Eating disorders in the twenty-first century

The first description of anorexia nervosa appeared in the literature over three hundred years ago. Since then, much has been learned about eating disorders, including the different presentations, medical complications, prognosis, and treatment strategies. In spite of this knowledge, the prevalence of eating disorders continues to grow. As well, eating disorders are seen in increasing frequency among males, children, and adults, and from all cultures and ethnicities. Of particular concern, is that patients with eating disorders often first present because of a complication such as amenorrhea, syncope, or abdominal pain, without disclosing the eating disorder. Therefore, all physicians should be aware of the various presentations of eating disorders, including the medical complications and risks, and be able to screen for a possible eating disorder. The major medical complications are due to the decreased caloric intake which leads to a hypometabolic state. While most complications are reversible with recovery, some, such as bone loss, may not be. Of particular concern during recovery is the possible development of a refeeding syndrome which occurs as the body goes from a catabolic to an anabolic state, causing hypophosphatemia, hypocalcemia and hypomagnesemia, which can lead to delirium, coma and death. Of further concern is that eating disorders have the highest mortality rate of all psychiatric disorders at 5.6% per decade. This article will review the changing demographics, medical complications, treatment options, and prognosis of eating disorders.