Eating disorders

Patients with eating disorders rarely consult physicians specifically for treatment, since most patients deny that they have a problem. It is therefore critical for the physician to recognize these disorders from symptom patterns and metabolic problems related to inappropriate compensatory behaviors in the binge-eating/purging population. Both anorexia nervosa and bulimia nervosa can be life threatening, especially if untreated, with mortality from anorexia reported as high as 5% to 10% in the literature.Appropriate management of metabolic consequences is important, as these are a major causes of death. Sequelae of vomiting and starvation are the other main causes of morbidity and mortality.The most effective components of treatment for the disorders themselves include the recognition and treatment of psychiatric comorbid conditions, cognitivebehavioral therapy, and nutritional guidance. Successful treatment is best accomplished with a multidisciplinary team approach including a physician for medical management, a psychiatrist/therapist, and a nutritionist.Secrecy is an inherent part of these disorders, with patients attempting to conceal their behaviors. Therefore, objective measures of good outcome (eg, weight gain, demonstrable cessation of purging) are more important than the patient’s subjective reports of improvement. For this reason it is imperative that the treatment team members (therapist, nutritionist, physician) maintain good communication with each other.