Detecting and treating bulimia nervosa: how involved are family physicians?

Relatively little is known about bulimia nervosa in the primary care setting. Existing medical literature suggests that primary care physicians have limited experience with bulimia nervosa.

Experiences of family physicians with bulimia nervosa specifically and eating disorders in general were assessed by a questionnaire mailed to a representative sample (596 subjects) of Ohio family physicians. The response rate was 52.6 percent.

Approximately 30 percent of the respondents had never diagnosed bulimia in a patient; 60 percent had no bulimic patients at the time of the survey. The mean career total of bulimic patients per physician was 5.3 (SD = 5.6). Younger physicians and female physicians were more likely to have bulimic patients. Having bulimic patients correlated significantly with having contact with bulimic and with anorexic persons in nonoffice settings.

Despite a general prevalence rate of about 1 percent for bulimia (much greater for the female population, particularly in adolescents and athletes), nearly one third of Ohio family physicians have never diagnosed bulimia in a patient, and nearly two thirds are not currently providing care for bulimic patients. Because screening is quick, inexpensive, and straightforward, all at-risk patients--athletes or those who have concerns related to paucity of menstruation, gastrointestinal symptoms, dieting or weight concerns, and depression--should be screened for bulimia.