspire pediatricians to not overlook eating disorders in their health screenings.

“We hope this study informs pediatricians and helps make them aware that among young children, rates of eating disorders are not different for boys and girls,” Rozzell says. “This may help pediatricians better recognize symptomology among young boys, given past research has focused on females.”

Rozzell notes that prevalence of eating disorders has not been assessed with Diagnostic and Statistical Manual of Mental Disorders, 5th Edition criteria among 9 to 10-year-old children, and there is generally less research done on eating disorders in pre-pubescent populations. This may be a novel area for new research, she adds.

“Now that the prevalence is identified, it would be ideal to further categorize the sample, looking at race, ethnicity, socioeconomic status, comorbidities, and so on, among these children,” Rozzell says. “Additionally, the data from the ABCD study is longitudinal and will last the course of 10 years. It would be of great importance to look at rates of eating disorders over time and how that may change depending on gender, or other factors.”

As far as how eating disorders develop and what factors may play a role in early development, Rozzell says the research team did not investigate these issues, but there is evidence that “internalizing body ideals through the media/peers/family, body dissatisfaction, and guilt surrounding eating are robust risk factors of eating disorders in other diverse samples.”

“This may be the same in this age group, however, we cannot say why these children are developing them at such a young age,” Rozzell adds.

Although further research is required, Rozzell says she hopes the study brings light to the issue and spurs more interest in this population.

“We hope this will impact clinical practice in primary care settings and allow pediatricians to understand how often eating disorders are occurring among 9- to 10-year-old children. Being aware of prevalence in this population may help those in a variety of mental health, or other healthcare settings recognize eating disorders and intervene at a young age,” Rozzell says. “We hope that the lack of gender differences found in our study also inform practice, and bolster the fact that eating disorders are not only occurring in a female population.”