Medical Management of Eating Disorders: An Update

Ulrich Voderholzer; Verena Haas; Christoph U. Correll; Thorsten Körner

Disclosures

Curr Opin Psychiatry. 2020;33(6):542-553. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: Eating disorders are associated with numerous medical complications. The aim of this study was to review recent progress in improving the medical management of patients with eating disorders.

Recent findings: With close medical monitoring and electrolyte supplementation, accelerated refeeding protocols improve weight restoration without increasing the risk of refeeding syndrome. Olanzapine improves weight restoration better than placebo, without leading to adverse metabolic effects seen in individuals not in starvation. Alterations of the gut microbiome in anorexia nervosa have been demonstrated, but their clinical relevance remains unclear.

Summary: Medical complications of eating disorders may facilitate the first contact with health professionals and treatment initiation. Medical complications of anorexia nervosa generally occur due to starvation, malnutrition and their associated physiological effects, whereas medical complications of bulimia nervosa are generally due to purging behaviors. Most medical complications in patients with binge eating disorder are secondary to obesity. Most medical complications of eating disorders can be effectively treated with nutritional management, weight normalization and the termination of purging behaviors. In summary, eating disorders are associated with many medical complications that have to be carefully assessed and managed as early as possible to improve long-term outcomes.

Introduction

Eating disorders are serious psychiatric disorders characterized by abnormal eating or weight-control behaviors.[1] Eating disorders can strongly impair physical health and are associated with markedly increased mortality compared with the general population. Among all psychiatric disorders, anorexia nervosa is associated with the highest mortality rates.[2] In fact, more than 50% of all deaths in anorexia nervosa patients are caused by medical complications that are predominantly starvation-related.[3] The physical damage involves nearly all bodily systems, and its severity generally depends on the extent and duration of weight loss. Further causes of medical complications in anorexia nervosa are secondary to purging behaviors, which are present in the purging subtype of anorexia nervosa. The medical complications of bulimia nervosa and binge eating disorder (BED) are mostly caused by excessive bingeing and potential consequences of associated obesity, or in bulimia nervosa also by purging behaviors.

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