Detection, evaluation, and treatment of eating disorders - The role of theprimary care physician

OBJECTIVE: To describe how primary care clinicians can detect an eating dis order and identify and manage the associated medical complications. DESIGN: A review of literature from 1994 to 1999 identified by a medline se arch on epidemiology, diagnosis, and therapy of eating disorders, including anorexia nervosa and bulimia nervosa. MEASUREMENTS AND MAIN RESULTS: Detection requires awareness of risk factors for, and symptoms and signs of, anorexia nervosa (e.g., participation in a ctivities valuing thinness, family history of an eating disorder, amenorrhe a, lanugo hair) and bulimia nervosa (e.g., unsuccessful attempts at weight loss, history of childhood sexual abuse, family history of depression, eros ion of tooth enamel from vomiting, partoid gland swelling, and gastroesopha geal reflux). Providers must also remain alert for disordered eating in fem ale athletes (the female athlete triad) and disordered eating in diabetics. Treatment requires a multidisciplinary team including a primary care pract itioner, nutritionist, and mental health professional. The role of the prim ary care practitioner is to help determine the need for hospitalization and to manage medical complications (e.g., arrhythmias, refeeding syndrome, os teoporosis, and electrolyte abnormalities such as hypokalemia). CONCLUSION: Primary care providers have an important role in detecting and managing eating disorders.