J Korean Med Assoc.  2018 Mar;61(3):191-197. 10.5124/jkma.2018.61.3.191.

Medical complications and management of eating disorders

• Kim YR

• KMID: 2406973
• DOI: http://doi.org/10.5124/jkma.2018.61.3.191

Abstract

As the physical abnormalities seen in eating disorders seem to be largely secondary to these patients' disturbed eating habits and their compromised nutritional state, most physical abnormalities associated with eating disorders are reversed by restoring healthy eating habits and sound nutrition. However, some medical consequences of eating disorders are irreversible or have later repercussions on health, especially those affecting the skeleton, the reproductive system, and the brain. Early medical intervention and psychiatric treatment are particularly important for those with or at risk of severe emaciation. Eating disorders are common among adolescent girls and young women and are associated with potentially serious medical complications, yet they often go undetected and untreated. All patients with eating disorders should be evaluated and treated for medical complications of the disease at the same time that psychotherapy and nutritional counseling are undertaken.

Keyword

Feeding and eating disorders; Anorexia nervosa; Bulimia nervosa; Binge-eating disorder; Complications

MeSH Terms

Adolescent
Anorexia Nervosa
Binge-Eating Disorder
Brain
Bulimia Nervosa
Counseling
Early Medical Intervention
Eating*
Emaciation
Feeding and Eating Disorders
Female
Humans
Psychotherapy
Skeleton

Reference

1. Neumark-Sztainer D, Hannan PJ. Weight-related behaviors among adolescent girls and boys: results from a national survey. Arch Pediatr Adolesc Med. 2000; 154:569–577.

2. Sullivan PF. Mortality in anorexia nervosa. Am J Psychiatry. 1995; 152:1073–1074.

3. Whitehouse AM, Cooper PJ, Vize CV, Hill C, Vogel L. Pre-valence of eating disorders in three Cambridge general practices: hidden and conspicuous morbidity. Br J Gen Pract. 1992; 42:57–60.

4. Sekari MK. Adolescent-onset anorexia nervosa: missing half of the story? Br J Psychiatry. 2009; 194:564–565.

5. Stoving RK, Andries A, Brixen K, Bilenberg N, Horder K. Gender differences in outcome of eating disorders: a retro-spective cohort study. Psychiatry Res. 2011; 186:362–366.

6. Treasure J, Cardi V, Leppanen J, Turton R. New treatment approaches for severe and enduring eating disorders. Physiol Behav. 2015; 152:456–465.

7. Fonville L, Giampietro V, Williams SC, Simmons A, Tchan-turia K. Alterations in brain structure in adults with anorexia nervosa and the impact of illness duration. Psychol Med. 2014; 44:1965–1975.

8. Fladung AK, Gron G, Grammer K, Herrnberger B, Schilly E, Grasteit S, Wolf RC, Walter H, von Wietersheim J. A neural signature of anorexia nervosa in the ventral striatal reward system. Am J Psychiatry. 2010; 167:206–212.

9. Fladung AK, Schulze UM, Scholl F, Bauer K, Gron G. Role of the ventral striatum in developing anorexia nervosa. Transl Psychiatry. 2013; 3:e315.

10. Gowers S, Bryant-Waugh R. Management of child and adole-scent eating disorders: the current evidence base and future directions. J Child Psychol Psychiatry. 2004; 45:63–83.

11. Williams PM, Goodie J, Motsinger CD. Treating eating disorders in primary care. Am Fam Physician. 2008; 77:187–195.

12. Kim YR. Eating Disorders and adolescent health. Pediatr Gastroenterol Hepatol Nutr. 2012; 15:Suppl 1. S1–S6.

13. Choi JR, Doh JH, Choi JS, Im S, Kim YR. QT Interval abnormalities in Korean women with anorexia nervosa. Korean J Psychopharmacol. 2014; 25:200–206.

14. Greenfeld D, Mickley D, Quinlan DM, Roloff P. Hypokalemia in outpatients with eating disorders. Am J Psychiatry. 1995; 152:60–63.

15. Gold PW, Kaye W, Robertson GL, Ebert M. Abnormalities in plasma and cerebrospinal-fluid arginine vasopressin in patients with anorexia nervosa. N Engl J Med. 1983; 308:1117–1123.

16. Kim YR, Son MH, Nah JC, Park HA. Medical findings in women with anorexia nervosa in a Korean population. Psychiatry Investi. 2013; 10:101–107.

17. Moshang T Jr, Parks JS, Baker L, Vaidya V, Utiger RD, Bon-giovanni AM, Snyder PJ. Low serum triiodothyronine in patients with anorexia nervosa. J Clin Endocrinol Metab. 1975; 40:470–473.

18. Biller BM, Saxe V, Herzog DB, Rosenthal DI, Holzman S, Klibanski A. Mechanisms of osteoporosis in adult and adolescent women with anorexia nervosa. J Clin Endocrinol Metab. 1989; 68:548–554.

19. Mortola JF, Rasmussen DD, Yen SS. Alterations of the adreno-corticotropin-cortisol axis in normal weight bulimic women: evidence for a central mechanism. J Clin Endocrinol Metab. 1989; 68:517–522.

20. Rigotti NA, Neer RM, Skates SJ, Herzog DB, Nussbaum SR. The clinical course of osteoporosis in anorexia nervosa: a longitudinal study of cortical bone mass. JAMA. 1991; 265:1133–1138.

21. Treasure J, Claudino AM, Zucker N. Eating disorders. Lancet. 2010; 375:583–593.

22. National Institute for Health and Care Excellence (NICE). Eating disorders: recognition and treatment [Internet]. London: NICE;2017. cited 2018 Feb 15. Available from: https://www.nice.org.uk/guidance/ng69/chapter/Recommendations.

23. Patton GC, Coffey C, Carlin JB, Sanci L, Sawyer S. Prognosis of adolescent partial syndromes of eating disorder. Br J Psy-chiatr. 2008; 192:294–299.

24. National Collaborating Centre for Mental Health. Eating disorders: core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. Leicester: British Psychological Society;2004.

25. Kaplan AS, Walsh BT, Olmsted M, Attia E, Carter JC, Devlin MJ, Pike KM, Woodside B, Rockert W, Roberto CA, Parides M. The slippery slope: prediction of successful weight maintenance in anorexia nervosa. Psychol Med. 2009; 39:1037–1045.

26. Fittig E, Jacobi C, Backmund H, Gerlinghoff M, Wittchen HU. Effectiveness of day hospital treatment for anorexia nervosa and bulimia nervosa. Eur Eat Disord Rev. 2008; 16:341–351.

27. Hailey D, Roine R, Ohinmaa A. The effectiveness of telemental health applications: a review. Can J Psychiatry. 2008; 53:769–778.

28. Mitchell JE, Crosby RD, Wonderlich SA, Crow S, Lancaster K, Simonich H, Swan-Kremeier L, Lysne C, Myers TC. A randomized trial comparing the efficacy of cognitive-behavioral therapy for bulimia nervosa delivered via telemedicine versus face-to-face. Behav Res Ther. 2008; 46:581–592.

29. Perkins SJ, Murphy R, Schmidt U, Williams C. Self-help and guided self-help for eating disorders. Cochrane Database Syst Rev. 2006; (3):CD004191.

30. Robinson P, Serfaty M. Getting better byte by byte: a pilot randomised controlled trial of email therapy for bulimia nervosa and binge eating disorder. Eur Eat Disord Rev. 2008; 16:84–93.

31. Vocks S, Tuschen-Caffier B, Pietrowsky R, Rustenbach SJ, Kersting A, Herpertz S. Meta-analysis of the effectiveness of psychological and pharmacological treatments for binge eating disorder. Int J Eat Disord. 2010; 43:205–217.

32. Sysko R, Walsh BT. A critical evaluation of the efficacy of self-help interventions for the treatment of bulimia nervosa and binge-eating disorder. Int J Eat Disord. 2008; 41:97–112.