Eating disorders: Detection, assesment, and treatment in primary care

PURPOSE: To review the epidemiology, diagnosis, and treatment of anorexia nervosa, bulimia nervosa, and binge eating disorder with a focus on early detection and practical interventions in primary care settings, as well as indications for referral to specialty care. EPIDEMIOLOGY: Eating disorders are relatively common, with lifetime prevalence rates in women of 0.3% for anorexia nervosa, 1% to 2% for bulimia, and 3% for binge eating disorder. REVIEW SUMMARY: Although food deprivation and excessive exercise are typically associated with anorexia nervosa and the restrict-binge-purge cycle with bulimia, combinations of these behaviors can occur in either disorder. Binge eating is characteristic of both bulimia and binge eating disorder but also can occur in the purging subtype of anorexia nervosa. This review presents useful screening tools and recommendations for intervention in primary care. Guidelines for coordination of care with mental health professionals and referral to inpatient behavioral specialty programs are reviewed. Long-term outcome studies suggest that 45% of patients with anorexia nervosa and 30% to 70% of those with bulimia have a favorable course. Although binge eating disorder has the most favorable outcome and often remits without treatment, weight loss remains a challenge in the treatment of this condition. TYPE OF AVAILABLE EVIDENCE: Cross-sectional studies, case-control studies, cohort studies, and randomized controlled trials. GRADE OF AVAILABLE EVIDENCE: Fair: bulimia and binge eating disorder; poor to fair: anorexia nervosa. CONCLUSION: Primary care physicians are often the first to identify eating disorders, and are frequently involved in comanagement of eating disorders with mental health professionals. Greater awareness of the symptoms, complications, and treatment options for these disorders is needed, including familiarity with behavioral and psychotherapeutic interventions, management of medical complications, and adjunctive use of medications.