A new study from Australia shows how important it is to focus on more than weight when evaluating patients with eating disorders. Eating disorders have become strongly associated with severely underweight individuals, but these illnesses can also affect people at or above a supposedly healthy weight.
Doctors Must Look At More Than Just Body Weight When Diagnosing EDNOS And Anorexia
The Australian study found that an increasing number of adolescents are meeting all the symptoms for a diagnosis of anorexia nervosa except for a very low body mass index (BMI). These symptoms include a fear of gaining weight, a distorted body image and an unhealthy rate of weight loss.
Individuals with these symptoms are generally diagnosed with EDNOS (Eating Disorder Not Otherwise Specified). The study suggests that the most important diagnostic measure of an eating disorder should be extreme weight loss rather than very low weight.
This study followed a group of 99 teenagers between the ages of 12 and 19 for a six years. At the beginning of the study, in 2005, only 8 percent of the adolescents had been diagnosed with EDNOS. However, by 2009, 47 percent of the subjects had EDNOS.
Similarities Of EDNOS And Anorexia Symptoms
Among the patients with EDNOS and the patients with anorexia, both the symptoms and the side effects were remarkably similar. The two groups lost a similar amount of weight: 28 pounds on average for those with anorexia, and an average of 29 pounds for those with EDNOS. Both groups contained patients who also suffered from depression and anxiety.
Symptoms of malnutrition such as dangerously low phosphate levels, depressed heart rate and the need for tube feeding were also common to both groups. About 39 percent of EDNOS patients and 41 percent of anorexia patients had low phosphate levels, 38 percent and 30 percent needed tube feeding, while heart rates dropped to 47 beats per minute for EDNOS patients and 45 beats per minute for anorexia patients.
Eating Disorders Hard To Diagnose In Normal-Weight Individuals
Extreme thinness is the most obvious symptom of anorexia nervosa, and without that symptom, it can be much more challenging to recognize the presence of an eating disorder. Patients with eating disorders become adept at camouflaging their disordered eating habits, but at a certain point it becomes almost impossible for them to disguise their extremely low weight.
However, in patients with EDNOS, it becomes more difficult to recognize when eating behaviors and weight loss have become problematic. For a time, symptoms of this illness can even appear healthy, especially when people who are considered to be overweight begin to lose weight.
However, patients with EDNOS are as genuinely ill as patients with anorexia, and are also at risk for dangerous side effects. Although these individuals may not appear physically unhealthy, the illness can be recognized by symptoms such as:
- negative statements about their appearance
- major changes in eating and exercising patterns
- loss of interest in hobbies
- signs of growing anxiety or depression
Symptoms like these mean that parents and other people close to patients often play an important role in recognizing the signs of an illness and bringing it to the attention of a medical professional, since low BMI and other outwardly indications are not present to indicate the existence of an eating disorder.
Lead researcher Melissa Whitelaw of The Royal Children’s Hospital in Melbourne, Australia, was not sure why cases of EDNOS had increased so significantly between 2005 and 2009. She speculates that a simple increase in awareness could explain some of the rise. It is also possible that increased awareness of the obesity problem has led more adolescents to begin diet and exercise habits that may start out healthy before developing into an illness.