Identifying and Managing Eating Disorders in Pediatric Obesity Treatment: Current Practices in Weight Management Programs throughout the United States

Background: Eating disorders (EDs) are common in adolescents with obesity. Detection of EDs, such as binge eating disorder (BED), within pediatric weight management programs (PWMPs) is vital to ensure that children and adolescents receive appropriate treatment, yet identification of EDs in PWMPs is not well-established. This study sought to understand current practices in the assessment and management of EDs in PWMPs in the United States.

Methods: A survey was developed by topic experts within Childhood Obesity Multi-Program Analysis and Study System to evaluate program practices related to the screening, diagnosis, referral, and treatment of EDs in PWMPs. Surveys were emailed to medical and behavioral health providers within these practices throughout the United States. Responses were tabulated and compared across program and provider characteristics.

Results: Of the 38 respondents, three-fourths regularly screened for one or more EDs (n = 29; 74%) with most screening informally using either no screener or a clinic-developed questionnaire (n = 20; 69%). Reasons for not screening included not being sure how to provide appropriate ED treatment (n = 6); lack of training (n = 5); and lack of time (n = 4). Most respondents were comfortable screening for EDs generally (69%), but behavioral health providers reported higher comfort levels than medical providers in making BED diagnoses (100% vs. 53%; p = 0.031).

Conclusions: To provide the best patient care for adolescents with obesity, training and structured guidelines are needed to improve ED screening, as well as referral and treatment practices.