Eating disorders represent serious, potentially life-threatening conditions marked by disturbed eating habits and excessive weight control behaviors that negatively impact both physical and mental health. Recognizing these conditions early in primary care settings is crucial as early intervention significantly improves the chances of preventing long-term health issues and disabilities. For primary care clinicians, vigilance for subtle indicators of disordered eating and body image dissatisfaction is paramount, necessitating careful monitoring of patients’ height, weight, and BMI trends for any concerning changes.
Upon diagnosing an eating disorder, subsequent primary care visits should incorporate a sensitive exploration of psychosocial and clinical factors. A thorough physical examination, including assessment of orthostatic vital signs, and targeted laboratory testing—such as a metabolic panel evaluating magnesium and phosphate levels, and electrocardiography when clinically indicated—are essential components of ongoing care. A collaborative approach involving a multidisciplinary team, including a dietitian, therapist, and family members or caregivers, is vital to deliver a unified, evidence-based therapeutic strategy. Decisions regarding escalating care intensity should be guided by the patient’s overall health status, considering factors like acute food refusal, episodes of uncontrollable binge eating or purging, presence of co-occurring mental health conditions, suicidal ideation, and any abnormal laboratory findings. Weight patterns, availability of outpatient resources, and the strength of social support systems also play a crucial role in determining the appropriate level of care.
Defining a healthy weight range in the context of eating disorder treatment is individualized, taking into account the degree of malnutrition and the patient’s weight trajectory before the illness onset. A gradual weight gain of 2.2 to 4.4 pounds per week is typically recommended to promote cardiovascular stabilization. Treatment modalities commonly include cognitive behavioral interventions aimed at addressing distorted body image and maladaptive dietary and physical activity behaviors. Family-based therapy is considered a first-line treatment approach, particularly for adolescent patients. Pharmacotherapy may be considered to manage co-occurring psychiatric conditions, but it should not be used as a standalone treatment for the eating disorder itself. Evidence supports the use of specific antidepressants or topiramate for bulimia nervosa and lisdexamfetamine for binge-eating disorder in conjunction with therapy and nutritional support.
Recovery from an eating disorder is characterized by the restoration of healthy biopsychosocial functioning, cognitive flexibility regarding eating patterns, resolution of disordered eating behaviors and distorted decision-making related to food, and, where applicable, the return to a healthy weight and regular menstruation. Preventive strategies should prioritize fostering a positive body image and promoting healthy attitudes towards food and body size, rather than focusing on weight or restrictive dieting practices.
