Reprinted from Eating Disorders: Critical Points for Early Recognition and Medical Risk Management in the Care of Individuals with Eating Disorders — Academy For Eating Disorders.
- Eating disorders are serious disorders with life-threatening physical and psychological complications.
- In addition to girls and women, EDs can affect boys and men; children, adolescents and adults; people from all ethnicities and socioeconomic backgrounds; and people with a variety of body shapes, weights and sizes.
- Weight is not the only clinical marker of an ED. People who are at normal weight can have EDs.
- It is important to remember that EDs do not only affect females at low weight. All instances of precipitous weight loss in otherwise healthy individuals should be investigated for the possibility of an ED, including post-bariatric surgery patients. In addition, rapid weight gain or weight fluctuations can be a potential marker of an ED.
- Individuals at weights above their natural weight range may not be getting proper nutrition and patients within their natural weight range may be engaging in unhealthy weight control practices.
- In children and adolescents, failure to gain expected weight or height, and/or delayed/interrupted pubertal development, should be investigated for the possibility of an ED.
- The medical consequences of EDs can go unrecognized, even by experienced clinicians.
- Eating disorders (including BED) can be associated with serious medical complications. Eating disorders can be associated with significant compromise in every organ system of the body, including the cardiovascular, gastrointestinal, endocrine, dermatological, hematological, skeletal, and central nervous system.
Presenting Signs and Symptoms
Individuals with EDs may present in a variety of ways. In addition to the cognitive and behavioral signs that characterize EDs, the following are possible physical signs and symptoms that can occur in patients with an ED as a consequence of nutritional deficiencies, binge-eating, and inappropriate compensatory behaviors, such as purging. However, an ED may occur without obvious physical signs or symptoms.
GENERAL
- Marked weight loss, gain or fluctuations
- Weight loss, weight maintenance or failure to gain expected weight in a child and adolescent who is still growing and developing
Cold intolerance - Weakness
- Fatigue or lethargy
- Dizziness
- Syncope
- Hot flashes, sweating episodes
ORAL AND DENTAL
- Oral trauma/lacerations
- Dental erosion and dental caries
- Perimolysis
- Parotid enlargement
CARDIORESPIRATORY
- Chest pain
- Heart palpitations
- Arrhythmias
- Shortness of breath
- Edema
GASTROINTESTINAL
- Epigastric discomfort
- Early satiety, delayed gastric emptying
- Gastroesophageal reflux
- Hemorrhoids and rectal prolapse
- Constipation
ENDOCRINE
- Amenorrhea or irregular menses
- Loss of libido
- Low bone mineral density and increased risk for bone fractures and osteoporosis
- Infertility
NEUROPSYCHIATRIC
- Seizures
- Memory loss/Poor concentration
- Insomnia
- Depression/Anxiety/Obsessive behavior
- Self-harm
- Suicidal ideation/Suicide attempt
DERMATOLOGIC
Lanugo hair
Hair loss
Yellowish discoloration of skin
Callus or scars on the dorsum of the hand (Russell’s sign)
Poor healing
Early Recognition
Consider evaluating an individual for an ED who presents with any of the following:
- Precipitous weight loss/gain
- Weight loss or failure to gain expected weight/height in a child and adolescent who is still growing and developing
- Substantial weight fluctuations
- Electrolyte abnormalities (with or without ECG changes), especially hypokalemia, hypochloremia, or elevated CO2. High normal CO2 in the presence of tow normal chloride and/or urine pH of 8.0 – 8.5 can indicate recurrent vomiting. Hypoglycemia may accompany such electrolyte changes.
- Bradycardia
- Amenorrhea or menstrual irregularities
- Unexplained infertility
- Excessive exercise or involvement in extreme physical training
- Constipation in the setting of other inappropriate dieting and/or weight loss promoting behaviors
- Type 1 diabetes mellitus and unexplained weight loss and/or poor metabolic control or diabetic ketoacidosis (DKA. These patients are at increased risk of developing sub-threshold and full syndrome EDs. Intentionally changing insulin doses (under-dosing or omission) will lead to weight loss, poor glycemic control (higher hemoglobin A1c), hypoglycemia/hyperglycemia, DKA, and acceleration of diabetic complications.
- A history of using one or more compensatory behaviors to influence weight after eating or perceived overeating or binge eating, such as self-induced vomiting, dieting, fasting or excessive exercise.
- A history of using/abusing appetite suppressants, excessive caffeine, diuretics, laxatives, enemas, ipecac, excessive hot or cold fluids, artificial sweeteners, sugar-free gum, prescription medications (i.e., insulin, thyroid medications), psychostimulants, street drugs, or a variety of complementary and alternative supplements.
Acute malnutrition is a medical emergency
Individuals with continued restrictive eating behaviors, binge eating or purging despite efforts to redirect their behavior require immediate intervention. Acute malnutrition is a medical emergency. Malnutrition can occur at any body weight, not just at a low weight.
For references and further information about the diagnosis and treatment of EDs visit: www.aedweb.org.
