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Everybody Knows Somebody

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At the American Medical Women’s Association 103rd Annual Meeting, I had a chance to present a session, “Binge Eating Disorders and Orthoexia.”

The lifetime risk for an eating disorder (ED) is 0.6% for Anorexia, 1% for bulimia and 2.8% for binge eating disorder. Chances are that most of us know “somebody” with an eating disorder.

For this reason, I encourage all physicians and other health care providers to consider the following two questions as screening for eating disorders.

  1. Are you comfortable with your current body shape and size?
  2. What have you done in the last year to change it?

Up to 91% of college age women have been on a diet in the last 2 years and 35% of dieters develop pathological dieting practices. While the typical person with an eating disorder is felt to be a young teen girl, the face of ED includes all, including new cases in adults and geriatric patients as well as men and women.

In adults it is not just those that had an ED in their youth who can have relapse, but there are many in which an ED surfaces as a way to control things when life gets out of hand, or when good intentions go awry.

In my presentation, I discussed orthoexia, or the desire to be “healthy,” and how it can lead to obsessive behaviors, restricting and over exercising that can be damaging to the body and the mind.

The two screening questions help to open the door to the conversation about eating disorders and body dysmorphic. While anorexia is restricting nutritional intake to such a degree that malnutrition can cause amenorrhea, loss of bone density, cardiac arrhythmia, easy bruising and electrolyte abnormalities, and may be easier to spot, other ED behaviors such as laxative and diuretic abuse, bulimia and over exercising are other actions that can be especially damaging.

Binge eating disorder (BED) has also been recognized formally and is perhaps one of the most common conditions but is less discussed and addressed. It is not unusual for patients to have episodes of eating large amounts of food in a short period of time, usually in private, multiple times per week. The excess food can have a calming effect encouraging repeated behaviors.

Recovery is possible for ED but recognition and a multidisciplinary approach is key. Regardless of the age of onset, comorbidities are equally severe and should be treated. The longer an ED remains untreated, the harder it is to get into remission.

Dr. Theresa Rohr-Kirchgraber is an internist and cares for adults with eating disorders. She is an associate professor of medicine and pediatrics at Indiana University School of Medicine.

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