Exploring Disordered Eating Beyond Binge Eating in Youth with Obesity

Exploring Disordered Eating Beyond Binge Eating in Youth with Obesity 150 150 JoAnna Pendergrass, DVM

Youth with obesity can suffer from various disordered eating behaviors beyond binge eating. A holistic approach to caring for these youth can help improve their long-term physical and psychological health outcomes.

A literature review recently published in Nutrients shed light on eating disorders beyond binge eating in youth with obesity.

In this review, Eileen Chaves, PhD, pediatric psychologist at Nationwide Children’s Hospital, and Karyn J. Roberts, PhD, RN, discussed several facets of eating disorders in youth with obesity, including prevalence, intersectionality and medical providers’ implicit weight biases.

They also provided recommendations for addressing disordered eating behaviors in pediatric practice, research and policy.

Compared to children at a healthy weight, youth with obesity are more likely to have either an eating disorder or disordered eating. The coexistence of obesity and eating disorders in youth can have long-term adverse physical and psychological consequences.

“Eating behaviors exist on a continuum,” says Dr. Chaves.

On one end are diagnosable eating disorders , such as anorexia nervosa, with healthy eating behaviors on the other end. Disordered eating lies in the middle and consists of subclinical eating disorders, like emotional eating.

Dr. Chaves adds that diagnosable and subclinical eating disorders differ in the frequency and severity of the atypical eating pattern.

The prevalence of eating disorders in youth with obesity is unknown because these conditions are either incompletely assessed or not assessed in pediatric practice. Historical misperceptions about who is primarily affected by eating disorders (single, white, affluent women) contribute to this inadequate assessment and may cause medical providers to assume that binge eating is the only eating disorder in youth with obesity.

Youth with obesity often experience weight-based victimization perpetrated by various entities, including family, friends and social media. Through implicit weight biases, medical providers contribute to this victimization with the “moral-medical framing of fat,” say the review’s authors.

This framing, explains Dr. Chaves, leads medical providers to continually communicate obesity’s dire health risk to a patient and attribute all the patient’s medical problems to obesity, regardless of the presenting problem.

Intersectionality, the connection between an individual’s social identities, influences how youth with obesity interact with their medical providers. The stresses of weight-based victimization are often compounded by having multiple disadvantaged social identities, such as being a sexual minority (e.g., gender non-binary). How a medical provider engages with a patient with obesity regarding their social identities can alleviate or worsen this stress.

Drs. Chaves and Roberts recommend modifying screening tools for eating disorders to include minority stress.

“Currently, there is not a screening tool that measures minority stress and disordered eating,” says Dr. Chaves, adding that this stress increases the risk of developing disordered eating.

The authors also advise medical providers to recognize their implicit weight biases and adjust how they interact with youth with obesity.

“Medical providers should recognize that disordered eating can occur in adolescents of all body shapes, sizes and weights,” says Dr. Chaves.

She recommends that medical providers ask permission to discuss eating habits and express genuine curiosity and kindness during the discussion. She also encourages medical providers to advocate for inclusive policies for children, regardless of weight and gender identity.

Additional research is needed, say the authors. They recommend studies that include analyzing the environmental and genetic contributions to eating behaviors and identifying barriers to screening for atypical eating behaviors in youth with obesity. Dr. Chaves plans to further evaluate how youth with obesity are negatively impacted by being weighed at medical appointments and if they may engage in disordered eating behaviors such as restrictive or emotional eating before appointments.



Roberts KJ, Chaves E. Beyond binge eating: The impact of implicit biases in healthcare on youth with disordered eating and obesity. Nutrients. 2023, 15, 1861.



About the author

JoAnna Pendergrass, DVM, is a veterinarian and freelance medical writer in Atlanta, GA. She received her veterinary degree from the Virginia-Maryland College of Veterinary Medicine and completed a 2-year postdoctoral research fellowship at Emory University’s Yerkes Primate Research Center before beginning her career as a medical writer.

As a freelance medical writer, Dr. Pendergrass focuses on pet owner education and health journalism. She is a member of the American Medical Writers Association and has served as secretary and president of AMWA’s Southeast chapter.

In her spare time, Dr. Pendergrass enjoys baking, running, and playing the viola in a local community orchestra.