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The Forgotten Systems: Medical Comorbidities Affected by an Eating Disorder

Saturday, March 25, 2017: 8:30 AM-10:00 AM
Del Mar II (Green Valley Ranch)

Background: Medical professionals screen for cardic, bone, and electrolyte complications in patients presenting with suspected or evidenced eating disorder behaviors. Less recognized medical comorbidities can be overlooked. This presentation looks at diabetes, pregnancy, renal disease, diet-related chronic conditions and the gastrointestinal system as the often forgotten comorbidities risk within ED populations.

Objectives: 1) Recognize the eating disorder behavior and the physical symptoms attributable to these behaviors within pregnancy, diabetes, and renal disease 2) Understand the diet-related chronic health conditions (DRCHCs) in conjunction with the contemporary GI issues that are prevalent within the eating disorder disease 3) Identify the emotional complexity of defining personal health when challenged to believe in full recovery from the eating disorder while simultaneously managing a life-changing or chronic illness

We are continually reminded of the complexity of eating disorders and their associated physical, psychological and sociocultural consequences. This complexity coupled with an increase in prevalence contributes to the rise of comorbidity occurrence. As clinicians we tend to look for these comorbidities after the eating disorder has been assessed. This is no longer considered pro-active prevention as eating disorders are present in many of the more “forgotten systems” and a co-illness with other chronic physical states. The outpatient clinician benefits from awareness of the physical and emotional implications of eating disorders, and how to recognize and simultaneously treat with another co-existing condition. It is essential that the treatment care plan include therapeutic interventions directed to the challenge of having two serious illness with the potential of one of those being chronic, requiring life-long management.

  1. Eating disorders (EDs) and pregnancy
    1. EDs and fertility
    2. Balance of metabolism, reproductive and appetite hormones
    3. “Pregorexia” signs/symptoms
    4. Physical/psychological effects
    5. Breast feeding/post-partum concerns
  2. Eating disorders and the insulin-dependent diabetic
    1. Similarities of diabetes mellitus (DM) and ED
    2. Symptom interaction
    3. Severe medical complications
    4. Mood disturbances
    5. Personality factors
    6. Psychotherapy perspectives
    7. Intervention
  3. EDs in diet-related chronic health diseases (DRCHCs): renal disease, cystic fibrosis
    1. Populations not usually screened for EDs
    2. Renal disease resulting from an eating disorder
    3. Eating disorders resulting from renal disease
    4. Pica with renal disease: Understanding, diagnosis, intervention
    5. Cystic fibrosis and associated ED eating behaviors
    6. Dietary and weight implications
    7. Association of cystic fibrosis and diabetes
  4. EDs in the DRCHCs: gastrointestinal illness (GI) and contemporary issues
    1. Food allergies
    2.  Irritable bowel syndrome 
    3. Lactose intolerance
    4. Celiac disease
    5. Contemporary dietary issues
    6. Polycystic ovary syndrome 
  5. Similar threads in these areas
    1. Triggers

i. Medical treatment affecting growth

ii. Malnutrition

iii. Visible signs of illness

iv. Body image disturbances

v. Feelings of lack of control

vi. Pain

vii. Prescribed dietary regimens

  1. Need for well-directed therapy to direct emotional dimension of chronic disease
  2. Extended care team

The advancement of recognition of comorbidities and medical complications alongside eating disorders has paralleled an increase of disease prevalence. Early assessment and recognition of co-occurring illness and the potential consequences on numerous physiologic systems is critical to full recovery from the eating disorder and management of the potentially chronic co-occurring disease. Cardiac complications, bone disease, and electrolyte imbalance are among the most widely recognized physical concerns of eating disorders. In addition to these complications, it is time for clinicians to recognize the complexity of eating disorders in association with other biological systems and less recognized medical comorbidities. This presentation will look at diabetes, pregnancy, renal disease, diet-related chronic health conditions (DRCHCs) and the gastrointestinal (GI) system as the often forgotten comorbidities risk of the eating disorder population. The DRCHCs that will be reviewed include: Cystic fibrosis, food allergies, irritable bowel syndrome (IBS), lactose intolerance, celiac disease, contemporary dietary issues and polycystic ovary syndrome. The medical complications as well as the emotional challenges will be reviewed as unique to each of these disease states. This presentation will serve as a call to action not only to those professionals that presently work with eating disorders but also to the medical, nutrition, and mental health providers who work in other areas of medical specialization and on coordinated care teams. Providing the awareness and screening education to areas of medicine such as obstetrics and gynecology, endocrinology, nephrology and gastroenterology assists in early detection and development of an appropriate team, and an individualized care plan that recognizes and addresses the comorbidities present and intervention necessary for medical and psychiatric stabilization. This presentation will highlight the shared characteristics of the presented diagnoses and eating disorders. This entwinement is often what masks one of the illnesses and prevents early detection and intervention. It is the hope of the presenters that these forgotten systems will move to the front and center of concern and promote a crucial new facet to the health assessment process.
Primary Presenter:
Karen Beerbower, MS, RD, LD/N, CEDRD, F.iaedp

Karen Beerbower, MS, RD, LD/N, CEDRD, F.iaedp is a licensed, registered dietitian with a Masters degree in Medical Science from Indiana University School of Medicine. She is Program Advisor for Blue Horizon Eating Disorder Services, LLC, and President of the private practice firm, Nutritional Guidance, Inc. Karen is a Board Member of iaedp and the Eating Disorder Network of Central Florida and a member of the ADA, Orlando Dietetic Association, NEDA, Academy of Eating Disorders, National Association of Anorexia Nervosa and Associated Disorders, Sports Cardiovascular & Wellness Nutritionists and Nutrition Entrepreneurs.

Tammy Beasley, RDN, CEDRD, LD, CSSD

Consultant, speaker, author, sports dietitian and certified eating disorder registered dietitian since 1993, Tammy Beasley brings years of experience and compassion to her work. Tammy currently serves as Director of iaedp's Certification Committee, having served as co-chair for three years prior. Her unique perspective on wellness, resulting from over 27 years of consulting in weight management, sports nutrition and EDs, has helped create the RevItUP! for Life program, which celebrates living well, without food or dieting guilt. She was recognized as Alabama's Outstanding Dietitian in 2007 and Emerging Dietetic Leader in 2010.

, Edward P. Tyson, MD, CEDS

Dr. Tyson has been treating eating disorders since his fellowship in Adolescent Medicine, which is the only specialty that mandates training in eating disorders. He has written a chapter on medical complications in Treatment of Eating Disorders: Bridging the Research-Practice Gap, and is a co-author of the medical guide for the Academy for Eating Disorders (AED). Teaching and advocating about eating disorders is a passion of his, and he frequently presents at eating disorder professional meetings, to universities, and to the public. He also advocates for legislation for those with eating disorders in Texas

and Joel Jahraus, MD, FAED, CEDS

Dr. Joel Jahraus, CEDS, Fellow AED, joined the Oliver-Pyatt Centers team in May 2012 as Medical Director, becoming Chief Medical Officer for Monte Nido and Affiliates’ national network in June 2016. A graduate of Washington University Medical School, Dr. Jahraus practiced primary care medicine several years before becoming Associate Director, University of Minnesota Family Medicine Residency Program, then became a Pre-doctoral Director, University of Minnesota Medical School, receiving the Distinguished Teacher of the Year Award. He co-authored a chapter on eating disorders in the Textbook of Psychosomatic Medicine 2010, published by APA, and a chapter on medical complications in The Treatment of Eating Disorders (Grilo and Mitchell 2010). Named a US News and World Report Top Doctor, he has been featured in two national ED documentaries, served as the NEDA help line consultant, is on the iaedp Board of Directors, and chairs the Medical Certification Subcommittee.

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