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Eating disorders such as anorexia nervosa and bulimia nervosa are significant and potentially life-threatening conditions affecting approximately one million Australians. Anorexia nervosa and bulimia nervosa are more common in female patients, particularly adolescents, and can have a mortality rate of up to 20 per cent – higher than any other psychiatric disorder.

For further information on this topic, learn more about the HealthCert Professional Diploma program in Women’s Health: fully CPD accredited online women’s health training for GPs, quality-assured by Bond University.

Early identification is one of the most critical aspects of managing eating disorders in primary care. Screening tools such as the SCOFF and ESP questionnaires can be used in a primary care setting to help detect potential eating disorders; however, it is also prudent to simply ask patients directly if they have any problems with disordered eating.

It is important to note that psychiatric comorbidities often exist in patients with eating disorders, such as anxiety, depression, substance misuse, social phobias, and post-traumatic stress disorder. These must also be screened for and managed alongside any eating disorder.

Physical consequences of eating disorders, particularly anorexia, include electrolyte derangements, cardiac arrhythmias, organ dysfunction and nutritional deficits. Therefore medical assessment, including weight, body mass index (BMI), blood pressure, relevant blood tests and an ECG to assess for medical instability, are essential in all patients with a known or suspected eating disorder. Electrolyte disturbances such as hypokalaemia can quickly become life-threatening and may require immediate hospital admission. Additional investigations, such as bone densitometry, may also be required.

Patients with an eating disorder should be medically reviewed by the GP at least annually.

Ongoing management of anorexia and bulimia requires an individualised and patient-centred approach involving a multi-disciplinary team, including physical, psychological, social and dietetic support. All patients with a suspected eating disorder should be referred to a specialised eating disorder service, where available.

Psychological therapies, such as cognitive behavioural therapy (CBT) or family therapy, in an individual or group setting are integral to managing eating disorders. These aim to address underlying issues contributing to a woman’s eating disorder, such as poor self-esteem, body dysmorphia, and previous trauma.

Dietetic support usually involves a comprehensive assessment and structured nutritional rehabilitation to achieve normal eating behaviours. The general practitioner can assist in dietary rehabilitation by organising regular reviews with the patient, ensuring their nutritional needs are met, and prescribing dietary supplementation, for example, thiamine or oral potassium. Many women with anorexia have concurrent reduced bone mineral density and may require supplementation with vitamin D.

Another consideration for the general practitioner is the provision of contraception, as many women with anorexia nervosa may become amenorrhoeic and may neglect the requirement for contraception. In addition, for patients with bulimia, vomiting may reduce the effectiveness of oral contraceptives. In these cases, long-acting reversible contraception should be considered, for example, a subdermal implant (SDI) or intrauterine contraception.

The GP is an integral part of the shared care team and will be a consistent team member throughout the patient’s journey from the initial diagnosis. This continuity of care is important for building trust and confidence, ultimately contributing to patient engagement and recovery. Even after recovery, the GP should regularly check in with any patients affected by an eating disorder to monitor for signs of relapse.

– Dr Samantha Miller, MBChB

For further information on this topic, learn more about the HealthCert Professional Diploma program in Women’s Health: fully CPD accredited online women’s health training for GPs, quality-assured by Bond University.

Read another article like this one: Complementary medicines to support women’s health

References

1. The Royal Australian and New Zealand College of Psychiatrists (2014). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders. https://www.ranzcp.org/files/resources/college_statements/clinician/cpg/eating-disorders-cpg.aspx
2. Department of Health, State Government of Victoria (2022). Anorexia nervosa. https://www.betterhealth.vic.gov.au/health/healthyliving/anorexia-nervosa
3. Australian Family Physician (207). Early detection of eating disorders in general practice. https://www.racgp.org.au/afp/2017/november/early-detection-of-eating-disorders
4. National Eating Disorders Collaboration. Eating disorders in Australia. https://nedc.com.au/eating-disorders/eating-disorders-explained/the-facts/eating-disorders-in-australia/
5. National Eating Disorders Collaboration. Eating Disorders: A professional resource for general practitioners. https://nedc.com.au/assets/NEDC-Resources/NEDC-Resource-GPs.pdf
6. National Institute for Clinical Excellence (NICE)(2019). Clinical Knowledge Summary: Eating disorders. https://cks.nice.org.uk/topics/eating-disorders/
7. Academy for Eating Disorders (2023). https://www.aedweb.org/