Anorexia In Children NOT Increasing?

Some people who have an interest in shock horror headlines (why?) have made a big deal about a so-called increase in eating disorders in young children.

I’ve always  hesitated to agree with all the hype and panic.

Lets look at the evidence. On 31st July the Sunday Telegraph ran the headline “Hundreds of preteen children treated for eating disorders….. including 197 children between the ages of five and nine, with cases within this age group almost doubling over the period.”

How do journalists get this information? Its easy and cheap. and often relies on reporting cards filled in by consultants to monitor rare conditions (2011;198:295-301). So is health information like this, obtained by freedom of information requests, accurate and useful?

Rachel Bryant-Waugh (consultant clinical psychologist /joint head of the feeding and eating disorders service at Great Ormond Street Hospital in London) said, “I think that there is a fundamental difficulty in confusing terms: it’s easy to see how these things get a bit muddled, and it then comes across in a way that is slightly misleading. It is very unlikely indeed that 5-7 year olds present with anorexia nervosa. … But they may have low weight and significant eating difficulties for many other reasons – for example, illness, gastrointestinal problems …..or a range of psychological factors. Such children might present with eating difficulties as the main problem, but they do not have anorexia or bulimia “.

So, when journalists use the Freedom of Information Act to ask for the numbers of children with “eating disorders”, they are not being specific enough to enable concrete conclusions. Waugh says…”Eating is a very complex behaviour in terms of all the processes required: many specialities care for children with eating problems. Formal eating disorders – that is, anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified (EDNOS) – are relatively rare in young children. However, they may be increasing in middle childhood. But the lack of consistent terminology means that there is a large difficulty in drawing conclusions here.” 

Mark Berelowitz, consultant child and adolescent psychiatrist at the Royal Free in London agrees. “The DSM puts eating disorders into two categories, one is eating disorders-anorexia, bulimia, EDNOS.  The other is feeding and eating disorders of infancy and early childhood. Its not clear that information given to journalists related to anorexia nervosa or the vast number of other conditions much more common in young children, like failure to thrive and other problems. 

The other thing is that with the best will in the world its hard to produce good data quickly during the summer holidays and in a short time scale: and ordinarily need to be scrutinised carefully before they’re submitted, and I would have been astonished if any trust would have high quality data at its fingertips”.

Of the apparent rise in anorexia diagnoses in the very young he said, “When you come across this seeming threefold rise you have to ask yourself how good are the data: if you project the rate forward you would get an absurd number”. 

It seems that journalists aren’t asking the right questions and the NHS Trusts are not giving accurate answers. “The data they got was from ALL FEEDING DISORDERS, and then in the press this was expressed effectively as anorexia nervosa. I suspect that if the Sunday Telegraph had asked the Royal College of Paediatrics and Child Health or any specific clinical service how many patients had these disorders in these young age groups we’d have very different numbers.”

So lets not alarm parents and doctors and lets not tar all children with funny eating issues with the same brush. It makes Good Press but it is…. LIES