Eating disorders are a severe mental health issue that usually manifests in childhood, adolescence, or early adulthood. They are characterized by severely abnormal eating patterns, as well as discomfort or impairment associated with food or weight (Hornberger et al., 2021). Anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant/restrictive food intake disorder, pica, and rumination disorder are the most prevalent eating disorders among young people. Of all mental illnesses, eating disorders have the greatest death rates and may have a significant negative impact on physical health (Stabouli et al., 2021). An eating disorder affects around 3% of young people in America; its prevalence is growing in tandem with rising rates of obesity and pressures associated with weight in younger generations (Jebeile et al., 2021). However, despite rising incidence and risks, eating disorders in young people continue to be underdiagnosed and undertreated for a variety of reasons, including stigma, health inequalities, and unequal access to evidence-based, coordinated specialty care models for a range of demographic groups
Multiple health inequalities and obstacles are interrelated and are causing the present crisis to affect disadvantaged groups more than others. This calls for prioritizing these populations in attempts to restructure health systems. Factors hindering eating disorder prevention include weight stigma in educational and medical environments, limited mental health knowledge across various demographics, a lack of culturally tailored evidence-based tools for early screening and education, inadequate resources in schools for promoting positive body image and coping skills, fitness testing and sports training in schools promoting unhealthy dieting practices without proper nutrition education, unsupportive school policies on meal timing, negative comments from peers and coaches about weight and body shape diversity, and broader adverse childhood experiences such as poverty, discrimination, and community violence intensifying emotional symptoms linked to the development of disordered eating (Kumar et al., 2020; McClelland et al., 2020).
Additional obstacles blocking access to eating disorder specialty care once medical risks or syndromes appear include: prohibitive treatment costs and low public inpatient bed availability necessitating unfeasible private pay options out of reach for most families; concentrated urban programs compounding disparities for rural and marginalized groups; diagnostic biases focused on thin white females leading many youth with eating disorders to remain dangerously overlooked and undertreated for years without their severe distress and impairments around binging, purging and lost control recognized equally to phenotypic underweight cases; crushing financial burden from insurance denials not accounting for social complexities underlying care delays until critical physical junctures or protracted psychiatric illnes; and widespread specialty provider shortages in communities distanced from properly coordinated eating disorder supports to intervene before cases become medically unstable (Hornberger et al., 2021; Jebeile et al., 2021).
Psychiatric mental health nurse practitioners have the necessary skills and knowledge in medical, mental health, and care coordination to address gaps through education, optimization, outreach, and policy initiatives. They aim to expand prevention programs tailored to diverse groups, improve access to care, and support equitable treatment for eating disorders to sustain long-term recovery. PMHNPs, as transformational nurse leaders focused on population wellness and health equity, can lead efforts to combat stigma and improve mental health literacy from a young age. This can help promote positive body image and resilience against harmful media influences and unhealthy eating habits before the development of disordered eating. Examples consist of campaigns promoting natural shape diversity, educational programs enhancing critical media literacy, and emotional education encouraging self-compassion and healthy nutrition choices for overall well-being instead of focusing on externally-driven weight control (Hornberger et al., 2021; Stabouli et al., 2021).
PMHNP supervision is crucial for promptly identifying and intervening in emerging symptoms to prevent long-term illness severity. This includes engaging youth with concerning patterns in brief guided treatments to prevent the escalation of severe eating disorders that require intensive care. Regular screenings in adolescent primary care to evaluate body dissatisfaction, weight/shape concerns, dieting, and compensatory behaviors, along with depression assessments due to their common occurrence, can help detect risks early. This can be supplemented with school-based or remote mental health services such as enhanced cognitive behavioral therapy or emotion-focused skills training when concerns arise (Jebeile et al., 2021; McClelland et al., 2020). PMHNP leadership enhances evidence-based treatment access, quality, and outcomes for diagnosed eating disorder cases by coordinating specialty teams that offer psychotherapy, nutrition therapy, medication management, and peer mentorship. This unified service model includes expanded delivery pathways such as telehealth partnerships and provider training in communities with limited resources. This approach ensures that appropriate levels of care are available in different regions to support recovery.
To address the growing youth crisis, committed, compassionate leadership in the clinical and policy domains is required. Diet-culture messaging is spreading across generations, and there are alarming care disparities that leave male and minority populations dangerously underserved and underidentified (Kumar et al., 2020). Psychiatric nurse practitioners are uniquely qualified to oversee such wide-ranging changes that benefit whole communities. Their academic background allows them to master the complex medical, mental health, and case coordination skills needed to clinically stabilize youth across risk profiles using evidence-based modalities. These are skills outside the scope of primary care and therapists, necessitating immediate mentorship support and promoting access expansion in rural areas lacking specialists in eating disorders (Kumar et al., 2020).
In addition, because of their holistic approach to population health, PMHNPs are better equipped to oversee upstream preventative programs that target underlying causes such as trauma, injustices, and societal dysfunctions that foster body dissatisfaction and other risk factors for disordered eating across the community. PMHNPs are the perfect workforce to realize this audacious vision towards mental health equity in the eating disorder space because of their broad skill sets that encompass both detailed clinical interventions and broad policy leadership, in addition to the genuine community trust they have earned through years of congruently supporting diverse families who are frequently marginalized within medical institutions. The moment has come for psychiatric nursing’s distinctive integrative and socially conscious viewpoint to unite and propel change via workforce development, obstacle removal, implementation guidance, and compassionate advocacy. This will establish optimal eating disorder screening, coordinated intervention, and medical stabilization as universal standards that benefit all young people, irrespective of their demographic makeup. To promote true embodied freedom and balanced nutritional health that supports community development, this is crucial.
In conclusion, psychiatric nurse practitioners, equipped with clinical expertise, a focus on health equity, and integrative population perspectives, are uniquely positioned to address the growing youth eating disorder crisis by removing systemic barriers, directing policy changes, and improving prevention and care standards for diverse families. PMHNPs are well-equipped with a wide range of skills in clinical best practices and leadership, making them perfectly positioned to achieve the ambitious goal of promoting mental health parity in the field of eating disorders. It is crucial for psychiatric nursing to utilize its unique training, ethical values, and practical experience to advocate for marginalized groups within the healthcare system and promote change. This includes implementing improved practices for treating eating disorders that are accessible to all young individuals, regardless of their background. This is vital for promoting true bodily autonomy and healthy nutrition, which can help communities thrive.
Hornberger, L. L., Lane, M. A., Lane, M., Breuner, C. C., Alderman, E. M., Grubb, L. K., … & Baumberger, J. (2021). Identification and management of eating disorders in children and adolescents. Pediatrics, 147(1). https://doi.org/10.1542/peds.2020-040279
Jebeile, H., Lister, N. B., Baur, L. A., Garnett, S. P., & Paxton, S. J. (2021). Eating disorder risk in adolescents with obesity. Obesity reviews, 22(5), e13173. https://doi.org/10.1111/obr.13173
Kumar, A., Kearney, A., Hoskins, K., & Iyengar, A. (2020). The role of psychiatric mental health nurse practitioners in improving mental and behavioral health care delivery for children and adolescents in multiple settings. Archives of psychiatric nursing, 34(5), 275-280. https://pubmed.ncbi.nlm.nih.gov/33032746/
McClelland, J., Robinson, L., Potterton, R., Mountford, V., & Schmidt, U. (2020). Symptom trajectories into eating disorders: A systematic review of longitudinal, nonclinical studies in children/adolescents. European Psychiatry, 63(1), e60. https://doi.org/10.1192/j.eurpsy.2020.55
Stabouli, S., Erdine, S., Suurorg, L., Jankauskienė, A., & Lurbe, E. (2021). Obesity and eating disorders in children and adolescents: the bidirectional link. Nutrients, 13(12), 4321. https://doi.org/10.3390/nu13124321