Richard E Kreipe

• Doctor of Medicine
• Professor Emeritus at University of Rochester

Early identification and intervention are critical to prevent physical and mental health complications, chronicity, and premature death associated with eating disorders. However, primary medical and behavioral health care clinicians often do not feel confident or competent to diagnose and manage patients with eating disorders. This pilot study desc...

The concluding chapter of this section outlines several gaps in current knowledge that will be critical to address in future research. DSM-5 introduced a number of changes in diagnostic criteria for eating disorders, and it is crucial to determine the utility of these revised criteria in addressing the needs of adolescents with clinically significa...

This chapter describes the diagnostic criteria used in clinical and research settings to define eating disorders and highlights important changes in the criteria introduced by DSM-5 in 2013. Emerging evidence suggests that the DSM-5 categories usefully capture a range of eating problems in need of clinical attention that were not well described in...

This chapter examines risk factors for the development of eating disorders and efforts to prevent them. A number of variables are considered to be risk factors; however, extant research has notable limitations, including the low prevalence of these conditions within the general population, which complicates the identification of reliable risk facto...

This chapter focuses on treatments for adolescents with eating disorders, using information derived from randomized controlled trials and evidence-based treatments for eating disorders in adults. Available data provide some guidance in selecting treatments, but there are significant limitations in research on psychological and pharmacological inter...

The landmark guide to pediatric medicine - updated and streamlined for today's clinicians and students Highlighting the numerous advances and developements in pediatrics, the new second edition provides a complete update of this premier clinical reference including signs and symptoms, behavioral health, care of healthy and high-risk infants, adoles...

It is now recognized that the prevalence of atopic disorders including (EoE) and immune based conditions such as celiac disease and inflammatory bowel disease are on the rise. This changing epidemiology coupled with advancements in the diagnosis of these conditions have led to greater numbers of adolescents needing treatment. Topics include: Swallo...

The medical practitioner has an important role to play in the management of adolescents with eating disorders, usually as part of a multidisciplinary team. This article reviews the role of the medical practitioner in the diagnosis and treatment of eating disorders, updating the reader on the changing epidemiology of eating disorders, revised diagno...

Recent research has modified both the conceptualization and treatment of eating disorders. New diagnostic criteria reducing the "not otherwise specified" category should facilitate the early recognition and treatment of anorexia nervosa (AN) and bulimia nervosa (BN). Technology-based studies identify AN and BN as "brain circuit" disorders; epidemio...

This groundbreaking multimedia resource embodies the core belief that identifying, reinforcing, and building on inherent strengths can facilitate positive youth development. Text and video combine to show how expert-tested, strength-based communication approaches work in today's teens. Contributions from leading practitioners - plus first-hand pers...

Background: Interactions between adolescents and their neighborhoods can promote or worsen health outcomes. The purpose of this study was to examine the perceptions of neighborhood social disorder and social cohesion on the adolescent health concerns of sexual behavior and delinquency. Methods: Convenience sample of 437 adolescents participating in...

The Life Course Perspective (LCP), or Model, is now a guiding framework in Maternal and Child Health (MCH) activities, including training, supported by the Health Resources and Services Administration's Maternal and Child Health Bureau. As generally applied, the LCP tends to focus on pre- through post-natal stages, infancy and early childhood, with...

This groundbreaking multimedia resource embodies the core belief that identifying, reinforcing, and building on inherent strengths can facilitate positive youth development. Text and video combine to show how expert-tested, strength-based communication approaches work in today's teens. Contributions from leading practitioners - plus first-hand pers...

CME Educational Objectives 1. Explain the core clinical features of avoidant/restrictive food intake disorder (ARFID). 2. Understand the diagnostic limitations of feeding disorders of infancy or early childhood in DSM-IV . 3. Describe the rationale for the recommendation that ARFID be included in DSM-5 . It is well recognized that a number of pati...

Disorders related to ingesting adequate variety and amounts of food, often dichotomized into feeding or eating disorders, depending on the need for affected individuals to be fed or to eat on their own respectively, include a wide variety of conditions. This paper focuses on disorders that are not also associated with behaviors related to weight-co...

To examine the agreement between three methods to calculate expected body weight (EBW) for adolescents with eating disorders: (1) BMI percentile, (2) McLaren, and (3) Moore methods. The authors conducted a cross-sectional analysis of baseline information from adolescents seeking treatment of disordered eating at The University of Chicago. Adolescen...

In this issue of the Journal of Adolescent Health, Jiang et al present the first comprehensive analysis of the 21 Critical National Health Objectives (CNHOs) of Healthy People 2010 (HP 2010), deemed to represent the most significant threats to the health of adolescents and young adults aged 10–24 years.

Trustworthy guidance spanning every aspect of adolescent health care. Unlike other adolescent medicine references, the all-new AAP Textbook of Adolescent Care is an action-oriented working tool expressly built for efficient, on-target clinical problem-solving. Broad scope - Nearly 200 chapters cover physical growth and development, examination and...

Trustworthy guidance spanning every aspect of adolescent health care. Unlike other adolescent medicine references, the all-new AAP Textbook of Adolescent Care is an action-oriented working tool expressly built for efficient, on-target clinical problem-solving. Broad scope - Nearly 200 chapters cover physical growth and development, examination and...

To review the literature related to the current DSM-IV-TR diagnostic criteria for feeding disorder of infancy or early childhood; pica; rumination disorder; and other childhood presentations that are characterized by avoidance of food or restricted food intake, with the purpose of informing options for DSM-V. Articles were identified by computerize...

In conclusion, my stewardship of SAM will be grounded in our mission, vision, and core values. I have discussed four areas: research, professional development, our presence in cyberspace, and a focus on clinical issues relevant to those who are in the trenches. We have much to do, and I cannot do it alone. As Henry Ford noted: "Coming together is a...

Now from the AAP! Adolescent Medicine: State of the Art Reviews (formerly Adolescent Medicine Clinics) is the official publication of the AAP Section on Adolescent Health. This widely respected resource continues to deliver practice-focused, useful information you won't see anywhere else. Topics in Evaluation and Management include: Introduction to...

For more than 75 years, the American Academy of Pediatrics has been the nation’s leading and most trusted child health expert. The all-new full color AAP Textbook continues the tradition by providing a wealth of expert guidance spanning every aspect of current clinical practice and sets a new standard for one-stop pediatric references! Directed by...

This chapter focuses on conditions characterized by severe disturbances in eating behavior that are grouped within the category of “eating disorders” in the Diagnostic and Statistical Manual, 4th edn. [1]. This reference text, popularly known as the DSM-IV, had a “text revision” in 2000, but there were no changes for eating disorder criteria. The p...

: The purpose of this article is to summarize major conceptual and clinical variables related to age-appropriate and developmentally appropriate classification of eating problems and disorders in children and adolescents. A review of current classifications and related literature in child development is provided. Problems with current classificatio...

There has been a paucity of theory-based interventions to improve health outcomes in overweight adolescents. Therefore, two intervention studies were conducted to: (a) determine the feasibility of implementing the Creating Opportunities for Personal Empowerment (COPE) Healthy Lifestyles Thinking, Emotions, Exercise, and Nutrition (TEEN) program wit...

An Internet search of "eating disorders" yields 15,000,000 websites and almost 20,000 images. Stories about eating disorders among popular performers also regularly appear in the press (see People magazine October 27, 2006 cover story), and TV (HBO's documentary Thin airs later this month, beginning November 14 th). As is often true, when there is...

A tripling in the number of overweight adolescents has occurred during the past two decades, with type 2 diabetes reaching epidemic proportions. Although obesity has been identified as a correlate of depression and low self-esteem in adolescents, the relationships among key cognitive/mental health variables and healthy attitudes, beliefs, choices,...

Preventive services guidelines recommend screening all adolescents for diet habits, physical activity and growth, counseling underweight teens about body image and dieting patterns, and counseling overweight or obese teens about dietary habits and exercise. In this study, we assess whether adolescents at risk for overweight or for eating disorders...

Somatoform disorders are presented in the first article in this issue of Adolescent Medicine Clinics because the physical symptoms that cause the adolescent to present for diagnosis and treatment reflect the interaction of the psyche and the soma in ways that are poorly understood. Because of dualistic conceptualizations that are encouraged by tech...

Approach to young patients with chronic medical complications Patients with chronic medical complications associated with an eating disorder (ED) often elicit negative countertransference from medical care providers (Franko & Rolfe, 1996). Common reactions by professionals include frustration with treating conditions that patients ‘bring on themsel...

This title, which is the very first to disseminate the findings of the Adolescent Mental Health Initiative sponsored by the Annenberg Foundation Trust at Sunnylands and the Annenberg Public Policy Center (APPC) of the University of Pennsylvania, addresses the current state of our knowledge about various mental health disorders in the teenage years,...

Patients with psychologic diagnosis such as eating disorders have been automatically disqualified as candidates for plastic surgery. We have previously reported on a cohort of women with bulimia nervosa who presented with symptomatic macromastia. All patients reported that dysfunctional eating habits where in part the result of breast enlargement....

This article addresses practical issues facing the primary care practitioner caring for an adolescent with an eating disorder. It is grounded in the four elements of successful treatment noted by Comerci: (1) recognizing the disorder and restoring physiologic stability early in its course, (2) establishing a trusting, therapeutic partnership with t...

Eating disorders are relatively common and frequently result in medical signs and symptoms. Armed with an appreciation of the protean manifestations of these complex health problems as well as an appreciation of the biopsychosocial approach needed to help the adolescent or young adult woman recover, the primary care physician is in an excellent pos...

Eating disorders are relatively common and frequently result in gynecologic abnormalities. The gynecologist must appreciate the various manifestations of these complex health problems as well as the biopsychosocial approach needed to help the adolescent or young adult woman recover from these chronic conditions. By recognizing both the medical and...

Women with eating disorders have been disqualified as candidates for plastic surgery. We present a group of 6 young women with bulimia nervosa who presented with clinically symptomatic evidence of macromastia. All patients reported that dysfunctional eating habits, at least in part, where due to breast enlargement. Five patients underwent bilateral...

To determine the outcome of patients with bulimia nervosa and symptomatic breast hypertrophy (macromastia) who had reduction mammaplasty and to identify factors that were associated with positive outcomes. Case series with semistructured, retrospective, personal interviews performed an average of 4 years after the procedure. University hospital-bas...

Objectives: To determine the outcome of patients with bulimia nervosa and symptomatic breast hypertrophy (macromastia) who had reduction mammaplasty and to identify factors that were associated with positive outcomes.Design: Case series with semistructured, retrospective, personal interviews performed an average of 4 years after the procedure.Set...

The scientific literature suggests that outcome for adolescents with eating disorders bears little relation to the type of treatment used. Practitioners of adolescent medicine care for adolescents with eating disorders and have reported outcome in three studies, to which a fourth is added in this paper. This new sample of 34 adolescents represents...

Anorexia nervosa and bulimia nervosa represent extreme manifestations of weight control patterns in adolescents. When they occur in children, they often are associated with more severe psychiatric or family dysfunction. However, rather than framing these conditions as purely psychiatric problems, it is more useful to approach them in terms of devel...

Anorexia nervosa and bulimia nervosa represent extreme manifestations of weight control patterns in adolescents. When they occur in children, they often are associated with more severe psychiatric or family dysfunction. However, rather than framing these conditions as purely psychiatric problems, it is more useful to approach them in terms of devel...

Bone densitometry is becoming more widely available and is no longer limited to studying the elderly. Rapid, safe, and accurate methods of measuring BMD now allow serial determination of this important factor in fracture risk and will undoubtedly become even more accessible in the future. Likewise, our knowledge about the mechanisms and genetics of...

We studied autonomic modulation of heart rate in 8 females with anorexia nervosa (AN) using power spectral analysis (PSA) of heart rate variability in the supine and standing positions at baseline and after 2 weeks of intensive nutritional rehabilitation, and compared findings with healthy female control subjects. The results indicate that there is...

Although many studies have explored the mechanism by which dietary restraint becomes disinhibited, few have examined how restraint is restored or "reinhibited." Using a taste test with preload design, we showed a sad movie clip interrupted by diet-related commercials, neutral commercials, or no commercials to women with high and low restraint score...

A 17-year-old male with anorexia nervosa developed atypical prolongation of his corrected QT interval (QTc) when placed on isoproterenol for profound sinus bradycardia. His QTc normalized after the infusion was discontinued. Autonomic imbalance may explain the observed QTc lengthening. Because bradycardia associated with weight loss in anorexia is...

We performed tetracycline double-labeled bone biopsies and serial bone densitometry on four patients with anorexia nervosa to determine the effects of various conditions of sex hormone replacement and body weight status. We found negligible bone mineral apposition rate in two patients with anorexia nervosa who were taking estrogen and progestin pil...

Almost half of the adult skeletal mass is laid down during the adolescent years. The concept of the "bone bank" reminds us that "deposits" of calcium are normally made to the skeleton until about 35 years of age in females. Subsequently, there are continuous "withdrawals" of bone mineral and loss of skeletal mass, eventually resulting in osteopenia...

The long-term outcome of 49 adolescent girls hospitalized for the treatment of anorexia nervosa on a pediatric service was determined by personal interview an average of 80 +/- 21 months after admission to the hospital. The mean age at follow-up was 22.7 years. Between admission to the hospital and follow-up, body weight increased, on average, from...

• The long-term outcome of 49 adolescent girls hospitalized for the treatment of anorexia nervosa on a pediatric service was determined by personal interview an average of 80±21 months after admission to the hospital. The mean age at follow-up was 22.7 years. Between admission to the hospital and follow-up, body weight increased, on average, from 7...

Menstrual dysfunction is a common concomitant of anorexia nervosa and bulimia. Initial investigations emphasized the role of weight loss and lean/fat ratio in amenorrhea. Subsequent studies suggest a more complex interaction between eating disorders and menstrual status. However, in past investigations, menstrual abnormalities have been confounded...

Primary -L rimary care practitioners are being challenged to provide preventive and curative services to adolescents. Adolescent health services are ideally provided by physicians knowledgeable about normal adolescent growth and development, the practice of adolescent medicine, and the causes of major morbidity and mortality in this age group.1 Und...

The clinical usefulness of gynecologic age (GA) (the difference between chronologic age [CA] and menarcheal age [MA]) is controversial. We compared CA and GA with bone age (BA) (the standard reference criterion for biologic maturity), in 107 Caucasian girls who ranged in age from 8.3 to 18.5 years. Chronologic age and GA each correlated significant...

Computerized tomographic brain scans of five patients with anorexia nervosa showed significantly more dilation of the third and lateral ventricles than in control subjects. Measurements of lean body mass suggest that these findings are secondary to the anorexic patients' protein malnutrition.

Twelve patients with anorexia nervosa were studied on the Clinical Research Center for periods of 15 to 58 days. Five patients were fed a diet providing 20% of energy from protein and seven patients were fed a diet with only 10% of energy from protein. These patients had a reduced lean body mass in addition to a loss of body fat, and during recover...