Medical Management of Eating Disorders: An Update

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


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

In This Article

Recent Evidence on Long-term-consequences of Medical Findings

In the last few years, there have been new findings about negative long-term effects of hormonal changes on fertility, childbearing or cardiovascular mortality. These findings complement existing knowledge about adverse long-term and sometimes irreversible effects on physical health even after remission.

Kärkkäinen, Mustelin[17] studied the long-term health-related consequences of disordered eating behaviors of young adults at age 24, using data of the population-based FinnTwin16 cohort study. Disordered eating behaviors at age 24 were associated cross-sectionally and prospectively with poorer self-rated health, higher BMI, larger waist circumference and greater psychological distress in both sexes. Adjusting for baseline BMI and potential confounders, disordered eating behaviors predicted poor self-rated health in men. In a recent epidemiologic survey of 36 309 adults in the USA, eating disorder diagnoses were significantly associated with medical conditions.[18] Anorexia nervosa was associated with fibromyalgia, cancer, anemia and osteoporosis, while BED was associated with diabetes, hypertension, high cholesterol and triglycerides, that is known medical correlates of obesity. In this study, bulimia nervosa was not significantly associated with any somatic conditions. A newer study, however, yielded different results. In a longitudinal cohort study, women hospitalized for bulimia nervosa were followed up for 12 years from 2006 to 2018 to identify incidences of cardiovascular disease and death.[19] The comparison group consisted of women hospitalized for pregnancy-related events. The study's findings suggested that bulimia nervosa is associated with an increased long-term risk of any cardiovascular disease, such as ischemic cardiac events and conduction disorders, as well as with death among women. The authors suggested that women with a history of bulimia nervosa should be screened regularly for ischemic cardiovascular disease and may benefit from prevention of and treatment for cardiovascular risk factors.

Eating disorders, especially anorexia nervosa, are regularly associated with multiple endocrine disturbances, and with amenorrhea in women. During recent years, long-term-follow-up studies investigated the enduring consequences of eating disorders on reproductive outcomes, finding that a history of both anorexia nervosa and bulimia nervosa was associated with delayed first birth and lower parity.[20] The adverse long-term effects on fertility were stronger in anorexia nervosa, with an 81% reduced parity compared with the general population.

Finally, most of the medical findings of patients with BED are a consequence of overweight and obesity, which are associated with multiple medical consequences. A recent review of studies on medical complications in BED concluded that BED and the loss of eating control in children may independently increase the likelihood of developing components of the metabolic syndrome.[21]