Eating Disorders from a Medical Perspective

NEDAwareness_2016_logoDo you or someone you care about struggle with an eating disorder?  These disorders are much more common than one would think – one reference from 2002 estimates that almost 30 million Americans suffer from an eating disorder (including males and females, at any age).


The most common eating disorders include anorexia, bulimia, and binge eating disorder.  The following statistics are from the National Association of Anorexia Nervosa and Related Disorders (ADAN):

  • Anorexia is the third most common chronic illness among adolescents.
  • 95% of those with an eating disorder are between the ages of 12 and 26 yrs old.
  • Over one-half of teenage girls and nearly one-third of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives.
  • 5% of college-aged women engage in bingeing and purging as a weight-management technique.
  • Eating disorders have the highest mortality rate of any mental illness.
  • Only 1 in 10 men and women with eating disorders receive treatment. Only 35% of people that receive treatment for eating disorders get treatment at a specialized facility for eating disorders.


Treatment of eating disorders usually focuses on psychotherapy, but these disorders are notoriously difficult to treat and many struggle for years with their food obsessions.  Traditional therapies usually neglect how nutritional deficiencies impact brain function, hormonal function, and gene expression.  Correcting these nutritional deficiencies is a key part of addressing any of the eating disorders.


Let’s just look at the mineral, zinc.  Symptoms of zinc deficiency include:

  • Decreased appetite
  • Weight loss
  • Altered taste perception, especially for meat
  • Depression
  • Poor growth in children and teens
  • Abnormal menstrual cycles
  • Poor wound healing
  • Poor immune system function – for example, catching every cold going around
  • Acne

Red meat, oysters and shellfish, sesame and pumpkin seeds are rich in zinc, but vegetarians are at risk for low intake and consequent zinc deficiency.


Who is at risk for an eating disorder?

  • Family history of an eating disorder
  • Obsessive-compulsive personality traits (perfectionism, inflexibility, OCD))
  • Low self-esteem, depression, anxiety
  • Participation in competitive, judged sports
  • Those with diabetes, both Type 1 and Type 2



The National Eating Disorders Association (NEDA) has a 3 minute, confidential online screening for eating disorders.  Early identification and intervention can be life-saving, and for those in the early stages, can block progression into the full-blown problem.  Take the screening test here.


Gastrointestinal disorders should be considered when one suspects an eating disorder.  Most commonly, Crohn’s disease, celiac disease, gastroesophageal reflux, or eosinophilic esophagitis can mimic the presentation of an eating disorder.  1


If you think you might have an eating disorder, ask your primary care provider to do some lab tests, and consider a referral to a gastroenterologist.  I recommend the following tests:

  • Complete blood count with differential
  • Comprehensive metabolic panel
  • Celiac testing (total IgA, deamidated gliadin IgA and IgG, endomysial antibody, tissue transglutaminase IgA and IgG)
  • Total cholesterol
  • Folate, vitamin B12, and methylmalonic acid
  • Red blood cell trace minerals (including zinc, magnesium, selenium)
  • Thyroid tests (free T4, free T3, reverse T3, antithyroid peroxidase [antiTPO] and antithyroglobulin [antiTG])
  • Ferritin, iron, iron binding capacity
  • Urinary organic acids
  • 25 hydroxy vitamin D
  • Essential fatty acids (omega 3:6 index or arachidonic acid:EPA index)


I came across Dr. James Greenblatt, MD’s book, “Answers to Anorexia” a few years ago.  I have found it an excellent resource for patients and families in addressing the medical challenges of eating disorders, and I highly recommend it.   He has several recommendations for parents to promote healthy attitudes about food and eating in their children.

  • Build your child’s self esteem.
  • Adopt a healthy attitude toward your own body.
  • Avoid battles over food with your child.
  • Don’t pressure your child to attain a certain weight or size.
  • Eat as a family.
  • Involve your child’s primary care physician.
  • Know the websites your child is viewing.
  • Get help at the first sign of trouble.


To your health,

Patty Powers, MD