Eating disorders are chronic conditions that usually start in adolescence and have profound effects on the patient’s physical and mental health, employment, education, social and family life. Anorexia nervosa has the highest mortality of any psychiatric disorder, death being due to suicide or complications of starvation. In both anorexia and bulimia there is a pathological fear of becoming fat coupled with an obsession about body size and shape.

A practice with 10,000 patients will have two patients with anorexia nervosa and about 18 with bulimia. Younger children are now presenting with eating disorders and these can be the cause of poor weight gain or delayed puberty. Men can also develop eating disorders, often under-diagnosed. An early diagnosis improves outcome.

Because patients tend to deny their illness it can be difficult to spot in general practice unless you are alerted by worried parents, friends or the school. Patients may present with non-specific symptoms like lethargy, headaches and abdominal symptoms. Suspect the possibility of an eating disorder if a patient comes to see you with:

• A BMI <17.5 with no other cause. In children and adolescents do not rely on BMI – look at growth pattern. BMI >15% of expected BMI is more useful in children.
  
• Constipation, abdominal pain, signs of starvation or vomiting.
  
• Amenorrhoea for more than 3 months (bulimics may have amenorrhoea with a normal weight).
  
• Request for a diet when their weight is patently normal.
  
• Poorly controlled type 1 diabetes – may be using reduction of their insulin dose to lose weight.
  
• Children with poor weight gain or delayed puberty.

The SCOFF questionnaire is useful as a screening tool. NICE recommends that GPs should be responsible for the initial diagnosis, participate in shared care and recognise any emergency.

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