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Eating disorders in teens
Adolescence is when eating disorders most often begin, and a teenager's still-growing body makes them especially serious. The teenage years bring rapid physical development, new social pressures, and a natural focus on appearance, and for a vulnerable young person an eating disorder can take hold quickly. Adolescents also respond well to treatment, and there is a clear, evidence-based first-line approach for the most common teen eating disorder.
This page covers when eating disorders start, the warning signs, why teens are at higher medical risk, and what treatment works. For an overview of the conditions, see what is an eating disorder.
When eating disorders begin
Adolescence is the peak window. In the national survey of adolescents, the median age of onset centered around 12 to 13 years for anorexia, bulimia, and binge eating disorder.1 About 2.7 percent of adolescents aged 13 to 18 will have an eating disorder, and the rate climbs through the teen years, reaching roughly 3 percent by ages 17 to 18.2 These are not rare illnesses in this age group.
Warning signs for parents
Many warning signs in teens are behavioral and easy to rationalize as a phase: new food rules or skipped meals, eating in secret or leaving the table after eating, preoccupation with weight or body, driven exercise, and pulling away from friends. One physical clue is specific to growing bodies: a growth-chart percentile that stalls, falls, or rises sharply, which the American Academy of Pediatrics flags as a reason to look closer.3 A significant increase in weight can be a warning sign too, not only weight loss. Because adolescents can hide symptoms, a parent's worry is itself a reason to seek an evaluation.
Why teens are at higher medical risk
Adolescents are building bone, growing in height, and going through puberty, all of which depend on adequate nutrition. Restriction, purging, or bingeing during this window can disrupt growth, bone development, heart function, and pubertal development, and teens can become medically unstable faster than adults.3 That combination, high stakes and quick deterioration, is why early recognition and prompt medical evaluation matter so much in this age group.
Family-based treatment is first-line
For adolescent anorexia, family-based treatment (FBT, also called the Maudsley approach) is the first-line, evidence-based treatment.3 It works in phases: parents are coached to take the lead on restoring their child's nutrition and weight at first, then gradually hand control of eating back to the teen, and finally support normal adolescent development.3 A landmark randomized trial found that FBT produced higher full-remission rates than individual therapy, with the advantage holding at 12-month follow-up (about 49 percent versus 23 percent).4 FBT also has growing evidence in adolescent bulimia, though the strongest data are in anorexia.3
Getting help
Start with the pediatrician, who can screen, perform a medical evaluation, track growth, and refer to an eating-disorder program.3 From there, an eating-disorder team determines the level of care. To take the next step, see how to help a loved one start treatment, the levels of care, or search for programs.
References
References
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Swanson SA, Crow SJ, Le Grange D, Swendsen J, Merikangas KR. Prevalence and Correlates of Eating Disorders in Adolescents: Results From the National Comorbidity Survey Replication Adolescent Supplement. Archives of General Psychiatry. 2011;68(7):714-723. Median age of onset about 12.3-12.6 years for anorexia, bulimia, and binge eating disorder; most adolescents with an eating disorder did not receive specific treatment. ↩
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National Institute of Mental Health, Eating Disorders (Statistics). Lifetime prevalence of eating disorders among adolescents aged 13-18 is about 2.7 percent (3.8 percent of females, 1.5 percent of males), rising with age. ↩
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Hornberger LL, Lane MA; AAP Committee on Adolescence. Identification and Management of Eating Disorders in Children and Adolescents. Pediatrics. 2021;147(1):e2020040279. Recommends pediatric screening at routine visits, attention to growth-chart changes, and family-based treatment as first-line for adolescent anorexia (with its phased structure); notes the medical risks specific to a growing body. ↩ ↩ ↩ ↩ ↩ ↩
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Lock J, Le Grange D, Agras WS, Moye A, Bryson SW, Jo B. Randomized Clinical Trial Comparing Family-Based Treatment With Adolescent-Focused Individual Therapy for Adolescents With Anorexia Nervosa. Archives of General Psychiatry. 2010;67(10):1025-1032. Full remission favored family-based treatment over individual therapy, significantly so at 12-month follow-up (49.3 percent versus 23.2 percent). ↩
Common questions
At what age do eating disorders usually start?
Adolescence is the peak period. In national data, the median age of onset is about 12 to 13 years for anorexia, bulimia, and binge eating disorder. Roughly 2.7 percent of adolescents aged 13 to 18 will have an eating disorder, and the rate rises through the teen years.
What are the warning signs in a teenager?
Watch for skipping meals or new food rules, eating in secret or disappearing after meals, preoccupation with weight or body, excessive exercise, social withdrawal, and physical signs like a growth-chart percentile that stalls, falls, or rises sharply, fainting, or missed periods. A significant change in weight, up or down, is an important early clue.
Why are eating disorders especially dangerous for teens?
Adolescents are still growing, so restriction and purging can affect height, bone development, heart function, and puberty during a critical window. Teens can become medically unstable quickly, which is why early recognition and prompt evaluation matter.
What is the first-line treatment for a teenager with anorexia?
Family-based treatment (FBT, sometimes called the Maudsley approach) is the first-line, evidence-based treatment for adolescent anorexia. Parents are coached to lead weight restoration at first, then gradually return control of eating to the teen. A landmark trial found higher remission with FBT than individual therapy.
Should I take my teen to the pediatrician?
Yes. The American Academy of Pediatrics recommends that pediatricians screen for eating disorders at routine visits, and a pediatrician can do the medical evaluation, track growth, and coordinate a referral to an eating-disorder program.
Talk to a licensed eating disorder program
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