Bulimia nervosa is a common eating disorder that predominantly affects young women. There are three main models of purging in bulimia. Resulting medical complications are related to the particular mode and frequency of purging.

A 20-year-old woman presents with fatigue; laboratory tests reveal a serum potassium level of 2.3 mmol per liter and a serum bicarbonate level of 36 mmol per liter. She is 163 cm (64 in.) tall and weighs 54 kg (119 lb). The findings on physical examination are normal. On questioning, she admits to binge eating and vomiting as frequently as five times per day. How should she be treated?

Read the full article in the New England Journal of Medicine.

The prevalence of obesity is rising at a very alarming rate in the United States. Estimates are that 27% of American adults are now considered obese, and another 52% are overweight. These individuals are at increased risk of premature mortality and the development of many comorbid illnesses. Numerous factors contribute to this epidemic. The medical treatment of obesity is difficult, but can be successful. Drug therapy and obesity surgery can be effective but more research is needed to improve all of the obesity treatments.

Mehler Philip S, Linas S. Use of a Proton-Pump Inhibitor for Metabolic Disturbances Associated with Anorexia Nervosa. New England Journal of Medicine 347(5):373-374, 2002. (Ltr)

1. https://www.nice.org.uk/guidance/cg9/documents/eating-disorders-full-guideline-second-consultation2

One of the most serious and potentially permanently disabling medical complications of anorexia nervosa is osteoporosis, which greatly increases the long-term risk of bone fractures. The decreased bone density in patients with anorexia nervosa (AN) is due to the many effects on bone metabolism of amenorrhea, reduced levels of insulin growth factor-1 (IGF-1), high cortisol levels and weight loss. Although estrogen replacement therapy is clearly efficacious in preventing postmenopausal osteoporosis, its efficacy in AN is uncertain.

 ABSTRACT: Grinspoon and colleagues (1) reported on predictive factors for osteopenia in anorexia nervosa. The accompanying editorial discussed potential pathophysiologic explanations that link body weight and bone mass (2). Previously, I and others reported that adipose tissue mass, even at low levels, regulates leptin levels in women with the restricting subtype of anorexia (3).

Bulimia nervosa (BN) is a prevalent illness. There are multiple different medical complications that impact the overall treatment plan and prognosis of these patients. Practitioners should be alert for medical complications that are a direct result of the mode of purging behavior utilized by the bulimic patient. The treatment will proceed most smoothly if the primary care physician and the mental health professional work collaboratively and have clear and frequent communication.

ABSTRACT: Anorexia nervosa is a psychiatric disorder characterized by abnormal eating behaviors that results in weight loss and has serious potential medical consequences. Most of these complications are readily treatable if diagnosed and attended to early in the course of the illness. In caring for patients with anorexia nervosa, the primary care physician has several critical roles. Because patients deny the severity of their illness, they delay seeking psychiatric treatment.