When people think of eating disorders, the first thing that comes to mind is anorexia because it is the most dramatic, obvious and deadly.  Actually, there are also several other different types of eating disorders that are much more common; Bulimia, Binge eating disorder and the most common, Eating Disorder Not Otherwise Specified (EDNOS).  The last diagnosis means that a patient has an eating disorder but that his or her symptoms come from several of the other diagnoses.  It is very common for a person with an eating disorder to move between diagnoses over the course of their lives.  The person may be underweight, normal weight or overweight.

Eating disorders are becoming more common and are occurring at younger ages and also in more boys and men.  From the perspective of a primary care physician, it is critical for parents and friends to pay attention to any sign of significant weight changes, complaints of nausea or difficulty eating.  This can be followed up by a visit to a physician who can look for subtle clues regarding negative body image and pursue the possibility of an early or full fledged eating disorder with sensitive follow up questioning.  It is also critical that a full medical workup be done to rule out other physical disorders that may be causing the symptoms.

Once a diagnosis has been made, treatment should include a team that includes the primary care physician, a therapist or psychiatrist, a dietician, and often family members.  The team members should communicate regularly to coordinate treatment.  Depending on the disorder, the patient should be evaluated by his or her primary care physician at least every two months and often as much as once a week.  The more frequent visits are necessary early in treatment and in patients whose eating behaviors can lead to serious medical complications such as anorexia and laxative abusers.  However, other medical conditions such as hypertension and diabetes can also occur when a patient is overweight and require medical intervention.

Prevention of eating disorders is difficult in a society that idolizes unnatural thinness.  The best thing a parent can do is to emphasize healthy eating, have healthy snacks available, encourage opportunities for physical activity and reinforce a child’s intrinsic value as well as his or her appearance.  My last advice is this; don’t wait if you have concerns.  The earlier treatment is started, the better the chance for success.