Eating Disorders and Their Medical Symptoms
Frederick R. Jelovsek MD
Eating disorders -- anorexia nervosa, bulimia nervosa and binge-eating disorder -- occur most commonly in adolescent girls or young women. The death rate from anorexia nervosa is 0.5% a year. Over 50% of eating disorders go unrecognized and it is thought that an estimated 3% of young women have these illnesses. A review article, Becker AE, Grinspoon SK, Klibanski A, Herzog DB: Eating Disorders. N Engl J Med 1999; 340:1092-1098. helps answer some of the questions about this unrecognized group of problems.
What are diagnostic criteria for these eating disorders?
Anorexia nervosa
- Body weight less than 85% of expected weight or body mass index (BMI) less than 17.5
- Intense fear of weight gain
- Inaccurate perception of own body size weight or shape
- Amenorrhea
Bulimia nervosa
- Recurrent binge eating ( at least 2 times per week for 3 months)
- Recurrent induced vomitting (purging), excessive exercise, or fasting ( at least 2 times per week for 3 months)
- Excessive concern about body weight or shape
- Absence of anorexia nervosa
Binge-eating disorder
- Recurrent binge eating (at least two days a week for 6 months)
- Marked distress with at least 3 of the following:
-
eating very rapidly
eating until uncomfortably full
eating when not hungry
eating alone
feeling disgusted or guilty after a binge
- No recurrent purging, excessive exercise or fasting
- Absence of anorexia nervosa
Other (atypical) eating disorders
- Clinically important disordered eating, inappropriate weight control, or excessive concern about body weight or shape that does not meet all the criteria for anorexia nervosa, bulimia nervosa, or binge-eating disorder.
How can I recognize an eating disorder in someone else?
There are both body changes and behavioral changes that may signal an eating disorder. Bodily changes may include:
- arrested growth
- marked change or frequent fluctuation in weight
- inability to gain weight
- fatigue
- constipation or diarrhea
- susceptibility to fractures
- delayed onset of first menses
- abnormal levels of blood chemistries
Behavioral changes may include:
- change in eating habits
- difficulty eating in social settings
- reluctance to be weighed
- depression
- social withdrawal
- absence from school or work
- deceptive or secretive behavior
- stealing (e.g., to obtain food)
- substance abuse
- excessive exercise
What is considered underweight or over weight?
While different criteria have been used by various medical groups the following levels are adapted from the Harvard Eating Disorders Center in Boston.
Weight ranges for adults
| Classification | BMI | Weight at 5'3" (162 cm) |
|---|---|---|
| Obese | over 30 | over 170 lbs (79 kg) |
| Overweight | 25-30 | 141-169 lbs (66-78 kg) |
| Normal weight | 20-25 | 113-140 lbs (53-65 kg) |
| Underweight | 17.5-20 | 91-112 lbs (46-52 kg |
| Very underweight | less than 17.5 | less than 90 lbs (46 kg) |
What are some of the medical complications of anorexia or bulimia?
There are many complications of these disorders. In the oral cavity, there can be increased dental caries, gum disease, parotid gland enlargement and swollen lymph nodes under the jaw. In the cardiovascular system, hypotension, EKG changes, slow heart rate, heart enlargement and mitral valve prolapse can be seen. Liver and pancreas damage, esophagitis, constipation and rectocoele are gastrointestinal manifestations commonly seen.
Since women with these disorders have no menses or ovarian ovulation, the secondary effects of low estrogens cause delay in puberty, osteoporosis, infertility, lipid abnormalities, euthyroid sick syndrome, and other endocrine or chemical disturbances. During pregnancy, insufficient weight gain and low birthweight babies occur.
Finally, skin changes such as dry skin and hair, hair loss, yellow skin and hand abrasions may be part of the clinical picture. Women may also have anemia, low white blood cell counts or low platelets, and even peripheral nerve problems.
How successful are the treatments for these eating disorders?
About half of women who have anorexia nervosa or bulimia nervosa will have a full recovery if they get in a psychiatric counselling program. Approximately 30% have a partial recovery and 20% have no substantial improvement in symptoms. Only if the weight gets to be 75% or less of expected body weight is hospitalization usually necessary. Psychopharmacologic therapy is less successful in anorexia and more commonly used with bulimia nervosa. Estrogens and regulation of menses or the prevention of hypoestrogenic complications must be individually applied.
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