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A major topic pertinent to the health and wellness of children and adolescents is the development of healthy lifestyle habits beginning at an early age. In this chapter, we explore the factors that influence these habits, the consequences of poor dietary patterns, and how the provider can educate the child or adolescent and family to successfully adopt healthy eating.

A great deal of dieting occurs in Western culture as part of normal eating. In fact, estimates suggest that anywhere from 15% to 80% of the population may be dieting at a given time. The term dieting in lay culture has been used to describe a wide variety of behaviors ranging from healthful (eg, eating more vegetables, cutting out processed foods) to extreme (eg, self-induced vomiting, laxative misuse). Further, consideration of dieting in the context of an individual’s weight status is an important factor in evaluating whether dieting is pathologic (in underweight or nonoverweight individuals) versus appropriate (in overweight individuals). Dieting can also be related to eating disorders (EDs). For example, it has been suggested that dieting typically precedes ED onset in cases of bulimia nervosa (BN), whereas for binge eating disorder (BED), binge eating has been reported as preceding the onset of dieting in approximately half of cases.

The provider needs to be aware of the risk factors for EDs, including eating behaviors that lead to development of obesity, and how to recognize these in patients. More than 8 million Americans suffer from EDs. Approximately 90% of them are young women; however, middle-aged women, children, and men are also affected. The prevalence of EDs appears to vary by the population being studied.

BED appears to afflict adults of all socioeconomic strata and education level equally. Furthermore, BED is often diagnosed in middle-aged adults. Finally, it should be noted that BED is the most prevalent ED in the United States, affecting 6–10% of young women. Recent research suggests that individuals diagnosed with an ED not otherwise specified (EDNOS) did not differ significantly from those with anorexia nervosa (AN) and BED in terms of eating or general pathology. However, individuals with BN exhibited greater eating and general psychopathology compared to EDNOS. Clinicians should monitor possible progression of EDNOS to full-syndrome AN, BN, or BED, especially given the paucity of treatment recommendations for EDNOS.

Obesity may be the sequela of disordered eating behaviors or may be the impetus for their development. One issue that is now at the forefront of the family medicine community is the epidemic of childhood obesity. Among children age 2–19 years, obesity is defined as a body mass index (BMI) at or above the 95th percentile of sex-specific BMI for age, and severe obesity is defined as a BMI at or above 120% of the 95th percentile. Nearly one in five children in the United States are now considered obese. Childhood obesity increases the risk of obesity in ...

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