Research reveals long-term health effects of eating disorders

The health effects of eating disorders such as anorexia, bulimia, and bulimia are complex, affect different organ systems, and are long-lasting, a large-scale follow-up study published in an open-access journal has found. BMJ Medicine.

The risk of developing serious conditions such as diabetes, kidney failure, liver failure, bone fractures, and early death is especially high during the first 12 months of life. diagnosis. However, these increased risks persist for years, highlighting the need for timely, integrated, multidisciplinary health services and continued monitoring to improve outcomes, the researchers concluded.

Rates of eating disorders in the UK have risen significantly since restrictions imposed due to the coronavirus pandemic, researchers say. But while the negative mental and physical effects are well known, the long-term effects are less well understood, they added.

To strengthen the evidence base, researchers reviewed de-identified medical records in the Clinical Practice Research Datalink, linked to hospital episode statistics and death certificate data for people across England over a 20-year period (including 1998 to 2018).

Approximately 24,709 people aged 10 to 44 who had been diagnosed with an eating disorder were matched with up to 20 people without these disorders (493,001 people in total) on age, gender, and general practitioner status, and their mental and physical health was tracked for 10 years.

Most of the total sample (89%) was female. Additionally, 14.5% (3577 people) of those with eating disorders had anorexia. 20.5% (5085) had bulimia. 5% (1215 people) had bulimia. And in 60% (14,832 people), the cause of their eating disorder could not be identified.

Analysis of the data revealed that eating disorders are associated with poorer physical and mental health, and a significantly higher risk of premature death.

Within a year of diagnosis, people with eating disorders were six times more likely to be diagnosed with kidney failure, nearly seven times more likely to be diagnosed with liver disease, and also had significantly higher risks of osteoporosis (six times), heart failure (two times), and diabetes (three times).

The risk of kidney failure and liver disease remained 2.5 to nearly 4 times higher after five years, with 110 and 26 more cases per 10,000 people than expected after 10 years, respectively.

Similarly, the risk of poor mental health was significantly higher 12 months after being diagnosed with an eating disorder. The risk of depression was seven times higher, with 596 additional cases per 10,000 people, while the risk of self-harm was more than nine times higher, with 309 additional cases per 10,000 people. And although the risks were lower, these increased risks persisted five years later.

They were also more than four times more likely to die from any cause within the first 12 months after diagnosis, and five times more likely to die from unnatural causes, including suicide. Five years later, these risks are still two and three times higher, representing 43 additional deaths per 10,000 from any cause and 184 per 100,000 from unnatural causes.

And 10 years after diagnosis, the additional deaths amounted to 95/10,000 and 341/100,000, respectively. The risk of suicide was nearly 14 times higher in the first year, but remained nearly three times higher 10 years later, accounting for 169 additional deaths per 100,000 people.

Researchers acknowledge that medical record data does not include severity of eating disorders, making it impossible to link severity to worse outcomes.

But they say: “Our data illustrate the significant long-term effects of eating disorders and highlight the potential opportunity for primary care to play a greater role in providing support and long-term monitoring to individuals recovering from eating disorders.”

They suggest: ”Providing this support may also require a closer and more consistent management approach in primary and specialty care for both physical medicine (nephrology, cardiology, endocrinology) and mental health services.”

It added: “A potential gap exists in the provision that a patient's difficulties are too complex for a low-intensity, brief intervention, but not complex enough for an expert team.”

And they conclude: ”It is essential to increase awareness among health care providers about the lasting effects of eating disorders and the need for ongoing support to manage current symptoms and recovery.. ”

In a linked editorial, Dr. Jennifer Couturier and Dr. Ethan Nella of McMaster University in Ontario, Canada, point out that despite the high prevalence of eating disorders, “their impact is under-recognized.”

They added: ”Previous research has shown that education about eating disorders is limited during medical training, and this study highlights the importance of disseminating this knowledge to all health professionals.

“Medical education must place greater emphasis on the recognition and management of eating disorders and provide primary care providers, specialists, and allied health professionals with the tools to identify early warning signs associated with eating disorders and monitor ongoing risks.. ”

They conclude: ”Multiple organ systems are affected by eating disorders, necessitating integration of care to properly treat patients. This situation puts primary care providers in an ideal position to provide guidance and coordination. [their] This suggests that early and sustained intervention is appropriate in primary care settings.”