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Medical Complications of Eating Disorders

In addition to increased understanding of medical issues associated with eating disorders among medical professionals, patients, families and non-medical treatment team members (therapists, dietitians, etc.) can champion for the use of basic strategies to identify and treat eating disorder complications in medical settings:
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Female doctor discussing with a patient
Female doctor discussing with a patient

While eating disorders are mental illnesses, starvation, bingeing, purging and over-exercise behaviors can take a serious physical toll on the human body. As a result, medical complications commonly occur in individuals with eating disorders. If not addressed in tandem with underlying psychiatric and emotional issues, these medical issues can result in hospitalization, long-term disability and even death. (1)

For those suffering from medical complications related to an eating disorder, there is good news and there is bad news.

First, the bad news. Unfortunately, patients and families often cannot rely on their community medical systems for effective treatment of the medical symptoms of eating disorders. A 2013 study found that providers are dissatisfied with their training in respect to eating disorders and their medical issues, citing a lack of skills, a lack of understanding of the complexity of eating disorders and a lack of resources for additional training and/or referral. (2) Despite the prevalence of medical complications among those suffering from anorexia nervosa, bulimia nervosa and related conditions, most practitioners are largely unfamiliar with these serious medical issues, which commonly include: (3)

• Detox from purging behaviors
• Gastroparesis
• Edema
• Liver function abnormalities
• Eye pain
• Swallowing difficulties
• Electrolyte abnormalities
• Osteoporosis
• Constipation
• SMA syndrome
• Abdominal pain

"The primary contributing factor to suboptimal medical treatment of eating disorders is the widespread lack of eating disorder training/exposure among medical professionals," explains Philip Mehler, MD, FACP, FAED, CEDS, Chief Medical Officer of Eating Recovery Center, Glassman Professor of Medicine at the University of Colorado and Medical Director of the ACUTE Center at Denver Health Medical Center. Widely recognized as the leading international expert in the medical treatment of eating disorders, Mehler continues, "Most doctors in America do not have the training to recognize and effectively manage the medical symptoms of eating disorders, and they often lack awareness of reputable experts specializing in the medical treatment of eating disorders to make educated referrals."

For example, medical professionals are largely unaware of the need to "detox" from bulimia and purging behaviors (including self-induced vomiting, laxative and/or diuretic abuse, etc.). In other words, a patient that ceases purging will often experience abdominal pain and constipation after stopping their laxatives, or they may experience significant edema resulting in weight gain. Edema results as a consequence of chronic severe volume depletion from loss of fluids (Pseudo-Bartter's Syndrome). This syndrome is severely worsened by overuse of a rapid infusion of IV saline fluids used in most medical settings (for treatment of low blood pressure, dehydration, hypokalemia and alkalosis), creating a potentially dangerous scenario in which eating disorder patients can come to harm. Adding insult to injury, the patient will often go back to purging behaviors to alleviate their uncomfortable symptoms that were not addressed in the community medical setting. (4)

As a result, we observe what Dr. Mehler refers to as a "revolving door phenomenon"--patients continue to seek care from providers lacking knowledge of eating disorders' medical complications, but never get the definitive treatment they need to alleviate their symptoms and achieve the medical stability necessary to fully engage in the intensive therapeutic work of recovery. Even worse, they often stop seeking care altogether--negative medical experiences leave an irreparable scar in the psyches of emotionally fragile eating disorder patients. The next time they suffer from the same (or new) uncomfortable medical symptoms, they may be reticent to seek needed treatment.

Together, medical complications of eating disorders and a lack of caregivers with experience in effective treatment of these patients combine to make eating disorders the most lethal mental illnesses. Conservative estimates suggesting mortality rates of four percent for anorexia nervosa, 3.9 percent for bulimia nervosa and 5.2 percent for eating disorders not otherwise specified. (5) However, it is likely that eating disorders are responsible for far more deaths than these statistics reveal. Individuals suffering from an eating disorder may ultimately die of organ failure, malnutrition or suicide. In these instances, it is common for the medical complication resulting in death to be reported as the cause of death instead of the eating disorder, which likely led to the fatal medical complication in the first place.

Now for the good news. Nearly all medical complications of eating disorders are treatable with competent medical care, consistent nutrition and full weight restoration. More and more educational programming is available to physicians, internists, pediatricians and nurses designed to increase exposure to eating disorders and provide practical training for the effective care of these complex illnesses. In addition to increased understanding of medical issues associated with eating disorders among medical professionals, patients, families and non-medical treatment team members (therapists, dietitians, etc.) can champion for the use of basic strategies to identify and treat eating disorder complications in medical settings:

1. Vitals are vital! Taking basic measures of bodily organs that are essential to life (heart, liver, lungs, stomach, etc.) can reveal objective information about the presence of an eating disorder and inform care accordingly.

2. Weight is not the only indicator of an eating disorder; however, comparing a patient's body weight to the Ideal Body Weight (IBW, adjusted for height and gender) can indicate the presence of an eating disorder when evaluated alongside other symptoms.

3. Rapid weight loss often indicates the presence of an eating disorder. In our society, weight loss is widely applauded in medical settings, often for good reason as we face a growing obesity rate. However, this cultural narrative can minimize the underlying cause of weight loss and prevent accurate diagnosis and treatment.

4. Evaluate past history of low weight or bulimic complications. Because of the complexity of eating disorders, particularly the complications of purging detox outlined above, this is important information for medical providers to ask and for patients/families to volunteer.

5. Review APA Guidelines for eating disorders. The American Psychiatric Association has outlined the national standard for addressing eating disorders, including treatment for common medical issues. These guidelines are available to everyone online--medical providers, patients and families alike, and can provide helpful information in the accurate diagnosis, treatment and referral of eating disorder patients.

Citations
1. Ackard, D., Richter, S., Egan, A. & Cronemeyer, C. "Poor outcome and death among youth, young adults, and midlife adults with eating disorders: an investigation of risk factors by age at assessment," International Journal of Eating Disorders. 47(7): 825-835, 2014
2. Canadian Psych, 54(3):160-165,2013
3. "Navigating Through the Medical System Leading to Inpatient Eating Disorder Treatment," a presentation by Philip Mehler, MD, FACP, FAED, CEDS delivered at the Eating Recovery Center Foundation Annual Eating Disorders Conference in Denver, CO on August 15, 2014.
4. Brown, C. & Mehler, P., Medical complications of self-induced vomiting," Eating Disorders, 2013
5. Crow, S.J., Peterson, C.B., Swanson, S.A., Raymond, N.C., Specker, S., Eckert, E.D., Mitchell, J.E. (2009) "Increased mortality in bulimia nervosa and other eating disorders." American Journal of Psychiatry, 166, 1342-1346.

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If you're struggling with an eating disorder, call the National Eating Disorder Association hotline at 1-800-931-2237.