Michele Yeo Elizabeth Hughes
Early identification in general practice
Eating disorders are serious illnesses that affect both the physical and socio-emotional health of young people; they have significant impact on families and cause significant mortality and morbidity. The main eating disorders comprise: • anorexia nervosa (AN) • bulimia nervosa (BN), and • ating disorders not otherwise specified (EDNOS), ie. e eating disorders that do not fully meet the criteria for either AN or BN. Although eating disorders are rare in the general population, they are relatively common in teenagers and young women. Eating disorders represent the third most common chronic illness (after asthma and obesity) in adolescent females. The prevalence of AN is about 0.3%; BN is more common, with a prevalence of about 1% in young women and 0.1% in men;1 and EDNOS occur at much higher rates than full syndrome disorders. Eating disorders are diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria2 (Table 1). Changes are proposed for DSM-V3 to better capture low body weight for growing adolescents and for patients who have lost significant weight but have not yet fallen below 85% of expected body weight, for example those who were previously overweight. Body image concerns occur frequently among adolescents and dieting is a priority for many young people.4 In the context of increasing rates of obesity there has been increased focus on weight reduction, dieting and physical activity in the general community. Young people who diet moderately are six times more likely to develop an eating disorder; those who are severe dieters have an 18-fold risk.5 While only a small proportion of those who diet develop an eating disorder, dieting is a major risk factor.
Eating disorders are complex illnesses that impact on both the physical and socio-emotional health of young people, and contribute to...