Eating disorders in children don't always look the way you'd expect. At the AAP 2026 National Conference, pediatricians from UCSF highlighted how conditions like atypical anorexia nervosa — where patients meet all criteria for anorexia except low body weight — are frequently missed, often until kids are seriously ill. A 13-year-old still in the 90th BMI percentile who lost 30 lbs in 9 months is a prime example: she had been fasting, cutting portions, and walking up to 2 hours daily to avoid bullying.

Clinicians were urged to track disruptions in a child's own growth trajectory rather than relying solely on population norms. A drop from a stable 75th percentile to the 40th, for instance, warrants attention — even if the number still looks "normal."

Key Takeaways:

• Bradycardia in an athlete with weight loss shouldn't be automatically chalked up to athletic heart syndrome — screen for eating disorders first
• Vague symptoms like fatigue, dizziness, or difficulty concentrating can be early signs
• Menstrual changes are another red flag worth probing
• Ask about GLP-1 drugs in the home; some teens are diverting them from family members to suppress appetite
• Screen for disordered eating before starting any patient on a GLP-1

Why it matters: Atypical anorexia nervosa is underdiagnosed and undertreated — and these patients often present sicker when they finally reach the hospital. Simple screening questions during routine weigh-ins could be a game-changer for early intervention.