Q&A: Recognizing, treating patients with eating disorders

Erica Swegler
Erica Swegler

Feb. 26 through March 4 is National Eating Disorders Week, a time to put a greater spotlight on conditions such as bulimia nervosa, binge-eating disorder and anorexia nervosa, according to the National Eating Disorders Association.

According to the association, 30 million Americans have an eating disorder, and millions more have food and body image issues that negatively impact their lives.

Erica Swegler, MD, a family physician in Austin, Texas, and a board member of American Academy of Family Physicians, said eating disorders can be triggered by both physical, psychological and social factors.

“Eating disorders are significant health issues that fall within the mental health arena,” she said in an interview. “As a physician, I’ve seen patients develop an eating disorder simply from hearing one negative comment from a classmate regarding their body type.”

In recognition of National Eating Disorders Week, Healio Family Medicine asked Swegler to discuss risk factors, treatments and other issues primary care providers should consider for patients with, or at risk for, an eating disorder. – by Janel Miller

Question: What are some of the risk factors and warning signs that a patient has an eating disorder?

Answer: Patients with an unrealistic body image, low confidence, and low sense of self-worth might be more susceptible to developing an eating disorder. In addition, parents who report that their child is hardly eating during meals, but notice food is missing from the refrigerator or pantry might have a child suffering from an eating disorder. People with eating disorders will often stash or hoard food for later consumption. In addition, parents who find over-the-counter laxatives or diuretics around the house that they did not buy may also have a child who has an eating disorder.

Q: What are some other signs of eating disorders?

A: Meeting weight categories for some sports can bring out eating disorders in both men and women, so physicians should make sure they ask their young athletes if they are trying to lose weight to meet the weight class for sports like wrestling.

There are other disorders that essentially function as an eating disorder, one being the female athlete triad. This is defined as when a woman stops having periods due to low body weight and low body fat, and it is often attributed to over exercising. These women can develop osteoporosis at a very young age, even if they don’t have any abnormalities in their eating. However, they are exercising to a point that is unhealthy.

Another sign of an eating disorder sometimes occurs in patients who have type 1 diabetes and who purposefully withhold their insulin treatments. This can cause their blood sugar to spiral out of control as they try to control their weight, much like a patient with more traditional eating disorders such as bulimia nervosa, binge-eating disorder, or anorexia nervosa. This last instance is extremely rare, but it can happen.

Q : How can a PCP discuss eating disorders with patients?

A: When patients come in for a physical exam, in addition to obtaining their weight, also be sure to calculate their BMI. Ask the patient, “Do you feel like you weigh too much or too little?” If a person has a BMI of 18 kg/m2, but he or she says things like, “Oh, I am so fat,” or, “My thighs are huge,” that should be an alarm. Anorexia and bulimia can cause metabolic abnormalities such as high or low potassium. Patients who have these conditions may feel no adverse effects, but may not realize the damage they are doing. I would advise telling patients who I suspect have anorexia or bulimia that they are really harming themselves and need treatment.

Q: What treatment options are available for patients with eating disorders?

A: Bringing in psychological support for counseling and a dietitian to teach the patient what is appropriate to eat is very important. Team-based care in the patient’s medical home is particularly vital when treating these disorders. When a patient is identified as having an eating disorder, engage psychological support and nutritional counseling as quickly and early as possible. Patients who have accepted that they have a disorder need to be informed that treating eating disorders is a long-term process, making clear to the patient that this is not something that is going to go away quickly in the next week or so. Medications that work on serotonin levels may also help patients with eating disorders. Unfortunately, part of the difficulty of treating these disorders is that, unlike with other substances that are being abused, with food the patient still must consume a proper amount on a daily basis.

For more information:

Familydoctor.org. “Eating Disorders.” https://familydoctor.org/condition/eating-disorders. Accessed Feb. 26, 2018.

Familydoctor.org. “For Parents: Eating Disorders in Teens.” https://familydoctor.org/for-parents-eating-disorders-in-teens. Accessed Feb. 26, 2018.

Familydoctor.org. “Therapy and Counseling.” https://familydoctor.org/therapy-and-counseling. Accessed Feb. 26, 2018.

NIMH.gov. “Eating Disorders: About More Than Food.” https://www.nimh.nih.gov/health/publications/eating-disorders/index.shtml. Accessed Feb. 26, 2018.

Disclosure: Swegler reports no relevant financial disclosures.

Erica Swegler
Erica Swegler

Feb. 26 through March 4 is National Eating Disorders Week, a time to put a greater spotlight on conditions such as bulimia nervosa, binge-eating disorder and anorexia nervosa, according to the National Eating Disorders Association.

According to the association, 30 million Americans have an eating disorder, and millions more have food and body image issues that negatively impact their lives.

Erica Swegler, MD, a family physician in Austin, Texas, and a board member of American Academy of Family Physicians, said eating disorders can be triggered by both physical, psychological and social factors.

“Eating disorders are significant health issues that fall within the mental health arena,” she said in an interview. “As a physician, I’ve seen patients develop an eating disorder simply from hearing one negative comment from a classmate regarding their body type.”

In recognition of National Eating Disorders Week, Healio Family Medicine asked Swegler to discuss risk factors, treatments and other issues primary care providers should consider for patients with, or at risk for, an eating disorder. – by Janel Miller

Question: What are some of the risk factors and warning signs that a patient has an eating disorder?

Answer: Patients with an unrealistic body image, low confidence, and low sense of self-worth might be more susceptible to developing an eating disorder. In addition, parents who report that their child is hardly eating during meals, but notice food is missing from the refrigerator or pantry might have a child suffering from an eating disorder. People with eating disorders will often stash or hoard food for later consumption. In addition, parents who find over-the-counter laxatives or diuretics around the house that they did not buy may also have a child who has an eating disorder.

Q: What are some other signs of eating disorders?

A: Meeting weight categories for some sports can bring out eating disorders in both men and women, so physicians should make sure they ask their young athletes if they are trying to lose weight to meet the weight class for sports like wrestling.

There are other disorders that essentially function as an eating disorder, one being the female athlete triad. This is defined as when a woman stops having periods due to low body weight and low body fat, and it is often attributed to over exercising. These women can develop osteoporosis at a very young age, even if they don’t have any abnormalities in their eating. However, they are exercising to a point that is unhealthy.

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Another sign of an eating disorder sometimes occurs in patients who have type 1 diabetes and who purposefully withhold their insulin treatments. This can cause their blood sugar to spiral out of control as they try to control their weight, much like a patient with more traditional eating disorders such as bulimia nervosa, binge-eating disorder, or anorexia nervosa. This last instance is extremely rare, but it can happen.

Q : How can a PCP discuss eating disorders with patients?

A: When patients come in for a physical exam, in addition to obtaining their weight, also be sure to calculate their BMI. Ask the patient, “Do you feel like you weigh too much or too little?” If a person has a BMI of 18 kg/m2, but he or she says things like, “Oh, I am so fat,” or, “My thighs are huge,” that should be an alarm. Anorexia and bulimia can cause metabolic abnormalities such as high or low potassium. Patients who have these conditions may feel no adverse effects, but may not realize the damage they are doing. I would advise telling patients who I suspect have anorexia or bulimia that they are really harming themselves and need treatment.

Q: What treatment options are available for patients with eating disorders?

A: Bringing in psychological support for counseling and a dietitian to teach the patient what is appropriate to eat is very important. Team-based care in the patient’s medical home is particularly vital when treating these disorders. When a patient is identified as having an eating disorder, engage psychological support and nutritional counseling as quickly and early as possible. Patients who have accepted that they have a disorder need to be informed that treating eating disorders is a long-term process, making clear to the patient that this is not something that is going to go away quickly in the next week or so. Medications that work on serotonin levels may also help patients with eating disorders. Unfortunately, part of the difficulty of treating these disorders is that, unlike with other substances that are being abused, with food the patient still must consume a proper amount on a daily basis.

For more information:

Familydoctor.org. “Eating Disorders.” https://familydoctor.org/condition/eating-disorders. Accessed Feb. 26, 2018.

Familydoctor.org. “For Parents: Eating Disorders in Teens.” https://familydoctor.org/for-parents-eating-disorders-in-teens. Accessed Feb. 26, 2018.

Familydoctor.org. “Therapy and Counseling.” https://familydoctor.org/therapy-and-counseling. Accessed Feb. 26, 2018.

NIMH.gov. “Eating Disorders: About More Than Food.” https://www.nimh.nih.gov/health/publications/eating-disorders/index.shtml. Accessed Feb. 26, 2018.

Disclosure: Swegler reports no relevant financial disclosures.