Until more is published, the story of eating disorders among physicians continues to be shrouded in anonymity and secrecy, providing only occasional glimpses of the toll taken on the profession in general and the struggle faced by individuals with anorexia and/or bulimia.
Last summer, in response to a New York Times blog about bullying in medical school, a friend memorialized a 51-year-old, Columbia University–trained physician, Dr. Connie L. Rizzo, who reportedly died of complications from anorexia. The poster, a former student, said Dr. Rizzo "told me that her medical school experience was so horrific that she remained traumatized from the incidents which occurred [there]...
"The slight, beautiful, shy, Italian immigrant student from a family of artisans with an IQ of 180 turned out to be a dedicated healer but died from complications brought on by anorexia. A few weeks before she died she told me that she dreamed of a flower whose petals were being torn off by angry weeds even as it just wanted its own little reach of sun."
Efforts by this newspaper to find out more details about Dr. Rizzo or the friend who poignantly memorialized her, were unsuccessful.
ACUTE Eating Disorders Unit Expands to Accommodate Need
A unique, intensive medical stabilization unit for patients with severe eating disorders is expanding, based on high demand, according to Dr. Gaudiani, assistant medical director for the Acute Comprehensive Urgent Treatment of Eating Disorders (ACUTE) Center at Denver Health.
Beginning in the fall of 2008, a five-patient inpatient unit opened there to serve eating disorders patients who delayed getting treatment until their conditions had destabilized to the point that, "to their astonishment, they were too sick to be served," even at dedicated inpatient eating disorders units within psychiatric facilities, she said.
The Center accepts only patients whose weight has fallen below 70% of ideal body weight.
The first 200 or so patients served by the center ranged in age from 17 to 65 years (mean, 27 years), and averaged a body mass index of 12.5 upon admission. The average length of stay was 2 weeks.
In response to increased demand, the unit is now expanding to eight beds and may further increase its census, said Dr. Gaudiani in an interview.
A report on outcomes published this year in the International Journal of Eating Disorders found that in the unit, 44% of patients had hypoglycemia, 76%, abnormal liver function, and 83%, abnormal bone density, and 45% developed refeeding hypophosphatemia. While on the unit, 92% had hypothermia (Int. J. Eat. Disord. 2012;45:85-92).
In the community, patients with severe eating disorders often are admitted to intensive care units for brief stabilization, which is "at best, a Band-Aid solution, and at worse, dangerous," since complications of refeeding can occur following discharge, said Dr. Gaudiani.
Once patients are stabilized at the ACUTE unit, they are transferred to inpatient residential eating disorders programs, and often fare well, she added in an interview.
Dr. Bermudez said the need for the unit, which collaborates with his center for psychiatric care, demonstrates the need for better education and training in eating disorders among medical professionals.
"Early recognition and timely intervention is of the utmost importance," he said.
When patients or families present to primary care or specialists in cardiology, ob.gyn., gastroenterology, or other subspecialties, physicians need to be alert for subtle symptoms in patients who may try to hide symptoms of the disease.
"It’s a clear area where we’ve got to chisel away at the obvious," said Dr. Bermudez.
"Loved ones quite often express the concern that they consulted with a physician who falsely reassured them about the seriousness of a patient’s condition. In defense of physicians, this is not a population that wants to be discovered."
On the other hand, certain medical conditions such as electrolyte imbalances or cardiac abnormalities, particularly in adolescents or young adults, should "make the light go off, so they say, ‘Aha!’ " he said.
A number of resources exist to educate physicians about promptly diagnosing eating disorders, including a video CME course offered by the American Medical Association and a 18-page downloadable pamphlet for professionals designed by the Academy for Eating Disorders.
Beyond distance learning or didactic training, however, awareness comes through "rubbing elbows with these patients for awhile" so that the patterns and behaviors intrinsic to the disorder become obvious, said Dr. Bermudez.
If physicians, medical students, and residents begin to recognize eating disorders in patients, they may also begin to see its signs and symptoms among themselves and their peers, he added.