Detection, Evaluation, and Treatment of Eating Disorders:

The Role of the Primary Care Physician


  • Judith M. E. Walsh MD, MPH,

    1. Division of General Internal Medicine, Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, Calif
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  • Mary E. Wheat MD,

    1. Barnard College Student Health Services, Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, NY
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  • Karen Freund MD, MPH

    1. Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston University Medical Center, Boston, Mass
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Address correspondence to Dr. Walsh: UCSF/Mount Zion Division of General Internal Medicine, 1701 Divisadero Box 1732, San Francisco, CA 94115 (e-mail:


OBJECTIVE: To describe how primary care clinicians can detect an eating disorder and identify and manage the associated medical complications.

DESIGN: A review of literature from 1994 to 1999 identified by a medline search on epidemiology, diagnosis, and therapy of eating disorders, including anorexia nervosa and bulimia nervosa.

MEASUREMENTS AND MAIN RESULTS: Detection requires awareness of risk factors for, and symptoms and signs of, anorexia nervosa (e.g., participation in activities valuing thinness, family history of an eating disorder, amenorrhea, lanugo hair) and bulimia nervosa (e.g., unsuccessful attempts at weight loss, history of childhood sexual abuse, family history of depression, erosion of tooth enamel from vomiting, partoid gland swelling, and gastroesophageal reflux). Providers must also remain alert for disordered eating in female athletes (the female athlete triad) and disordered eating in diabetics. Treatment requires a multidisciplinary team including a primary care practitioner, nutritionist, and mental health professional. The role of the primary care practitioner is to help determine the need for hospitalization and to manage medical complications (e.g., arrhythmias, refeeding syndrome, osteoporosis, and electrolyte abnormalities such as hypokalemia).

CONCLUSION: Primary care providers have an important role in detecting and managing eating disorders.