Eating Disorder Guidelines Released

Megan Brooks

May 20, 2011

May 20, 2011 — The Academy of Eating Disorders (AED) has published guidelines for detecting and managing eating disorders in primary care practice.

"Eating disorders are generally first picked up in primary care physicians' offices, but there is very little training in recognition, detection, diagnosis, and treatment of eating disorders in either medical school or residency," Mark Warren, MD, cochair of the task force that wrote the guidelines, noted in an interview with Medscape Medical News.

Eating Disorders: Critical Points for Early Recognition and Medical Risk Management in the Care of Individuals with Eating Disorders can be downloaded from the academy's Web site. There is also a brochure that can be downloaded for printing and distribution.

Designed to be user-friendly, the document provides a list of signs and symptoms and strategies to help general practitioners make an early diagnosis, medically stabilize patients, and initiate evidence-based care for patients with eating disorders.

Sections include what the physical examination should include; what laboratory and imaging studies to obtain; risk factors and prevention strategies for the refeeding syndrome, a potentially fatal shift of fluid and electrolytes that can occur when refeeding (orally, enterally, or parenterally) a malnourished patient; timely interventions; goals of treatment; and ongoing management.

Eating disorders can have life-threatening physical and psychological consequences, the task force notes, and they affect not only girls and women but also boys and men, people from all ethnicities and socioeconomic backgrounds, and people with a variety of body shapes, weights, and sizes.

"It is important to remember that eating disorders do not only affect females at low weight," the authors note, and that weight is not the only clinical marker of an eating disorder; people who are at normal weight can have an eating disorder.

Endorsed by Pediatricians

"All instances of precipitous weight loss in otherwise healthy individuals should be investigated for the possibility of an eating disorder, including post–bariatric surgery patients. In addition, rapid weight gain or weight fluctuation can be a potential marker of an eating disorder," the authors report.

Dr. Mark Warren

The possibility of an eating disorder should also be considered in children and adolescents who fail to gain expected weight or height and/or when delayed/interrupted pubertal development is evident.

"We are hoping this resource makes a huge difference for primary care doctors who are the front line of care for people with eating disorders," said Dr. Warren, medical director of the Cleveland Center for Eating Disorders in Ohio.

He said the guidelines have been vetted by experts in the field of eating disorders.

"The Society of Adolescent Medicine has endorsed it, and we just learned that the American Academy of Pediatrics will also endorse it. We're also looking to the American Psychiatric Association and other professional organizations to endorse it — and I think they will — and really encourage their members to use it," Dr. Warren said.

"Too many patients with eating disorders don't get expert care until after a long period of illness," Dr. Warren added. "Better information in the hands of primary care physicians will be of huge value to those who suffer from eating disorders."

"Our hope is that professionals, patients, and families will access this material to ensure that care is prompt, safe, and supported by evidence and that each person with an eating disorder has the opportunity for a full recovery and a productive life," said task force cochair Ovidio Bermudez, MD, medical director of adolescent services at Eating Recovery Center in Denver, Colorado.

The authors have disclosed no relevant financial relationships.


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