ABSTRACT
In children and teenagers vulnerable to eating disorders, dieting can become an obsession that takes on a power of its own. With early onset eating disorder traits, it is worth finding out whether the mother has a history of an eating disorder. Bulimia nervosa is characterised by recurrent bingeing and vomiting. Bulimia nervosa rarely occurs before the onset of puberty but may occur in 1–2% of females aged 16–35, and perhaps one thirtieth of this in males. Assessment of possible bulimia nervosa involves thinking of the possibility, so ask about binge-eating and compensatory behaviours, especially vomiting. As part of the assessment of obesity, it is worth looking at general behavioural issues within the family and in particular how the child is rewarded. Established food fads do not respond well to psychological treatments, and it is probably not a good use of resources to attempt to treat selective eating in primary school children.
