Medical Complications and Consequences of Eating Disorders

Statistics

From Susan Ice, M.D., Medical Director, The Renfrew Center

• Millions of Americans diagnosed annually

• 90% + are adolescent and young women

• Highest mortality rate of any mental illness -- up to 20%

Eating Disorders: Lifetime Prevalence

• 0.5-3.7% of females suffer from anorexia nervosa

• 1.1-4.2% of females suffer from bulimia nervosa

• 2-5% of males and females suffer from binge eating disorder

• 4.5% females, 0.4% males report bulimia in first year of college Source: APA Work Group on Eating Disorders, 2000

Eating Disorders: Prevalence

• 0.5-1% of adolescents have anorexia nervosa

• 2-3% of adolescents have bulimia nervosa

Eating Disorders: Incidence

• Doubled since 1960s

• Increasing in younger age groups, as young as 7 years

• Occurring increasingly in diverse ethnic and sociocultural groups

• 40-60% of high school girls diet

• 13% of high school girls purge

• 30-40% of junior high girls worry about weight

• 40% of 9-year-old girls have dieted

• 5-year-old girls are concerned about diet

Source: Journal of the American Academy of Child and Adolescent Psychiatry

Eating Disorders: Anorexia Nervosa - Characteristics

• Emaciated look

• Physically active

• Profound weight loss

• Loss of menses

• Body image distortion

• Fear of weight gain

Eating Disorders: Anorexia Nervosa - Medical Complications

• General Health

  • Cardiovascular compromise

  • Osteoporosis

  • Metabolic slowdown

  • Multiple organ compromise

• Suicide

• In adolescence

  • Growth retardation

  • Pubertal delay

  • Peak bone mass reduction
     

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Eating Disorders: Anorexia Nervosa - Medical Complications of Treatment

• Potential negative body response to food and nutritional supplements

• “Refeeding” could cause medical crises:

  • cardiac failure

  • electrolyte disturbances

Eating Disorders: Bulimia Nervosa - Characteristics

• Individual “looks normal”

• Bingeing and purging behaviors

• Individual overly concerned about her body

• Secretive

Eating Disorders: Bulimia Nervosa - Medical Complications

• Dehydration

• Heart problems

• Electrolyte disturbances

• Gastrointestinal problems

Eating Disorders: Bulimia Nervosa - Associated Psychiatric Disorders

• Addictions

• Personality disorders

• Depression

• Manic-depression

• Post-traumatic reactions
   

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Eating Disorders: Binge Eating - Characteristics

• More prevalent: ½ of all clients of diet clinics

• Represented across all ages

• Equally represented between sexes

• Associated with problems of obesity

  • Cardiovascular

  • Diabetes

  • Musculoskeletal

  • Infectious diseases

Eating Disorders: Risk Factors

• Genetic

• Temperamental

• Familial

• Peer group

• Sociocultural forces promote ideal body image as thin

  • Fashion industry

  • Media

  • Entertainment

Eating Disorders: Treatment

• Early detection and intervention necessary

• Treatment must be as complex as the illness

  • Nutritional

  • Medical

  • Psychiatric

  • Psychotherapy with patient, family

• Varied levels of care

Eating Disorders: Recovery

• 1/3 recover after initial episode

• 1/3 fluctuate with recovery and relapse

• 1/3 suffer chronic deterioration

  • Multiple re-hospitalizations

  • Marginal members of society

  • Minimal work capacity

  • Limited social relationships

Eating Disorders: Congress’ Role

Authorize funding for and access to comprehensive treatment

• Adopt APA guidelines for medical necessity for eating disorders

• Guarantee patient’s right to privately pay

• End exclusion of eating disorders from mental health insurance policies

• Pass mental health parity legislation

Authorize funding for continued research

• Risk factors

• Treatment outcome studies

• Prevention strategies

Authorize funding for education

• Increase public awareness of signs, symptoms, treatment, long-term consequences

• Improve access to competent providers

• Develop programs for the training of professionals in treating eating disorders

Eating Disorders: The Future

• It’s up to each of us.

From Jim Gray, Ph.D., American University

Bulimia Nervosa:

• Description:
  Bingeing with a sense of loss of control followed by vomiting, laxative abuse, diuretics, extreme fasting or extreme exercise at least twice a week, body image overemphasized in self evaluation. Sometimes the food will be chewed then spit out.

• Prevalence:
  3.5% of the young (15-35 years) female population. (Males represent only 5-10% of eating disordered individuals)

Anorexia Nervosa:

• Description:
  Severe weight loss, fear of fatness, distorted body image, body image over emphasized in self evaluation, loss of period.

• Prevalence:
  0.5% of the young (15-35 yrs.) female population

Mortality:

• Anorexia Nervosa has the highest mortality rate of any psychiatric disorder, as high as 20%.

• Death can occur after severe bingeing in bulimia nervosa as well.

Treatment can work:

• Day Hospital treatment can work.

• Sixteen studies using cognitive-behavioral therapy showed substantial symptom relief and increase in self esteem. Anderson & Maloney, Clinical Psychology Review, October 2001.

• Anti-depressant medication is useful in treating bulimia nervosa.

Consequences of Eating Disorders:

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Anorexia Nervosa

• Heart Muscle Shrinkage

• Slow and Irregular Heart Beats

• Heart Failure

• Amenorrhea

• Kidney Stones and Kidney Failure

• Lanugo (Development of Excessive Fine Body Hair on Face, Arms and Legs)

• Muscle Atrophy

• Constipation

• Delayed Gastric Emptying, Bowel Irritation

• Osteoporosis

• Death

Bulimia Nervosa

• Electrolyte imbalance, heart arrhythmia, heart failure

• Teeth erosion and cavities

• Irritation and tears in the throat, esophagus and stomach

• Laxative dependence

• Emetic Toxicity

• Death

From Body Wars: Making Peace with Women’s Bodies, by Margo Maine, Ph.D., Gürze Books, 2000

• 42% of 1st-3rd grade girls want to be thinner

• 45% of boys and girls in grades 3-6 want to be thinner

• 37% have already dieted

• 6.9% score in the ED range

• 51% of 9-10 year old girls feel better about selves when dieting

• 9% of 9 year old have vomited to lose weight

• 81% of 10 year old are afraid of being fat

• 53% of 13 year old girls are unhappy with their bodies

• 78% of 18 year old girls are unhappy with their bodies

• The #1 wish of girls 11-17 years old is to lose weight

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