Medical Complications of Eating Disorders
Dr. Risa Fridy is an adolescent and young adult medicine physician.
Dr. Fridy graduated from Cornell University and earned her medical degree from Sidney Kimmel Medical College. She completed her residency in Pediatrics at the Icahn School of Medicine at Mount Sinai Hospital, followed by a three-year fellowship in Adolescent Medicine at the Children’s Hospital at Montefiore – Albert Einstein College of Medicine. During fellowship, Dr. Fridy received specialized training in the treatment of patients with eating disorders. In 2020, Dr. Fridy founded her own private medical practice, Tribeca Adolescent & Young Adult Medicine.
In today’s episode/post, Dr. Risa Fridy and I discuss the medical complications related to eating disorders. We mainly focus on restrictive eating disorders and purging behaviors and their impact on the body. We also cover how doctors monitor these risks so you’ll know what they’re doing next time you visit the doc. My hope is that this information will empower you to find the right doctor and take significant steps toward recovery.
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What is Adolescent Medicine?
It’s not pediatrics, and it’s not adult care. So what is it?
Dr. Fridy specializes in treating teenagers to young adults, and she specializes in eating disorders. Her youngest patient is around 10, and the oldest is around 30. (yes, if you are 30, you are still a young adult 😉)
This age range is a specialty in and of itself because of the whirlwind of changes, both physical and mental.
The Role of an Eating Disorder Doctor
The mission: to evaluate and improve upon the physical and medical health of patients.
An eating disorder doctor makes sure to examine every aspect of a patient from the moment they walk into her office.
When visiting an eating disorder doctor, the number one question that needs to be answered is: Is my patient medically stable?
Having an eating disorder wreaks havoc on the entire body, both internally and externally. The impact is all-encompassing, leaving no part untouched.
A doctor will first start taking mental notes about the patient right as they walk in. (not making judgments of a patient but noticing any changes in attitude, behaviors, and overall demeanor). Next, there will be a conversation about the patient’s medical history, then do a very extensive exam.
The body is affected by an eating disorder in many ways. A doctor will check a patient’s vitals to see just how much it has been affected.
Here are some things they may notice:
Heart rate is slow, known as bradycardia
Low Blood Pressure which is called hypotension
Height: appears to be possibly stunted growth (compared to their own trajectory.)
Weight: [sometimes] considerably low- Understanding the natural trajectory of each patient is imperative (Be sure to bring the growth charts!)
Episode 72: Examining the Harmful Implications of the AAP’s Guidelines on Weight Loss Medication and Surgery for Children is a resource where I chat with Jessica Setnick, MS, RD, CEDRD-S, in more detail on eating disorder complications and issues that arise by focusing too much on weight.
The Effects of Malnourishment on the Body
There are various ways to check the patient’s overall health. We cannot rely on the weight on the scale. These numbers are not reliable, so it is important to get information from multiple sources. Vital signs speak volumes about the body’s health!
One example is orthostatic exams. This is when a patient lies down and then stands up. The doctor is observing how well the body adjusts to the change in gravity.
The reason why this is important is because if the body is malnourished (well, specifically dehydrated), it’ll be harder to regain one’s balance immediately after getting up. Dehydration is a sign your body is in preservation mode (this indicates the patient is starving)
The body would then fail to compensate for the change in gravity.
To learn more about starvation, listen to Episode 08. Starvation Study: The Extreme Psychological and Behavioral Effects of Malnourishment.
All the Blood Work:
One huge part of the exam is the blood work. There are so many different aspects of the blood that can be observed and measured.
*These numbers are expected to change, so it is very common to do multiple blood work draws to get a comprehensive look at the overall health of the patient*
Here is a brief (not exhaustive) list of what can be seen in the blood work:
FSH and LH- are hormones from the brain that tell the body to make the sex hormones
Sex Hormones are low- specifically estrogen and testosterone
When the body is in preservation mode, these hormones are suppressed
Electrolytes- potassium, sodium, and phosphorus would show they are all out of whack.
CPK- Creatine Phosphokinase (muscle protein) - These numbers would be higher for someone who is over-exercising and burning through muscles over time, causing the muscles to break down.
Iron levels: checking to see if the patient is anemic.
Cholesterol- would be wonky in a starvation state.
Organ Functions: checking to see if there is an acute kidney injury and abnormal liver enzymes.
Thyroid- Using the hormones (T3) produced by the thyroid, a physician can track a patient’s nutrition.
With restrictive eating, Insulin, Glucose, and A1C usually appear to be normal.
Additional Examinations:
EKG to check heart function
Referral to a cardiologist if necessary
Bone density study (DEXA scan)
Here is an episode I did with Dr. Marci Goolsby that goes more into bone density. 78. Bone Density and Disordered Eating
Urine Analysis- to check to see how diluted the urine is
Signs of Purging Complications
Alkalosis is when the body becomes too basic due to the lack of acid because of vomiting up stomach acid
Low Potassium, which could cause cardiac arrest
High sodium levels due to vomiting or low levels due to water loading
Water loading= intentionally drinking excessive amounts of water to manipulate the scale numbers
Vomiting blood
Vomiting Blood Complications:
If someone is vomiting blood, it's a major cause for concern. There’s a real risk of physical trauma to your GI system, including Mallory-Weiss tears (esophageal tears).
In clinical practice, though, there are times when a patient could see blood in their vomit but never turn into profuse bleeding or become hypotensive. There are capillaries and vessels that can burst, or the acid is wearing down parts of the esophagus which could cause blood.
With either of these situations, it’s undoubtedly a frightening experience; consult with a doctor!
The Need for Data:
Having data helps clinicians help their patients understand the severity of their eating disorders. The numbers paint a vivid picture and empower patients on their journey to recovery.
This podcast episode provides a glimpse into the importance of comprehensive examinations and the complexities of eating disorder treatment. It is imperative to work with a doctor who knows and understands the intricacies of eating disorders.
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Tweetable Quotes
“Having an eating disorder wreaks havoc on the entire body, both internally and externally. The impact is all-encompassing, leaving no part untouched.” - Rachelle Heinemann
“We cannot rely on the weight on the scale. These numbers are not reliable ” - Dr. Rise Fridy
“Having data helps clinicians help their patients understand the severity of their eating disorders. The numbers paint a vivid picture and empower patients on their journey to recovery.” -Rachelle Heinemann
Resources
Related Episodes:
Episode 08. Starvation Study: The Extreme Psychological and Behavioral Effects of Malnourishment.
78. Bone Density and Disordered Eating
Website:
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Hey there! I’m Rachelle, the host of the Understanding Disordered Eating Podcast. As a Licensed Mental Health Counselor, I work with clients to make sense of life’s messy emotional experiences.
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