Eating disorders
Eating disorders are associated most commonly with teenagers
and young adults. Anorexia nervosa rarely persists into later life, but without
successful treatment it may be fatal. When anorexia does last into mid-life,
serious health consequences can arise due to prolonged malnutrition. These
include heart failure, liver damage, and hypokalemia-induced arrhythmias.
In contrast, bulimia and binge eating can persist for years
and may be associated with obesity. Purging is less common in mature women than
in adolescents and may take different forms. Self-induced vomiting is unlikely
to be continued into mid-life and would likely result in severe dental damage
if it were. Laxative and diuretic abuse may be more likely in this age group.
Underweight patients are easy to identify and question
further about eating habits. Because many bulimics are normal weight or
heavier, they are more difficult to recognize. Routine questions may be helpful
in identifying patients for more targeted questioning, such as:
- Are you concerned about your weight?
- Do you ever binge or feel out of control when eating?
A positive response should trigger further assessment of
intake, purging, exercise, and use of laxatives or diuretics.
Patients with eating can often benefit from counseling,
whether or not they are willing to attempt to “cure” their problem. True
anorexia nervosa generally requires a multidisciplinary team approach to
management. Some women, while not meeting strict criteria for anorexia,
maintain an unhealthy fixation on weight and may over-restrict their intake.
Providers can work with these patients to identify a healthy body weight and
encourage a balanced, varied diet.
REFERENCE
- Hu, F.B., Manson, J.E and Willett, W.C. Types of dietary fat and risk of coronary heart disease; a critical review. J. Am. Nutr. 2001
