Eating Disorders

Review by

H Bissada, MD, FRCPC
Ottawa, Ontario

It is refreshing to see an internist and a psychiatrist co-editing a book on the medical care and complications of eating disorders. Written by a team of 11 internists and psychiatrists knowledgeable in this field, the book is a valuable source of medical information for family physicians, psychiatrists, psychologists, and other health professionals who treat patients with eating disorders. Not intended as a comprehensive medical review, the book provides a clinically useful overview of the most common medical problems encountered by clinicians treating these patients. It comprises 15 chapters and 2 appendices. Generally, each chapter covers the most common medical complications affecting a specific organ system and provides relevant clinical vignettes. Appendix I provides practical information on a few obscure syndromes, while appendix II presents a model for writing first-day orders for inpatients with eating disorders, including a practical bowel protocol for constipation resulting from laxative abuse. The following is a brief overview of the book.

Reviewing the treatment of comorbid psychiatric conditions in chapter 1, the author addresses the issue of substance abuse and recommends that the eating disorder be treated first.

This recommendation assumes that the craving for the abused substance will end when the eating-disorder symptoms are completely controlled—surprising, because most eating-disorders programs advocate that psychological treatment for patients who are actively abusing drugs is ineffective. Rather, they insist that patients with comorbid eating disorders and substance abuse successfully complete a drug-rehabilitation program before entering an eating-disorder program.

In chapter 4, the author addresses the subject of nutritional rehabilitation and reviews in detail the refeeding process. In discussing the formula to calculate the Ideal Body Weight (IBW), however, he did not mention the Body Mass Index (BMI) commonly used to determine the minimum healthy body weight. One wonders whether the author has valid reasons for not using the BMI; if so, it would be educational to share them with readers.

Chapter 6 discusses the treatment for gastroparesis. The use of the gastrokinetic agent cisapride is suggested, with a warning of its potential risk for exacerbating cardiac conduction abnormalities. It is worth noting that shortly after the publication of this book, cisapride was withdrawn from the market because of these potential cardiac problems. Presently, prokinetic agents such as domperidone (Motilium) are used instead.

It is very common for eating disorders patients, particularly those with anorexia nervosa (AN), to feel invincible and to deny their illness and, particularly, its seriousness. This is very frustrating for the clinicians who treat these patients. Chapter 13 eloquently addresses this issue, advocating the use of medical information in a psychotherapeutic way. The author recommends showing the medical information to patients on a formal report in which the patients can see their abnormal results and compare them with normal values. This approach is ethically appropriate and therapeutically very effective in combating denial of the illness.

Chapter 11 discusses the medical problems of the athlete patient with an eating disorder. In terms of prevention and early detection of eating disorders symptomatology, this topic is particularly useful for clinicians who work with athletes. It refers to the differential vulnerability in athletes who are exposed to “appearance thinness” or “performance thinness.” Unfortunately, the author does not describe which sports are categorized as requiring “appearance thinness” and which are categorized as “performance thinness.”

Although chapter 12’s title refers to the pharmacologic treatment of obesity, the chapter goes much further, providing a comprehensive and well-written review on the subject of obesity.