About Eating Disorders

What is an Eating Disorder? 

An eating disorder is a condition that causes someone to develop a distorted relationship with food, body image or both. These disorders don’t develop by choice. Eating disorders — including anorexia nervosa, bulimia nervosa, avoidant restrictive food intake disorder (ARFID) and other specified feeding or eating disorder (OSFED) — are serious mental health conditions.  

Eating disorders occur across all genders, races, ethnicities and body sizes, affecting roughly 28.8 million Americans in their lifetime. Research shows that about 25% of affected individuals are racial minorities and nearly 10% to 30% of cases are male.  

The effects of eating disorders on a child’s mind and body can amplify other mental health issues, such as anxiety, depression or obsessive-compulsive disorder (OCD). Eating disorders can also cause lasting damage to a child’s organs and overall health.  

Left untreated, eating disorders can lead to lifelong physical and mental health issues, and even death. The earlier specialists diagnose and treat an eating disorder, the more likely a child is to fully recover. 

Types of Eating Disorders 

We treat four main eating disorders:  

• Anorexia nervosa (anorexia)  
• Avoidant restrictive food intake disorder (ARFID)
• Bulimia nervosa (bulimia)  
• Other specified feeding or eating disorder (OSFED)  

Anorexia nervosa 

Anorexia nervosa occurs when a child restricts their own food intake and engages in other behaviors (overexercising, purging, laxative use) leading to a lower-than-healthy weight  for their age and height. These behaviors are accompanied by a distorted self-image; the individual believes they are a healthy weight or overweight, despite being underweight.

Learn more about anorexia nervosa

Bulimia nervosa   

Bulimia nervosa is a condition that involves binge eating and then purging through self-induced vomiting or the use of laxatives, diuretics or diet pills. Some people with bulimia purge after a binge by fasting for days or engaging in excessive exercise.

Bulimia is extremely damaging to the child’s health, even when they maintain a normal weight.

Learn more about bulimia

Avoidant restrictive food intake disorder (ARFID)

ARFID involves restricting or avoiding eating food, leading to weight loss, failure to gain weight or significant nutrient deficiencies as a child grows. ARFID does not stem from body image concerns. In some cases, those with ARFID may have an intense fear of vomiting or choking on their food so they avoid eating to a dangerous degree. Some may be extremely selective eaters — sometimes from birth — and avoid certain textures or colors, while others have a low interest in food or report low appetite.  

Learn more about ARFID

Other specified feeding and eating disorder (OSFED)

OSFED is a category for eating disorders that don’t meet the criteria for another eating disorder but involve similar behaviors and symptoms, most commonly those of atypical anorexia nervosa. They exhibit all symptoms of anorexia, but their body weight remains within the “normal” or even “overweight” range. Children with this condition are just as likely to require hospitalization and eating disorder treatment. 

Learn more about OSFED

What causes eating disorders?  

Eating disorders are caused by a combination of factors including genetics, family history, environment, personality traits such as perfectionism, and underlying mental health conditions such as anxiety.  

Signs and symptoms of an eating disorder 

Many people with eating disorders, including children and teens, genuinely do not recognize how ill they are. Even when they do, shame, stigma and fear can make it difficult to ask for help. This fear is why friends, family members, coaches and teachers often play a critical role in identifying warning signs. While symptoms vary by disorder, common behaviors include:  

• Excessive weight loss: This might include significant weight loss or failure to gain weight as expected during growth. 
• Weight fluctuations: Although people with bulimia usually maintain near-normal body weight, their binge and purge behaviors may cause erratic weight gains and losses. 
• Unusual eating habits: Behaviors include taking small bites to stretch out eating time or compulsively arranging food on the plate. 
• Avoiding family meals: Children might make excuses that they are too busy or claim they’re eating elsewhere. 
• Secretive behavior around eating or bathroom use: A child who often runs water, plays music or flushes the toilet repeatedly while using the bathroom may be hiding the sounds of vomiting. 
• Use of laxatives or diet pills: Taking any medication outside of recommended use can be dangerous to overall heath.  
• Regular disappearance of food: This could be a sign of binge eating. 
• Excessive and obsessive exercise: Children and teens may attempt to burn off calories they consumed. 
• Physical signs of malnutrition: Signs may include dull or thinning hair, hair loss, the splitting or softening of nails, fine body hair on arms and legs, extreme sensitivity to cold, and dental cavities and gum disease. 
• Absence of menstrual periods: This change may be related to the loss of body fat. 
• Low self-esteem or mood changes: These may include irritability, depression or discussing suicide. 
• Distorted body image: No matter how thin they get, they may believe they are overweight. 
• Drug or alcohol abuse: Sometimes teenagers with eating disorders turn to substance abuse to relieve feelings of fear, shame and depression.

Eating disorders and issues can be hard to talk about. And you might not know what to look for. Jennifer Hagman, MD, Medical Director of our Eating Disorder Program, answers common questions about eating disorders.

Treatment for eating disorders  

Professional care is almost always necessary to successfully treat eating disorders, and family-based treatment (FBT) provides the best outcomes. That is why Children’s Hospital Colorado’s approach to eating disorder treatment emphasizes the importance of family involvement. In addition to professional care, we empower families to manage eating disorder symptoms at home, which helps minimize time out of school and away from their normal routine.  

For children with significant medical concerns, an inpatient medical stabilization stay is often necessary before we can safely begin FBT.  

We offer two eating disorder programs that support children and teens age 6 to 17 or 18, depending on the level of care. Placement in these programs is based on the clinical needs of each child. 

• Day Treatment Program: Also known as a partial hospitalization program, this care is designed for children and teens who need more intensive support through eating disorder recovery, but do not require 24-hour care.  

Learn more about the Day Treatment Program

• Outpatient Clinic: This includes individual, family and group therapy, as well as psychiatric medication management, as needed. If you’re not sure if outpatient services are right for your child, call us at 720-777-6200 to speak with our team.  

Learn more about the Outpatient Clinic

Ways you can help now  

Remember that there is no single reason a child develops an eating disorder. Early identification and treatment greatly improve outcomes, so discuss your concerns openly with your child and seek professional help as soon as you identify concerning behaviors. Most families start by contacting their pediatrician or primary care provider. 

Contact the Eating Disorders Program  

To schedule an appointment or ask questions, call 720-777-6200 to speak with a member of our team. Our experts will guide you through the assessment and admissions process.  

Learn more about scheduling an appointment