Early Warning Signs for Eating Disorders in Children: A Realist Synthesis of Websites Summarizing Caregiver and Consumer Perspectives.

Objective: A larger number of younger children are being diagnosed with an eating disorder (ED), with parents typically reporting a delay between early warning signs (EWS) and seeking help. The aim of the current investigation was to identify the common EWS for EDs in children noticed by caregivers and consumers as reported on websites to inform earlier detection and intervention.

Method: A realist synthesis of websites summarizing caregiver and consumer perspectives on the EWS for EDs in children was conducted by searching Google, Bing, and Yahoo! for all years covered through 24 October 2023.

Results: The initial search identified 140 websites, of which 62 met criteria for eligibility (93.5% summarized content targeted at caregivers, 6.5% included direct perspectives). Six categories and 24 sub-categories of EWS were identified across 214 individual EWS. The most common EWS, mentioned in at least 40% of websites, were: excessive or compulsive exercise, any weight loss, obsession or preoccupation with food or food preparation, and cutting out major food groups.

Discussion: This web synthesis identified the EWS of developing EDs in children most reported by caregivers and consumers; however, many of the websites contained subjective interpretations of people's experiences which were unverified and may capture potential bias. Future prospective research is required to verify caregiver and consumer experiences and to explore whether these EWS are predictive of ED onset. These results can then inform early detection strategies for EDs and may assist caregivers in recognizing when clinical assessment for an ED is required.