Eating disorders: recognition, evaluation, and implications for obstetrician/gynecologists(1)

Eating disorders are a common finding in adolescent females. The lifetime prevalence of anorexia nervosa and bulimia nervosa is as high as 3.7% and 4.2%, respectively. The disease is much more common in females than males and is often associated with depression and other mood disorders. Complications from eating disorders can include amenorrhea, osteoporosis with pathologic fractures, electrolyte disturbances, dehydration, cardiac arrhythmias, and even death. Eating disorders appear not only to increase the risk of miscarriage, but also are associated with preterm delivery and lower infant birth weights. Treatment for eating disorders can be lifesaving and is more effective when instituted before the patient becomes severely underweight. Evaluation of patients with suspected eating disorders includes a thorough history and physical examination as well as baseline screening laboratory tests. A high index of suspicion is needed to detect patients with eating disorders because many are in denial about their illness. Inpatient hospitalization is recommended for significant metabolic abnormalities and for patients who weigh <85% of their estimated healthy body weight. Treatment for eating disorders includes nutritional rehabilitation, behavioral therapy, and often antidepressant therapy. The obstetrician/gynecologist is one of the few health care providers that young, otherwise healthy women who are at risk for eating disorders will see on a regular basis, and they must be diligent to recognize the signs and symptoms of these diseases so that appropriate and timely interventions can be made.