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Massachusetts Medical Society's
Physician Focus

September 2011

Eating Disorders


  • As many as 10 million females and one million males in the U.S. are affected by eating disorders.

  • The three major disorders are anorexia, bulimia, and binge eating disorder.

  • The physical health consequences of eating disorders can be severe: high blood pressure, reduced bone density, heart disease, and diabetes, among other conditions.

  • Eating disorders are usually accompanied by mental health issues, such as low self-esteem, depression, and anxiety.

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Massachusetts Child Psychiatry Access Project

Klarman Eating Disorders Center at McLean Hospital

Multi-Service Eating Disorders Association

National Eating Disorders Association

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Eating Disorders PSA

From Left, Bruce Karlin, M.D., Esther Dechant, M.D., Beth Mayer, L.I.C.S.W.
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Medicine has yet to pinpoint the specific causes of eating disorders, but there’s a list of contributing factors, among them genetics, environmental factors, cultural issues, depression, and anxiety. It’s usually not one thing that’s the cause, say health professionals, but rather a number of different things all coming together.

The eating disorders of anorexia, bulimia, and binge eating are prevalent, increasing, and present a combination of serious physical and mental health issues for patients. “Eating disorders take over people’s lives,” says Esther Dechant, M.D. “They change the way you live, they take a lot time, take up a lot of psychological space, and seriously disrupt lives.” 

Dr. Dechant, medical director of the Klarman Eating Disorders Center at McLean Hospital in Belmont, Massachusetts, and Ms. Beth Mayer, LICSW, chief executive officer of the Multi-Service Eating Disorders Association, a national nonprofit group based in Newton, Massachusetts, offered insights into the causes, effects, and treatment of eating disorders in the September edition of Physician Focus with the Massachusetts Medical Society with show host Bruce Karlin, M.D.

The topic requires definitions and distinctions. Anorexia is characterized by not eating enough, self starvation in a sense, and thus being too thin. Bulimia consists of episodes of binge eating – consuming huge amounts of food in short time periods - followed by actions to compensate for overeating, such as vomiting or use of laxatives. Binge eating is consuming huge amounts of food but without the compensatory actions to purge one’s system; it is often associated with obesity. 

The vast majority of those with anorexia and bulimia – some 85-95 percent - are women. Binge eating disorder affects about two percent of all adults – up to four million Americans, reaching slightly more women than men. Many of those affected are young. 

“Adolescent eating disorders are growing and growing,” says Ms. Mayer, a licensed social worker who has been in the field of eating disorders for more than 25 years, “and they are highly shameful illnesses. People usually come to the disorder with depression or anxiety. Genetics plays a big role as well.”

The physical consequences of these illnesses are varied – and serious. “Anorexia takes over your brain,” says Dr. Dechant, an adolescent psychiatrist. “A malnourished brain is not the same as a nourished brain.” Patients with anorexia, she says, don’t see themselves as thin, and they are terrified of gaining weight. And that makes it hard to recover from the illness.

The most serious physical effects of anorexia include cardiac conditions from a weakened heart and deteriorating bone health, the latter a particular concern for adolescents. The teenage years, says Dr. Dechant, are the most important for developing strong skeleton and bones. “If you don’t do that during your teen years, you stop forming bones. That results in a lifelong condition, and that’s irreversible.” 

The danger from bulimia comes from the purging, which changes electrolytes in the human body and can also cause cardiac problems. Gastrointestinal issues may also arise from the constant purging. 
The effects of binge eating are those similar to obesity – heart conditions, diabetes, high blood pressure, high cholesterol. 

Treating the disorders can be complex. “It’s usually not one thing in one particular patient,” says Dr. Dechant, “but a number of different things. You treat the eating disorder and everything else that goes along with it.” While many patients can be treated on an out-patient basis, some may require hospitalization. 

“The medicine that is most important in all eating disorders is food,” says Ms. Mayer. “Nutritional therapy is critical, to teach the patients what is a normal amount of food.” 

Dr. Dechant is optimistic, however. “My final word is hope. These disorders are difficult, parents are often very upset, but patients get better. Getting to treatment is really important.”

Watch the accompanying video for the full discussion, including conversation on how patients with these conditions view themselves, how to recognize and discover if someone has one of these conditions, and the steps health professionals take to treat the illnesses. 

MMS/Richard Gulla