Eating disorders in the 21st century: identification, management, and prevention in obstetrics and gynecology

Eating disorders are extremely common and carry a high degree of medical and psychiatric morbidity. These disorders are challenging to treat because many patients deny their symptoms, have poor motivation to change, and can become frustrating to the clinician. Case identification based upon suggested screening questions and ongoing management of medical consequences are important roles for the obstetrician/gynecologist involved in the care of these patients. This chapter discusses the benefits and limitations of contemporary treatment, special populations at risk (e.g. athletes, diabetics), and screening guidelines for office practice. Signs, symptoms, laboratory abnormalities, and the perils of associated psychiatric illness are briefly reviewed. Patients do respond to a comprehensive, integrated treatment plan that includes nutritional stabilization, psychotherapy, and pharmacotherapy. Collaboration between all professionals involved in the patient's care is essential for state-of-the-art care. Those patients who become pregnant or wish to become pregnant pose certain additional treatment considerations. Ongoing and future research aimed at understanding how eating disorders develop - and may be prevented by early identification and education - will result in enhanced knowledge of these life-threatening and often chronic illnesses in the 21st century.