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Recognizing and Responding to Binge Eating in Children

Reprinted from Eating Disorders Today

By the age of two, many children have developed damaging eating habits that may persist throughout their lives. Like their parents, they are eating too few vegetables and fruits and too much highly processed food laden with sugar, fat, and salt. They have already learned to prefer, and sometimes even to demand, french fries, soda, pizza, hot dogs, sugary desserts, and candy.

Such early eating patterns, compounded by psychological and emotional challenges, may set the stage for the possible development of binge eating disorder (BED). So, how is BED diagnosed in children?

The first thing to consider is that the symptoms of eating disorders in children may be different from those experienced by adults. Thus, the criteria for diagnosing children may also differ. An article in a recent edition of Eating Disorders Review described a new set of research criteria for diagnosing binge eating disorders among children.

Marsha Marcus, Ph.D., and Melissa A. Kalarchian, Ph.D., of Western Psychiatric Institute and Clinic in Pittsburgh suggest that in children, loss of control over eating may be a more important factor than eating an objectively large amount of food. Also, as they speculated in the International Journal of Eating Disorders, dieting may not be consistently associated with binge eating in children.

The proposed criteria are described below. The researchers also point out the need for further research to clarify relationships among depression and eating and weight problems in children and adolescents. In addition, they stress that due to the alarming increase in obesity among ethnic minority children, a better understanding of binge eating in minority populations is critically important.

Proposed Binge Eating Disorder Criteria for Children
The first diagnostic criterion is a pattern of recurrent episodes of binge eating. (Criteria have not been established to specify how often such episodes occur.) An episode of binge eating is characterized by both of the following:

1. Food seeking in the absence of hunger (such as after a full meal)
2. A sense of lack of control over eating ("When I start to eat, I just can't stop.")

The second criterion is episodes of binge eating that are associated with one or more of the following:

1. Food seeking in response to negative emotions such as sadness, boredom, or restlessness
2. Food seeking as a reward
3. Sneaking or hiding food

The third criterion is that the symptoms persist over a period of at least 3 months.

Finally, for binge eating disorder to be distinguished from bulimia nervosa, there is an absence of behaviors such as purging (self-induced vomiting), fasting, or excessive exercise aimed at diminishing the effects of bingeing.

Signs and Symptoms
According to the KidsHealth.org website, the following are some of the signs and symptoms that may suggest the presence of an eating disorder in your child:

- Preoccupation with food and the next meal or snack
- Eating more than usual, while still saying she or he is hungry
- Eating very rapidly or Eating constantly
- Sneaking or hoarding food, even immediately after meals
- Feeling ashamed or fearful when confronted about this
- Excessive concern with weight and body shape
- Making negative comments about her/himself
- Feeling lonely, depressed, worried, preoccupied
- Spending a great deal of time alone

If You Suspect Your Child Has a Binge Eating Disorder
Make time to talk to your child. Explain that bingeing is a serious medical problem and that professional assistance may be necessary to help them understand how to take steps toward healthier eating and nutrition. If the situation warrants it, schedule a visit with a doctor or therapist who is familiar with childhood eating disorders.

In the meantime, avoid making comments about your child's appearance or weight. They are already hypersensitive about these issues, and the focus should be more on behaviors and feelings than their size. Provide a variety of nutritious food selections, but don't try to force food choices on your child or enforce drastic restrictions. Be sensitive to their unmet emotional needs and, if possible, help to constructively resolve any family issues that may be contributing factors. Help them find satisfying activities in which they can excel. Teach them that bodies are beautiful in all different shapes and sizes, and provide examples of what to say when other kids criticize or tease.

Above All, Seek Help
A child who may be developing an eating disorder should receive a thorough physical and psychological evaluation, followed by appropriate professional treatment. Early intervention is important to prevent long-term serious consequences. While binge eating disorder is a serious problem, it can be evaluated and treated successfully. Like any other challenge in life, moving in a new direction begins by taking one step at a time.

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