Report 8 of the Council on Science and Public Health (A-07)

Eating Disorders and Promotion of Health Body Image

Summary

Objective.  To review the etiology, incidence, and treatment of eating disorders, as well as strategies to promote early recognition and access to appropriate medical intervention for people with these disorders.  The report also reviews prevention programs, including those aimed at pre-adolescent children and their parents.

Methods.  Review articles and position papers on eating disorders by health professional organizations and the Agency for Healthcare Research and Quality were summarized for this report.  Literature searches were conducted in the PubMed database for English-language review articles published between January 2005 and July 2006 using the search terms eating disorders, anorexia nervosa, bulimia nervosa, and binge eating disorder, cross-indexed with the terms etiology, incidence, treatment, and prevention.  Additional information was obtained by searching the Cochrane Database of Systematic Reviews and the Web sites of relevant federal agencies and professional and advocacy organizations.

Results. Anorexia nervosa and bulimia nervosa are the most commonly known and studied eating disorders, although most people who exhibit disordered eating behaviors are diagnosed with “eating disorder not otherwise specified” (EDNOS).  Genetic, social, and environmental factors, including dieting behaviors, are implicated in the etiology of eating disorders.  Efforts to combat overweight and obesity, particularly in children and adolescents, must avoid inadvertently encouraging unhealthful dieting and weight loss behaviors.  Most patients will not present to a primary care physician with a complaint of an eating disorder, but rather for treatment of other, possibly related, conditions.  Several health professional organizations have published position papers on the identification and treatment of eating disorders, including recommended screening questions.  However, there is no simple, standardized treatment for these disorders.  Treatment can take years and involve different health specialists.  Relapses are common, and many of those who recover continue to suffer from other eating disorders or mental health issues.  Early intervention is recommended, although insurance coverage is often limited for early stages of these disorders and for long treatment durations.  Research on eating disorders has been limited by inconsistent criteria for the early stages of anorexia nervosa, bulimia nervosa, and other EDNOS conditions; varying definitions of outcomes; high drop-out rates; and small sample sizes, especially across age, sex, and cultural groups.  Insufficient evidence is available to recommend any specific prevention programs. 

Conclusions.  Eating disorders are serious, difficult-to-treat conditions that can affect people of any age, sex, ethnic, or socioeconomic group.  More research is needed on the etiology, prevention, and treatment of all eating disorders, including the variety of conditions currently classified under EDNOS.  Research on primary prevention, particularly in pre-adolescent children and their parents, is noticeably lacking.  Increased awareness of the signs, symptoms, and seriousness of eating disorders may improve rates of early intervention and treatment.  However, more work is needed to improve access to care for individuals at all stages of illness and economic status. 

RECOMMENDATIONS

The following statements, recommended by the Council on Science and Public Health, were adopted by the AMA House of Delegates as directives at the 2007 AMA Annual Meeting:

1. This report will be widely disseminated to assist primary care physicians and other healthcare professionals in the early recognition and treatment of eating disorders.  (Directive)
2. The AMA supports increased funding for research on the epidemiology, etiology, diagnosis, prevention, and treatment of eating disorders, including research on the effectiveness of school-based primary prevention programs for pre-adolescent children and their parents, in order to prevent the onset of eating disorders and other behaviors associated with a negative body image. (Directive)

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