Until recently there were few ways to identify children at risk for developing eating disorders later in life. Now, results of a recent study show that body mass index and growth patterns may give pediatricians helpful clues to children at risk. A child with persistently low body mass index may be at increased risk for development of anorexia nervosa when he or she reaches adolescence. The study was recently reported by Dr. Nadia Micali, professor and head of the Geneva University Hospital’s Division of Child and Adolescent Psychiatry, with eating disorders colleagues at the University of North Carolina. The pattern can be seen as early as 2 years of age for boys and 4 years of age for girls, according to the researchers. One of the co-authors, Dr. Cynthia Bulik, Distinguished Professor of Eating Disorders at the University of North Carolina School of Medicine, noted that clinicians need to be particularly alert when a child falls off and remains off the growth curve throughout childhood. She added, “The same holds true for children who exceed and remain above the growth curve—their risk is increased for other eating disorders, such as bulimia nervosa and binge eating disorder.” The authors also noted that their study highlights the need to consider metabolic risk factors as well as psychological, sociocultural, and environmental elements in the development of eating disorders. The difference is that childhood body weight changes start to emerge at a very early age—far before social pressures to be thin or to diet. The results of the authors’ long-term study were published in theJournal of the American Academy of Child and Adolescent Psychiatry (2018; doi: 10.1016/jaac. 2018.11.008.).