Primary Care

Please note: Eating disorders develop in men, women, girls, and boys. For ease in reading, we have used "she" and "her" in the text below.

Professional treatment for an eating disorder generally includes medical care and monitoring, nutrition counseling, psychotherapy, and medication. When an individual presents with unexpected weight loss, the first priority of the primary care physician (internist, pediatrician, adolescent medicine specialist) is to assess her. Taking a complete medical history, performing a physical exam, and obtaining certain laboratory tests are key in ascertaining whether a patient's symptoms are related to an eating disorder and/or to another illness, such as diabetes mellitus, inflammatory bowel disease, celiac disease, a malignancy, thyroid dysfunction, or Addison's disease.

Pre-adolescents, adolescents and some adults with eating disorders present for medical evaluation not because they want to but because others—parents, athletic coaches, or roommate—bring them. The older teenager or adult who does initiate a visit to her primary care doctor will not necessarily discuss her eating habits; instead, she is likely to request help for abdominal pain or another symptom that might or might not be related to her disordered eating. Or she may have a “physical” without mentioning a word about her extreme weight control practices (severe food restriction, binge eating, or purging). Many physicians screen for eating disorders during routine office visits by posing a few salient questions such as “How do you feel about your current weight?” “Do you eat in secret?” “Are you comfortable with your eating habits?” How an individual responds to these sorts of preliminary inquiries helps the doctor determine whether further assessment is needed.

There is no one diagnostic test that indicates whether or not an individual has an eating disorder. Instead, the doctor puts together many pieces of information—patient/parent interview, physical exam, lab findings—to create an overall picture. In addition to setting up treatment, the doctor will work with the patient—and often with her family—to enhance her motivation to regain her health.

References
Practice guideline for the treatment of patients with eating disorders
American Psychiatric Association (APA). Practice guideline for the treatment of patients with eating disorders. 3rd ed. Washington (DC): American Psychiatric Association ; 2006 Jun. 128 p. [765 references].

Primary care physicians' knowledge of and attitudes toward the eating disorders: do they affect clinical actions?
Currin, L., Waller, G., Schmidt, U. Primary care physicians' knowledge of and attitudes toward the eating disorders: do they affect clinical actions? International Journal of Eating Disorders. 2009; 42: 453-8.

Treatment of eating disorders in children, adolescents, and young adults
Fisher, M. Treatment of eating disorders in children, adolescents, and young adults. Pediatrics in Review. 2006; 27: 5-16.

Case records of the Massachusetts General Hospital. Case 29-2008. A 19-year-old man with weight loss and abdominal pain
Goldstein, M.A., Herzog, D.B., Misra, M., Sagar, P. Case records of the Massachusetts General Hospital. Case 29-2008. A 19-year-old man with weight loss and abdominal pain. New England Journal of Medicine. 2008; 359: 1272-83.

Anorexia nervosa: an increasing problem in children and adolescents
Halmi, K.A. Anorexia nervosa: an increasing problem in children and adolescents. Dialogues in Clinical Neuroscience. 2009; 11: 100-103.

SCOFF, the development of an eating disorder screening questionnaire
Hill, L.S., Reid, F., Morgan, J.F., Lacey, J.H. SCOFF, the development of an eating disorder screening questionnaire. International Journal of Eating Disorders. 2010; 43: 344-51.

Feasibility and acceptability of screening for eating disorders in primary care
Johnston, O., Fornai, G., Cabrini, S., Kendrick, T. Feasibility and acceptability of screening for eating disorders in primary care. Family Practice. 2007; 24: 511-7.

Eating disorders in primary care. A guide to identification and treatment
Kondo, D.G., Sokol, M.S. Eating disorders in primary care. A guide to identification and treatment. Postgraduate Medicine. 2006; 119: 59-65.

Long-term skeletal effects of eating disorders with onset in adolescence
Misra, M. Long-term skeletal effects of eating disorders with onset in adolescence. Annals of the New York Academy of Sciences. 2008; 1135: 212-8.

Medical complications of anorexia nervosa and bulimia nervosa
Mitchell, J.E., Crow, S. Medical complications of anorexia nervosa and bulimia nervosa. Current Opinion in Psychiatry. 2006; 19: 438-43.

Bulimic eating disorders in primary care: hidden morbidity still?
Mond, J.M., Myers, T.C., Crosby, R.D., Hay, P.J., Mitchell, J.E. Bulimic eating disorders in primary care: hidden morbidity still? Journal of Clinical Psychology in Medical Settings. 2010; 17: 56-63.

Screening for eating disorders in primary care: EDE-Q versus SCOFF
Mond, J.M., Myers, T.C., Crosby, R.D., Hay, P.J., Rodgers, B., Morgan, J.F., Lacey, J.H., Mitchell, J.E. Screening for eating disorders in primary care: EDE-Q versus SCOFF. Behaviour Research and Therapy. 2008; 46: 612-22.

Managing anorexia nervosa
Nicholls, D., Hudson, L., Mahomed, F. Managing anorexia nervosa Archives of Disease in Childhood. (In press).

Managing eating disorder patients in primary care in the UK: a qualitative study
Reid, M., Williams, S., Hammersley, R. Managing eating disorder patients in primary care in the UK: a qualitative study. Eating Disorders. 2010; 18: 1-9.

Identification and treatment of eating disorders in the primary care setting
Sim, L.A., McAlpine, D.E., Grothe, K.B., Himes, S.M., Cockerill, R.G., Clark, M.M. Identification and treatment of eating disorders in the primary care setting. Mayo Clinic Proceedings. 2010; 85: 746-51.

Course and outcome of eating disorders in a primary care-based cohort.
van Son, G.E., van Hoeken, D., van Furth, E.F., Donker, G.A., Hoek, H.W. Course and outcome of eating disorders in a primary care-based cohort. International Journal of Eating Disorders. 2010; 43: 130-8.

Treating eating disorders in primary care
Williams, P.M., Goodie, J., Motsinger, C.D. Treating eating disorders in primary care. American Family Physician. 2008; 77: 187-95.

Gastrointestinal complaints in patients with eating disorders
Winstead, N.S., Willard, S.G. Gastrointestinal complaints in patients with eating disorders. Journal of Clinical Gastroenterology. 2006; 40: 678-82.


Stethoscope photo by The Doctor, Flickr.com Creative Commons.


This page was updated on November 15, 2010 in collaboration with Mark A. Goldstein, MD, Chief, Division of Adolescent and Young Adult Medicine, Massachusetts General Hospital.