Eating disorders: prevalence and health consequences
Anorexia nervosa (AN) and bulimia nervosa (BN) are most prevalent in the adolescent and young adult population. The annual incidence of AN and BN for females is estimated to be from 0.5% to 3.7% and from 1.1% to 4.2%, respectively. Prevalence is on the rise across ethnicities and levels of socioeconomic status. Common psychiatric comorbidities include depression, substance-related disorders, and anxiety. Health consequences can include changes in growth hormone, hypothalamic hypogonadism, bone marrow hypoplasia, structural abnormalities of the brain, heart and kidney failure, tooth decay, and hair loss. Eating disorders have the highest mortality rate of any mental illness. Suicide rates in outpatient samples are estimated to be approximately 5-6% per decade of follow up, with rates around 10-11% in inpatient samples.
Binge eating disorder (BED) is seen in individuals who are overweight or obese. Prevalence is estimated to average 30% in adult weight-control program samples and up to 4% in adult nonpatient community samples. Onset typically occurs in late adolescence to young adulthood. Individuals with BED are at risk for Type II diabetes, hyperlipidemia, hypercholesterolemia, and sleep apnea. Among the most insidious and common adverse effects may be the socio-emotional consequences of obesity including discrimination, prejudice, and rejection.
Treatment requires an integrated multidisciplinary approach
Eating disorders (ED) are conceptualized as psychiatric disorders with medical consequences that require a multidisciplinary approach: medicine, psychiatry, psychology, nutrition, social work, and nursing. Eating disorder patients, perhaps more than most, require coordinated care among the various specialties involved.
The UCSF Eating Disorders Program is a joint effort of the Adolescent and Young Adult Medicine Clinic in the Division of Adolescent Medicine, the Department of Pediatrics and the Department of Psychiatry's Young Adult and Family Center. Our goals are to:
- Provide comprehensive clinical care to patients ages 10-24
- Offer interdisciplinary education and experience for trainees in adolescent medicine, child and adolescent psychiatry, and nutrition
- Conduct innovative research to investigate biopsychosocial issues important in the onset, course, treatment, and outcome of eating disorders
- Develop novel interventions, both in terms of content and modes of delivery, so that better care can be provided to more patients
Providing clinical care through evidence-based treatment
BridgeMedical and nutritional services are provided at the Adolescent and Young Adult Medicine Clinic at 400 Parnassus Avenue, and mental health services are provided at the Young Adult and Family Center at 401 Parnassus Avenue. The multidisciplinary core treatment team consists of eating disorder specialists in adolescent/young adult medicine, psychiatry, clinical psychology, nutrition, social work, and nursing. Services include:
- Medicine: initial comprehensive medical evaluation, and continued medical management, as well as coordination of care among the various disciplines
- Nutrition: working with patients and families to help restore healthy eating patterns; working with the team to monitor improvements in patients' nutritional status
- Psychology/clinical social work: an initial comprehensive psychological evaluation, initial implementation of the appropriate empirically-validated intervention, referral, and providing coordinated care with adolescent medicine
- Psychiatry: psychiatric consultation
- Social work: counseling families on issues that pertain to community resources and health insurance
The best evidence available indicates that family therapy, with a specific initial focus on parental control of re-nutrition, is most effective in the treatment of AN in adolescents. For young adults, the evidence suggests that clinical management and supportive psychotherapy is indicated during the acute phase, and that cognitive behavioral therapy (CBT) may reduce risk for relapse once weight is restored.
Psychological interventions for BN include dialectical behavior therapy (DBT), CBT, and interpersonal therapy (IPT). Individual or group therapy using CBT reduces core psychological and behavioral symptoms in both the short and the long term. DBT has also resulted in significant improvement in binge eating and eating pathology.
There is very little research on BED. Short-term trials suggest that SSRIs may reduce eating as well as psychiatric and weight symptoms. CBT and DBT decrease binge eating and associated psychological features. A combined CBT and medication approach may confer added benefit in terms of both binge eating and weight loss.
Patients are referred to appropriate Youth and Family Center programs, including:
- Intensive Family Therapy Program
- Cognitive-Behavior Therapy Program
- Dialectical Behavior Therapy Program
- Medication Management Program
Comprehensive interdisciplinary education and experience
The ED Program offiers a unique opportunity for interdisciplinary collaboration among medicine, psychiatry, psychology, nutrition, social work, and nursing. It is offered as an elective for psychiatry fellows. Beyond clinical supervision, several learning forums currently exist:
- ED case conference - We hold an ED weekly case conference to ensure that patient care is optimally coordinated among the various clinicians, assess patient progress, and plan treatment goals. This conference is interdisciplinary and inherently offers with it the opportunity to learn what comprehensive care of ED patients entails.
- Journal club - This forum allows us to stay current by reading and discussing journal articles on topics in medicine, psychology/psychiatry, and clinical nutrition.
- Seminars and Grand Rounds - We periodically invite ED scholars and clinicians to conduct seminars and/or grand rounds, and to meet with faculty and trainees to discuss the most current research on intervention and prevention.
Although there is a substantive body of research on eating disorders, particularly AN, eating disorders are not well understood. Faculty and fellows in the ED Program are currently engaged in the development of an innovative ED research program.
Please complete the UCSF Benioff Children's Hospital Teen Clinic appointment request form. You may also call our intake and referral service at (415) 476-7500 or toll-free at (800) 723-7140.
Core faculty and staff
- Kim Norman, MD
- Eva Ihle, MD, PhD
- Sarah Buckelew, MD
- Andrea Garber, PhD
- Anya Ho, PhD
- Justine Underhill, LCSW