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Detection, evaluation, and treatment of eating disorders

The role of the primary care physician

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Abstract

OBJECTIVE: To describe how primary care clinicians can detect an eating disorder and identify and manage the associated medical complications.

DESIGN: A review of literature from 1994 to 1999 identified by a MEDLINE search on epidemiology, diagnosis, and therapy of eating disorders, including anorexia nervosa and bulimia nervosa.

MEASUREMENTS AND MAIN RESULTS: Detection requires awareness of risk factors for, and symptoms and signs of, anorexia nervosa (e.g., participation in activities valuing thinness, family history of an eating disorder, amenorrhea, lanugo hair) and bulimia nervosa (e.g., unsuccessful attempts at weight loss, history of childhood sexual abuse, family history of depression, erosion of tooth enamel from vomiting, partoid gland swelling, and gastroesophageal reflux). Providers must also remain alert for disordered eating in female athletes (the female athlete triad) and disordered eating in diabetics. Treatment requires a multidisciplinary team including a primary care practitioner, nutritionist, and mental health professional. The role of the primary care practitioner is to help determine the need for hospitalization and to manage medical complications (e.g., arrhythmias, refeeding syndrome, osteoporosis, and electrolyte abnormalities such as hypokalemia).

CONCLUSION: Primary care providers have an important role in detecting and managing eating disorders.

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References

  1. leGrange D, Telch CF, Tibbs J. Eating attitudes and behaviors in 1,435 South African Caucasian and non-Caucasian college students. Am J Psychiatry. 1998;155:250–4.

    CAS  Google Scholar 

  2. Field AE, Colditz GZ, Peterson KE. Racial/ethnic and gender differences in concern with weight and in bulimic behaviors among adolescents. Obes Res. 1997;5:447–54.

    PubMed  CAS  Google Scholar 

  3. Robinson TN, Killen JD, Litt IF, et al. Ethnicity and body dissatisfaction: are Hispanic and Asian women at increased risk for eating disorders? J Adoles Health. 1996;19:384–93.

    Article  CAS  Google Scholar 

  4. American Psychiatric Association. Practice Guidelines for Eating Disorders. Am J Psychiatry. 1993;150:2–28.

    Google Scholar 

  5. Halmi KA, Eckert E, Marchi P, Sampugnaro V, Apple R, Cohen J. Comorbidity of psychiatric diagnoses in anorexia nervosa. Arch Gen Psychiatry. 1991;48:712–8.

    PubMed  CAS  Google Scholar 

  6. Eckert ED, Halmi KA, Marchi P, Grove W, Crosby R. Ten year follow-up of anorexia nervosa: clinical course and outcome. Psychol Med. 1995;25:143–55.

    PubMed  CAS  Google Scholar 

  7. Comerci GD, Graydanus DE. Eating disorders: anorexia nervosa and bulimia. In: Hoffman ED, Graydanus DE, eds. Adolescent Medicine. Stamford, Conn: Appleton and Lange; 1997.

    Google Scholar 

  8. Bulik CM, Wullivan PF, Rorty M. Childhood sexual abuse in women with bulimia. J Clin Psych. 1989;50:460–4.

    CAS  Google Scholar 

  9. Fairburn CG, Agras WS, Wilson GT. The research on the treatment of bulimia nervosa: practical and theoretical implications. In: Anderson GH, Kennedy SH, eds. The Biology of Feast and Famine: Relevance to Eating Disorders. New York, NY: Academic Press; 1995:317–40.

    Google Scholar 

  10. Steen SN. The competitive athlete. In: Rickert VI, ed. Adolescent Nutrition: Assessment and Management. New York, NY: Chapman and Hall; 1996:223–47.

    Google Scholar 

  11. Tofler IR, Stryer BK, Micheli LJ. Physical and emotional problems of elite female gymnasts. N Engl J Med. 1996;335:281–3.

    Article  PubMed  CAS  Google Scholar 

  12. Rodin G, Craven J, Littlefield C, Murray M, Daneman D. Eating disorders and intentional insulin undertreatment in adolescent females with diabetes. Psychosomatics. 1991;32:171–6.

    PubMed  CAS  Google Scholar 

  13. Steel JM, Young RJ, Lloyd GG, Clarke BF. Clinically apparent eating disorders in young diabetic women: associations with painful neuropathy and other complications. BMJ. 1987;294:859–62.

    PubMed  CAS  Google Scholar 

  14. Johnson GL, Humphries LL, Shirley PB, et al. Mitral valve prolapse in patients with anorexia nervosa and bulimia. Arch Intern Med. 1986;146:1525–9.

    Article  PubMed  CAS  Google Scholar 

  15. Meyers DG, Starke H, Pearson P, Wilken MK. Mitral valve prolapse in anorexia nervosa. Ann Intern Med. 1986;105:384–6.

    PubMed  CAS  Google Scholar 

  16. Freund KM, Graham SM, Lesky LG, Moskowitz MA. Detection of bulimia in a primary care setting. J Gen Intern Med. 1993;8:243–8.

    Article  Google Scholar 

  17. Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ. 1999;319:1467–8.

    PubMed  CAS  Google Scholar 

  18. Sigman G. How has the care of eating disorder patients been altered and upset by payment and insurance issues? Let me count the ways. J Adolesc Health. 1996;19:317.

    Article  PubMed  CAS  Google Scholar 

  19. Katz RL, Keen CL, Hurley LS, Kellams-Harrison KM, Glader LJ. Zinc deficiency in anorexia nervosa. J Adolesc Health Care. 1987;8:400–6.

    Article  PubMed  CAS  Google Scholar 

  20. Birmingham CL, Goldner EM, Bakan R. Controlled trial of zinc supplementation in anorexia nervosa. Int J Eating Disord. 1994;15:251–5.

    CAS  Google Scholar 

  21. Szmuckler GI, Young GP, Miller G, Lichenstein M, Binns DS. A controlled trial of cisapride in anorexia nervosa. Int J Eating Disorders. 1995;17:347–57.

    Article  Google Scholar 

  22. Isner JM, Roberts WC, Heymsfield SB, Yager J. Anorexia nervosa and sudden death. Ann Intern Med. 1985;102:49–52.

    PubMed  CAS  Google Scholar 

  23. Bhanji S, Mattingly D. Anorexia nervosa: some observations on “dieters” and “vomiters.” Brit J Psych. 1981;139:238–41.

    Article  CAS  Google Scholar 

  24. Rampling D. Acute pancreatitis in anorexia nervosa. Med J Aust. 1980;74:126–32.

    Google Scholar 

  25. Saleeh JW, Lebwohol P. Metoclopromide-induced gastric emptying in patients with anorexia nervosa. Amer J Gastroenterol. 1980;74:127–32.

    Google Scholar 

  26. Stewart DE, Robinson E, Goldbloom DS, Wright C. Infertility and eating disorders. Am J Obstet Gynecol. 1990;163:1196–9.

    PubMed  CAS  Google Scholar 

  27. Sobanski E, Hiltmann WD, Blanz B, Klein M, Schmidt MH. Pelvic ultrasound scanning of the ovaries in adolescent anorectic patients at low weight and after weight recovery. Eur Child Adolesc Psychiatry. 1997;6:207–11.

    PubMed  CAS  Google Scholar 

  28. Lai KY, de Bruyn R, Lask B, Bryant-Waugh R, Hankins M. Use of pelvic ultrasound to monitor ovarian and uterine maturity in childhood onset anorexia nervosa. Arch Dis Child. 1994;71:228–31.

    PubMed  CAS  Google Scholar 

  29. Treasure JL, Wheeler M, King EA, Gordon PA, Russell GF. Weight gain and reproductive function: ultrasonographic and endocrine features in anorexia nervosa. Clin Endocrinol. 1988;29: 607–16.

    CAS  Google Scholar 

  30. Croyan MS, Ibbertson HK. Low serum T3 and hypothyroidism in anorexia nervosa. J Clin Endocrinol Metab. 1977;44:167–72.

    Article  Google Scholar 

  31. Gold PW, Gwirtsman H, Avgerinow PC, et al. Abnormal hypothalamic-pituitary-adrenal function in anorexia nervosa: pathophysiologic mechanism in underweight and weight-corrected patients. N Engl J Med. 1986;314:1335–42.

    Article  PubMed  CAS  Google Scholar 

  32. Nestel PJ. Cholesterol metabolism in anorexia nervosa and hypercholesterolemia. J Clin Endocrinol Metab. 1979;38:325–9.

    Google Scholar 

  33. Gold P, Kaye W, Robertson GI, Ebert M. Abnormalities in plasma and CSF arginine vasopressin in patients with anorexia nervosa. N Engl J Med. 1983;308:1112–23.

    Google Scholar 

  34. Silverman JA. Anorexia nervosa: clinical observations in a successful treatment plan. J Pediatrics. 1974;84:68–73.

    Article  CAS  Google Scholar 

  35. Reiger W, Brady JP, Weisberg E. Hematologic changes in anorexia nervosa. Am J Psychiatry. 1978;135:984–5.

    Google Scholar 

  36. Rigotti NA, Nussbaum SR, Herzog DB, Neer RM. Osteoporosis in women with anorexia nervosa. N Engl J Med. 1984;311:1601–6.

    Article  PubMed  CAS  Google Scholar 

  37. Rencken ML, Chesnut CH, Drinkwater BL. Bone density at multiple skeletal sites in amenorrheic athletes. JAMA. 1996;276:238–40.

    Article  PubMed  CAS  Google Scholar 

  38. Rigotti NA, Neer RM, Skates SJ, Herzog DB, Nussbaum SR. The clinical course of osteoporosis in anorexia nervosa: a longitudinal study of cortical bone mass. JAMA. 1991;265:1133–8.

    Article  PubMed  CAS  Google Scholar 

  39. Drinkwater BL, Nilson K, Chestnut CH, Bremner WJ, Shainholtz S, Southworth MB. Bone mineral content of amenorrheic and eumenorrheic athletes. N Engl J Med. 1984;311:277–81.

    Article  PubMed  CAS  Google Scholar 

  40. Cumming DC. Exercise-associated amenorrhea, low bone density and estrogen replacement therapy. Arch Intern Med. 1996;156:2193–5.

    Article  PubMed  CAS  Google Scholar 

  41. Recker R, Davies KM, Hinders SM, Heaney RP, Stegman R, Kimmel DB. Bone gain in young adult women. JAMA. 1992;268:2403–8.

    Article  PubMed  CAS  Google Scholar 

  42. Klibanski A, Biller BMK, Schoenfeld DA, Herzog DB, Saxe VC. The effects of estrogen administration on trabecular bone loss in young women with anorexia nervosa. J Clin Endocrinol Metab. 1995;80:898–904.

    Article  PubMed  CAS  Google Scholar 

  43. Hergenroeder AC, O’Brian Smith E, Shypailo R, Jones LA, Klish WJ, Ellis K. Bone mineral changes in young women with hypothalamic amenorrhea treated with oral contraceptives, medroxyprogesterone or placebo over 12 months. Am J Obstet Gynecol. 1997;176:1017–25.

    Article  PubMed  CAS  Google Scholar 

  44. Black DM, Cummings SR, Karpf DB, et al. Randomized trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet. 1996;348:1535–41.

    Article  PubMed  CAS  Google Scholar 

  45. Hosking D, Chilvers CED, Christiansen C, et al. Prevention of bone loss with alendronate in postmenopausal women under 60 years of age. N Engl J Med. 1998;338:485–92.

    Article  PubMed  CAS  Google Scholar 

  46. McClung M, Clemmensen B, Daifotis A, et al. Alendronate prevents postmenopausal bone loss in women without osteoporosis. Ann Intern Med. 1998;128:253–61.

    PubMed  CAS  Google Scholar 

  47. Robin AL, Siegel PT, Koepke T, Moye AW, Tice S. Family therapy versus individual therapy for adolescent females with anorexia nervosa. J Dev Behav Pediatr. 1994;15:111–6.

    Article  PubMed  CAS  Google Scholar 

  48. Eisler I, Dare C, Russell GF, Szmukler G, LeGrange D, Dodge E. Family and individual therapy in anorexia nervosa. A 5-year follow-up. Arch Gen Psychiatry. 1997;54:1025–30.

    PubMed  CAS  Google Scholar 

  49. Gowers S, Norton K, Halek C, Crisp AH. Outcome of outpatient psychotherapy in a random allocation treatment study of anorexia nervosa. Int J Eating Disord. 1994;15:165–77.

    Article  CAS  Google Scholar 

  50. Treasure J, Todd G, Brolly M, Tiller J, Nehmed A, Denman F. A pilot study of a randomised trial of cognitive analytical therapy vs educational behavioral therapy for adult anorexia nervosa. Behav Res Ther. 1995;33:363–7.

    Article  PubMed  CAS  Google Scholar 

  51. Fairburn CG, Shafran R, Cooper Z. A cognitive behavioral theory of anorexia nervosa. Behav Res Ther. 1999;37:1–13.

    Article  PubMed  CAS  Google Scholar 

  52. Halmi KA, Eckert E, LaDu TJ, Cohen J. Anorexia nervosa: treatment efficacy of cyproheptadine and amitriptyline. Arch Gen Psychiatry. 1986;43:177–81.

    PubMed  CAS  Google Scholar 

  53. Gwirtsman HE, Guze BH, Yager J, Gainsley B. Fluoxitene treatment of anorexia nervosa: an open clinical trial. J Clin Psychiatry. 1990;51:378–82.

    PubMed  CAS  Google Scholar 

  54. Kaye WH, Weltzin TE, Hsu LK, Bulik CM. An open trial of fluoxetine in patients with anorexia nervosa. J Clin Psychiatry. 1991;52:464–71.

    PubMed  CAS  Google Scholar 

  55. Attia E, Haiman C, Walsh BT, Flater SR. Does fluoxetine augment the inpatient treatment of anorexia nervosa? Am J Psychiatry. 1998;155:548–51.

    PubMed  CAS  Google Scholar 

  56. Garfinkel PE, Garner DM. The Role of Drug Treatments for Eating Disorders. New York, NY: Brunner/Mazel; 1987.

    Google Scholar 

  57. Wells LA, Logan KM. Pharmacologic treatment of eating disorders: a review of selected literature and recommendations. Psychosomatic. 1987;28:470–9.

    CAS  Google Scholar 

  58. House RC, Grisius R. Periomolysis: unveiling the surrepitious vomiter. Oral Surg. 1981;6:152–5.

    Article  Google Scholar 

  59. Clark DC. Oral complications of anorexia nervosa and/or bulimia: with a review of the literature. J Oral Med. 1985;40:134–8.

    PubMed  CAS  Google Scholar 

  60. Dawsen J, Jones C. Vomiting induced hypokalemic alkalosis and parotid swelling. Practitioner. 1977;28:267–8.

    Google Scholar 

  61. Levin PA, Falko JM, Dixon K, Gallup EM, Saunders B. Benign parotid enlargement in bulimia. Ann Intern Med. 1980;93:827–9.

    PubMed  CAS  Google Scholar 

  62. Walsh BT, Croft CB, Katz JL. Anorexia nervosa and salivary gland enlargement. Int J Psychiatry Med. 1981;11:255–61.

    Article  PubMed  CAS  Google Scholar 

  63. Larsen K, Skov Jensen B, Axelsen F. Perforation and rupture of the esophagus. Scand J Thorac Cardiovas Surg. 1983;17:311–6.

    CAS  Google Scholar 

  64. Saul SH, Dekker A, Watson CG. Acute gastric dilatation with infarction and perforation. Report of fatal outcome in patient with anorexia nervosa. Gut. 1981;22:978–83.

    PubMed  CAS  Google Scholar 

  65. Mitchell JE, Pyle RL, Miner RA. Gastric dilatation as a complication of bulimia. Psychosomatics. 1982;23:96–7.

    PubMed  CAS  Google Scholar 

  66. Breslow M, Yates A, Shisslak C. Spontaneous rupture of the stomach: a complication of bulimia. Int J Eating Disorders. 1986;5:137–42.

    Article  Google Scholar 

  67. Mitchell JA, Boutacoff LI. Laxative abuse complicating bulimia: medical and treatment implications. Int J Eating Disorders. 1986;5:325–34.

    Article  Google Scholar 

  68. Cummings JH. Laxative abuse. Gut. 1974;15:758–66.

    PubMed  CAS  Google Scholar 

  69. Cooke WT. Laxative abuse. Clin Gastroenterol. 1977;6:659–73.

    PubMed  CAS  Google Scholar 

  70. Al-Mufty NS, Bevan DH. A case of subcutaneous emphysema, pneumomediastinum and pneumoretroperitoneum associated with functional anorexia. Brit J Clin Pract. 1977;31:160–1.

    PubMed  CAS  Google Scholar 

  71. Donley AJ, Kemple TJ. Spontaneous pneumomediastinum complicating anorexia nervosa. Br J Med. 1978;11:1604–5.

    Google Scholar 

  72. Brotman MC, Forbath N, Garfinkel PE, Humphrey JG. Myopathy due to ipecac syrup poisoning in a patient with anorexia nervosa. Can Med Assoc J. 1981;125:453–4.

    PubMed  CAS  Google Scholar 

  73. Adler AG, Walinsky P, Krall RA, et al. Death resulting from ipecac syrup poisoning. JAMA. 1983;243:1977–8.

    Google Scholar 

  74. Palmer EP, Guay AT. Reversible myopathy secondary to abuse of ipecac in patients with major eating disorders. N Engl J Med. 1986;313:1457–9.

    Article  Google Scholar 

  75. Brotman AW, Rigotti N, Herzog DB. Medical complications of eating disorders: outpatient evaluation and management. Compr Psychiatry. 1985;26:258–72.

    Article  PubMed  CAS  Google Scholar 

  76. Mitchell JE, Pyle RI, Eckert ED, Hatsukami D, Lentz R. Electrolyte and other physiological abnormalities in patients with bulimia. Psychol Med. 1983;13:273–8.

    Article  PubMed  CAS  Google Scholar 

  77. Mitchell JE, Seim HC, Colon E, Pomeroy C. Medical complications and medical management of bulimia. Ann Intern Med. 1987;107:71–7.

    PubMed  CAS  Google Scholar 

  78. Fairburn CG, Jones R, Peveler RC, Hope RA, O’Connor M. Psychotherapy and bulimia nervosa: the longer-term effects of interpersonal psychotherapy, behavior therapy and cognitive behavior therapy. Arch Gen Psychiatry. 1993;50:419–28.

    PubMed  CAS  Google Scholar 

  79. Goldbloom DS, Olmsted M, Davis R, et al. A randomized controlled trial of fluoxetine and cognitive behavioral therapy for bulimia nervosa: short term outcome. Behav Res Ther. 1997;35:803–11.

    Article  PubMed  CAS  Google Scholar 

  80. Treasure J, Schmidt U, Troop N, Tiller J, Todd G, Turnbull S. Sequential treatment for bulimia nervosa incorporating a self-care manual. Br J Psychiatry. 1996;168:94–8.

    PubMed  CAS  Google Scholar 

  81. Lewandowski LM, Gebing TA, Anthony JL, O’Brien WH. Meta-analysis of cognitive-behavioral treatment studies for bulimia. Clin Psychol Rev. 1997;17:703–18.

    Article  PubMed  CAS  Google Scholar 

  82. Thackwray DE, Smith MC, Bodfish JW, Meyers AW. A comparison of behavioral and cognitive-behavioral interventions for bulimia nervosa. J Consult Clin Psychology. 1993;61:639–45.

    Article  CAS  Google Scholar 

  83. Garner DM, Rockert W, Davis R, Garner MV, Olmsted MP, Eagle M. Comparison of cognitive behavioral and supportive expressive therapy for bulimia nervosa. Am J Psychiatry. 1993;150:37–46.

    PubMed  CAS  Google Scholar 

  84. Fairburn CG, Norman PA, Welch SL, O’Connor ME, Doll HA, Peveler RC. A prospective study of outcome in bulimia nervosa and the long-term effects of three psychological treatments. Arch Gen Psychiatry. 1995;52:304–12.

    PubMed  CAS  Google Scholar 

  85. Walsh BT, Wilson GT, Loeb KL, et al. Medication and psychotherapy in the treatment of bulimia nervosa. Am J Psychiatry. 1997;154:523–31.

    PubMed  CAS  Google Scholar 

  86. Mitchell JE, Pyle RL, Eckert ED, Hatsukami D, Pomeroy C, Zimmerman R. A comparison study of antidepressants and structured group psychotherapy in the treatment of bulimia nervosa. Arch Gen Psychiatry. 1990;47:149–57.

    PubMed  CAS  Google Scholar 

  87. Agras WS, Rossiter EM, Arnow B, et al. Pharmacologic and cognitive-behavioral treatment for bulimia nervosa: a controlled comparison. Am J Psychiatry. 1992;149:82–7.

    PubMed  CAS  Google Scholar 

  88. Thiels C, Schmidt U, Treasure J, Garthe R, Troop N. Guided self-change for bulimia nervosa incorporating use of a self-care manual. Am J Psychiatry. 1998;155:947–53.

    PubMed  CAS  Google Scholar 

  89. Fluoxetine Bulimia Nervosa Collaborative Study Group. Fluoxitene in the treatment of bulimia nervosa: a multi-center placebocontrolled double blind trial. Am J Psychiatry. 1992;49:139–47.

    Google Scholar 

  90. Goldstein DJ, Wilson MG, Thompson VL, Potvin JH, Rampey AH, Jr. Long term fluoxetine treatment of bulimia nervosa. Fluoxetine Bulimia Nervosa Research Group. Br J Psychiatry. 1995;166:660–6.

    Article  PubMed  CAS  Google Scholar 

  91. Fornari VM, Sandberg DE, Lachenmeyer J, Cohen D, Matthews M, Montero G. Seasonal variations in bulimia nervosa. Ann NY Acad Sci. 1989;575:509–11.

    Article  Google Scholar 

  92. Lam RW, Solyom L, Tompkins A. Seasonal mood symptoms in bulimia nervosa and seasonal affective disorder. Compr Psychiatry. 1991;32:552–5.

    Article  PubMed  CAS  Google Scholar 

  93. Levitan RD, Kaplan AS, Rockert W. Chracterization of the “seasonal” bulimic patient. Int J Eating Dis. 1996;19:187–92.

    Article  CAS  Google Scholar 

  94. Lam RW, Goldner EM, Soplyom L, Remick RA. A controlled study of light therapy for bulimia nervosa. Am J Psychiatry. 1994;151:744–9.

    PubMed  CAS  Google Scholar 

  95. Blouin AG, Blouin JH, Iversen H, et al. Light therapy in bulimia nervosa: a double-blind, placebo controlled study. Psychiatry Res. 1996;60:1–9.

    Article  PubMed  CAS  Google Scholar 

  96. Braun D, Sunday S, Fornari V, Halmi K. Bright light therapy decreases winter binge frequency in women with bulimia nervosa: a double-blind, placebo controlled study. Compr Psychiatry. 1999;40:442–8.

    Article  PubMed  CAS  Google Scholar 

  97. Rodin GM, Johnson LE, Garfinkel PE, Daneman D, Kenshole AB. Eating disorders in female adolescents with insulin-dependent diabetes mellitus. Int J Psychiatry Med. 1986;16:49–57.

    Article  PubMed  Google Scholar 

  98. Krowlewski AS, Warram JH, Cristlieb AR, Busick EJ, Kahn CR. Risk of proliferative diabetic retinopathy in juvenile-onset type I diabetes: a 40 year follow-up study. Diabetes Care. 1985;9:443–52.

    Article  Google Scholar 

  99. Rydall AC, Rodin GM, Olmsted MP, Devenyi RG, Daneman D. Disordered eating behavior and microvascular complications in young women with insulin-dependent diabetes mellitus. N Engl J Med. 1997;336:1849–54.

    Article  PubMed  CAS  Google Scholar 

  100. American College of Sports Medicine. The female athlete triad: disordered eating, amenorrhea, osteoporosis: call to action. Sports Med Bulletin. 1992;27.

  101. Carlat DJ, Camargo CA, Herzog DB. Eating disorders in males: a report on 135 patients. Am J Psychiatry. 1997;154:1127–32.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. the Division of General Internal Medicine, Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, Calif

    Judith M. E. Walsh MD, MPH

  2. Barnard College Student Health Services, Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, NY

    Mary E. Wheat MD

  3. Women’s Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston University Medical Center, Boston, Mass

    Karen Freund MD, MPH

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  1. Judith M. E. Walsh MD, MPH
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Correspondence to Judith M. E. Walsh MD, MPH.

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Walsh, J.M.E., Wheat, M.E. & Freund, K. Detection, evaluation, and treatment of eating disorders. J GEN INTERN MED 15, 577–590 (2000). https://doi.org/10.1046/j.1525-1497.2000.02439.x

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