Eating disorders in adults

Eating disorders: common in adolescents, but not uncommon in adults!

ACP Internist recently published a great article on eating disorders in adults. Here are a few high yield points: 

  • Overall prevalence of eating disorders in patients >40yo is 3.5% in women and 1-2% in men, the majority of which are untreated. Estimates are complicated by underrepresentation of midlife individuals in research on this topic.
  • The 2 most common eating disorders at midlife are “other specified feeding and eating disorders” (OSFED—a catch-all category previously known as “eating disorder not otherwise specified”) and binge eating disorder. 
  • Men are vulnerable to the same disordered eating behaviors as women, representing 25% of those with anorexia nervosa, 36% of those with binge eating disorder, and 25% of those with bulimia nervosa.
  • Significant life events are often associated with the onset of an eating disorder, including relationship problems (e.g. divorce), death of a loved one, change of job, retirement, and menopause. 
  • Older patients are more susceptible to sequelae from eating disorders, including osteoporosis, arrhythmia, CHF, gastroparesis, depression, anxiety, and substance use disorders. 

Clarifying misconceptions…

February 22-28 is National Eating Disorders Awareness Week!

The National Eating Disorders Association has lots of great resources for patients and physicians, including a lot of information about misconceptions and implicit bias that we may have related to this topic.

More facts about #5:

  • Despite similar rates of eating disorders among non-Hispanic Whites, Hispanics, African-Americans, and Asians in the United States, people of color are significantly less likely to receive help for eating disorders.
  • Rates of disordered eating have increased across all demographic sectors, but at a faster rate in male, lower socioeconomic, and older participants. 
  • Rates of multiple eating disorders are generally higher in the LGBTQ+ community. 

More facts about #6:

  • Eating disorders have the second highest mortality rate of any psychiatric disorder, surpassed only by opioid use disorder. 
  • Young people between 15-24yo with anorexia have 10x the risk of dying compared to their same-aged peers. 
  • Anorexia has an estimated mortality rate of around 10%, of which 1 in 5 deaths is by suicide. 

Warning signs of eating disorders…

Emotional / behavioral: 

  • Weight loss, dieting, and control of food are primary concerns
  • Food rituals
  • Social withdrawal
  • Frequent dieting, body checking
  • Extreme mood swings

Physical: 

  • Noticeable weight fluctuations 
  • GI complaints
  • Dizziness upon standing
  • Difficulty concentrating, sleeping
  • Issues with dental, skin, hair, and nail health

A low BMI in an older adult is a red flag. If you have a middle-aged adult with a BMI less than 19, then ask about nutrition and eating disorders. —ACP Internist


Screening

Most patients with disordered eating behaviors don’t recognize their problem and may not bring it up to their doctors. 

Multiple screening tools exist, including an online screening tool for patients ≥13yo from the National Eating Disorders Association as well as the SCOFF questionnaire. 

3 simple screening questions to integrate into practice: 

  • What did you eat yesterday? (24-hr diet history)
  • Are you comfortable with your current body shape and size? 
  • What have you done in the last year to try to change your body?

Further reading!

Academy for Eating Disorders’ Guide to Medical Care for Eating Disorders

International Association of Eating Disorders Guide for Communicating with Individuals with Eating Disorders