High Prevalence of Eating Disorders in the ED

Pam Harrison

November 26, 2012

The prevalence of eating disorders among teens who present to the emergency department (ED) is much higher than previously thought, new research shows.

Suzanne Dooley-Hash, MD, and colleagues from the University of Michigan, in Ann Arbor, found that 16% of patients between 14 and 20 years of age screened positive for an eating disorder during an ED visit for any reason.

Males accounted for 26.6% of all eating disorders identified during the ED visit; no difference in eating disorder rates was observed across ethnic or income groups.

"One of the reasons I was interested in this subject is because I think eating disorders are underdiagnosed, so that was the initial reason for doing this study," Dr. Dooley-Hash told Medscape Medical News.

"Our prevalence figures may be slightly higher than elsewhere, as Ann Arbor is a college town and these are the people at risk for eating disorders.

"But a lot of the more recent studies have been finding similar numbers, and we also think it is more common in males than ever before as well."

The study is published in the November issue of the International Journal of Eating Disorders.

Binging Most Common

Patients aged 14 to 20 years who presented to the ED of the University of Michigan Medical Center in Ann Arbor from October 15, 2010, to March 1, 2011, were eligible for screening.

Patients were first instructed on the use of a touchscreen tablet computer, which they used to complete a 20-minute screening survey.

A modified version of a validated self-report questionnaire, the SCOFF, was used to screen for the presence of eating disorders.

The abbreviated Patient Health Questionnaire 2 (PHQ-2) was used to measure depressive symptoms as well.

The first 3 questions on the 10-item Alcohol Use Disorders Identification Test (AUDIT)-C were also used to assess for risk drinking behavior during the past 3 months.

A total of 942 ED patients (mean age, 17.7 years) completed the computerized questionnaires.

Analysis of baseline characteristics in those who screened positive for an eating disorder showed that they were 2.6 times more likely to be female (P < .001).

Average body mass index (BMI) was also higher in patients with eating disorders, at 26.0 vs 23.2 for those with no eating disorder.

They were also over 3 times more likely to be obese than those with no eating disorder.

Patients who screened positive for an eating disorder also were more than 3 times as likely to be depressed as well as almost twice as likely to display risky drinking behavior.

Smoking, cannabis use, and the use of stimulants and other drugs were also more prevalent in those who screened positive for an eating disorder than in those with no eating disorder.

  Screened Positive for Eating Disorder (n = 143) No Eating Disorder (n = 749)
BMI > 30 (obese) 24.5% 9.1%
Depression 31.9% 9.9%
Risky drinking 39.2% 25%
Smoking 52.4% 31.9%
Cannabis use 46.1% 32.8%
Stimulant use 23.1% 7.1%
Other drug use 39.2% 20.8%


"People often think that patients with eating disorders are really thin, but anorexia represents only a minority of eating disorder diagnoses," Dr. Dooley-Hash noted.

"The most common eating disorder is actually binge eating — people just binge, but they don't purge. So the eating disorder doesn't usually cause people to lose weight, it just causes them distress."

Confirms Long-Held Suspicions

Kathryn Zerbe, MD, Oregon Health and Science University, Portland, told Medscape Medical News that the study supports what those in the field have long suspected — that many eating disorders go unrecognized by medical practitioners.

"When asked about it, patients will often tell you that they have these symptoms," Dr. Zerbe noted.

However, the fact that these young people could answer questions through an impersonal computer device suggests that this approach may help override the shame that many patients feel about their eating disorder.

Although some remain in denial for decades, "we can infer that a certain percentage of these people do want to be helped," she added.

Early identification of patients with an eating disorder is very important, she added, because they are more amenable to an intervention at the earlier stages of the disorder and, by inference, should have better outcomes.

"These young people are still impressionable," Dr. Zerbe noted.

"And this is why I think we see better outcomes in adolescents when they are diagnosed early."

The study was funded by the National Institute on Alcohol Abuse and Alcoholism. The authors and Dr. Zerbe have disclosed no relevant financial relationships.

Int J Eat Disord. 2012;45:883-890. Abstract