Eating Disorders in an obesogenic environment

Melissa Whitelaw is the Clinical Specialist Dietitian for the RCH Specialist Eating Disorder Program that is managed by the Centre for Adolescent Health. She is currently undertaking a part-time PhD at the University of Melbourne (Department of Paediatrics) under the supervision of Prof Susan Sawyer, Dr Heather Gilbertson and Dr Katherine Lee and will be exploring a new eating disorder in adolescents.

Over the last 7 years, the clinicians in the RCH Eating Disorder Program have become increasingly aware of a new group of adolescents with eating disorders.  These patients have previously been above their expected body weight and in response to concerns about obesity have lost weight.

Such patients typically lose weight without medical review – and commonly lose a large amount of weight over a short time. Such weight loss frequently continues to spiral down and the adolescent loses perspective about what is an appropriate weight. Drive for ongoing weight loss can lead to an inappropriately restricted nutritional intake and in some cases excessive exercise regimes. In some adolescents, such weight loss has been observed to lead to the same physical sequelae as Anorexia Nervosa, such as a very low heart rate, a distorted body image and no periods in previously menstruating girls. In some cases hospital admission is required for medical stabilisation.

The confusion is that these patients are not underweight – despite presenting with serious medical complications and psychological distress usually observed in Anorexia
Nervosa. Without a low body weight, timely diagnosis and medical intervention is frequently delayed and may impact recovery.

Melissa will be assessing the change in the frequency of adolescents presenting with
premorbid overweight to the RCH. She will then determine the relative severity of their physical sequelae compared to underweight patients, and the prognosis of this form of eating disorder.

It is anticipated that this study will raise awareness about this new eating disorder
and the challenges for public health messaging in the context of appropriate concerns about overweight and obesity.

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