In a Canadian context of increasing obesity and continuing cultural pressure to be thin—which affects predominantly women but increasingly men as well—dieting and disordered eating are common. However, formal eating disorders are relatively rare.
They typically emerge in adolescence and young adulthood, so primary care practitioners need to be particularly attuned with patients in this age range; it is an opportunity to intervene early so that an acute problem has less chance of becoming a chronic one.
The distress and physical complications of eating disorders require primary care practitioners to be vigilant in diagnosing people at risk. Because specialized treatment for eating disorders is scarce, primary care practitioners will inevitably be involved in the patient’s care.
The secrecy and shame often associated with having an eating disorder may conceal detection, but once diagnosed and treated, patients can be optimistic about their recovery (van Son et al., 2009).
When to Refer to a Specialist
There are few resources—either individual clinicians or specialized programs—for people with eating disorders. Nevertheless, you can search through the National Eating Disorder Information Centre.
It is important to think broadly about the term “specialist” when seeking treatment for this clinical population. People with specialized expertise may be found in primary care, pediatrics, internal medicine, women’s health, nursing, psychology, nutrition, social work and occupational therapy. Community-based support groups for patients and their families may provide specialized experiential expertise.
If there is diagnostic uncertainty, especially about possible comorbid psychiatric diagnoses, obtain a psychiatric consultation.
Consider the need for hospitalization:
- In anorexia nervosa, when weight loss becomes precipitous and out of control or reaches frank emaciation, hospitalization is usually required to minimize the multiple physical complications and to provide intensive and supervised re-feeding.
- In bulimia nervosa, hospitalization is rarely required unless there is severe metabolic instability, electrolyte disturbance with cardiac risk from hypokalemia, or suicidality.
- In binge eating disorder, there is no current role for hospitalization.
In Eating Disorders: