A 14-year-old girl is brought to the office by her parents for a sports participation examination. The patient is a competitive figure skater and practices before and after school 5 days a week. Her parents are concerned because she recently announced that she will eat only a vegetarian diet, and they are having difficulty providing an adequate variety of meat-free food options around her busy school and athletic training schedule. The patient is otherwise healthy; menarche occurred at age 12 and she has regular menstrual cycles. Vital signs are normal. BMI is 17 kg/m². Physical examination is normal for age. Which of the following is the most appropriate next step in management of this patient?

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11ec160b_3622_6da4_9249_41089a6de892_MD0001_00 This adolescent girl has recently adopted a vegetarian diet, which is causing concern for her parents. Such changes in eating habits are common in adolescents and are often due to benign reasons (eg, wanting to eat "healthy" or improve athletic performance, concerns about animals, desire to identify with a role model or peer group). However, an eating disorder (eg, anorexia nervosa) should also be considered, especially in a patient with a low or low-normal BMI (or involvement in an activity that emphasizes leanness). The next step in evaluating this patient is to directly but nonjudgmentally inquire about her motivations for vegetarianism. As when discussing any sensitive topic with adolescents, she may best be interviewed alone, without her parents present. If no worrisome features (eg, preoccupation with weight, abnormal body image) are found or new complications (eg, amenorrhea) develop, she can be followed clinically without additional specific intervention. (Choice A) Patients on a vegetarian diet should be advised to consume a variety of foods; intake of nonmeat animal-derived foods (eg, eggs, dairy) can often facilitate adequate intake of protein and micronutrients. However, additional supplements are not usually necessary unless specific deficiencies (eg, iron deficiency) develop. (Choices C and D) If no signs of an eating disorder are found on detailed discussion with the patient, her parents may be reassured about the nutritional adequacy of a varied, balanced vegetarian diet, although education regarding healthy meal planning may be helpful. However, optimal family counseling first requires a better understanding of this patient's motivations. (Choice E) This patient appears to have normal growth, development, and physical examination findings. However, additional information about the patient's attitudes toward eating, weight, and body image is needed before ruling out an eating disorder and reassuring the parents. Educational objective: Abrupt dietary and other behavioral changes are common in adolescents and are often due to benign reasons. However, an eating disorder (eg, anorexia nervosa) should also be considered, especially in a patient with a low or low-normal BMI. __________ References: Identification and management of eating disorders in children and adolescents. (http://www.ncbi.nlm.nih.gov/pubmed/33386343)

A 14-Year-Old Girl Is Brought to the Office by Her