2014 Medical Research Highlights in Eating Disorders
Philip S. Mehler, MD, FACP, FAED
Given the formidable number of medical complications associated with anorexia nervosa and bulimia, and the increased mortality risk inherent to both illnesses, it is critical that there be ongoing research in the medical spheres of these eating disorders. 2014 was a productive year for medical research in anorexia nervosa and bulimia nervosa. Some of the notable studies are:
- Osteoporosis continues to be highly prevalent in patients with anorexia nervosa. It remains one of the few complications of anorexia nervosa wherein weight restoration may not by itself reverse the adverse sequale. A study by Fazeli et al (J Clin Endocrinol Metab 2014;[99:13]22-1329), recently demonstrated that teriparatide significantly improved bone mineral density in patients with anorexia nervosa.
- Given that albumin has surprisingly not been found to correlate with severity of weight loss in anorexia nervosa, there is a need for a blood test which better reflects the severity of illness. In a study by Gaudiani et al (Int J Eat Disord 2014;[47:14]8-156), prealbumin was found to correlate with the disease severity and body weight percentage below ideal body weight.
- Since weight restoration is the primary focus in the treatment of patients with anorexia nervosa, there is a glaring need for rigorous trials to define the most appropriate rate at which patients should undergo refeeding. A recent study by Rocks et al (J Acad Nutr Diet 2014;1[14:89]7-907), supports an emerging theme that promotes a less restrained approach to Kcal initiation and progressive kcal increases.
- Although there was several studies which have demonstrated an increased fracture risk in adults with anorexia nervosa, which increases soon after the diagnosis of anorexia nervosa, such studies heretofore were lacking in childhood and adolescent anorexia nervosa. A study by Faje et al (Int J Eat Disord 2014;[47:45]8-466), is the first to show that the risk of fracture is also significantly higher during childhood in patients with anorexia nervosa.
- Gastrointestinal symptoms are often a source of vexation for patients with anorexia nervosa, especially towards the early stages of refeeding. These symptoms can include bloating, excessive gas and diarrhea. A brief report by Takimoto et al (Int J Eat Disord 2014;[47:20]3-205), may help elucidate the cause of this problem in that they found low levels of serum diamine oxidase activity in anorexia nervosa-restricting patients. This may indicate a disturbance in intestinal structural integrity which can result in malabsorption and cause some of the aforementioned bothersome symptoms.
- Although not a research study, the 2014 review paper on the endocrine effects of anorexia nervosa by Miller (Endocrine Metab Clinics of North Amer 2014;[42:51]5-528), is a terrific manuscript worthy of close review. The endocrine complications of anorexia nervosa are many. This review is a salient refresher for clinicians who care for these patients.
About the author –
Philip S. Mehler, MD, FACP, FAED
Philip S. Mehler, MD, FACP, FAED, is the Executive Medical Director & Chief Medical Officer at the Eating Recovery Center in Denver and the Medical Director of ACUTE at Denver Health. A Phi Beta Kappa and an Alpha Omega Alpha Graduate of The University of Colorado School of Medicine. Dr. Mehler is a Professor of Medicine at the University of Colorado School of Medicine where he holds the Glassman Endowed Chair.
He has published over 350 manuscripts in the area of anorexia nervosa and bulimia and hospital quality improvement and two books on the medical complications of eating disorders. Dr. Mehler has been listed in Best Doctors in America since 1996 for eighteen consecutive years and recently in US News & World Report’s as the top 1% of internists. For many years Dr. Mehler has been named by 5280 Magazine as a Top Internal Medicine Physician. He is recognized as a national and international expert in the medical complications of anorexia nervosa. He has won numerous teaching and research awards from the University of Colorado School of Medicine. In June of 2014, Dr. Mehler retired from Denver Health as its Medical Director and Chief Clinical Officer after a 28 year career.
Medical complications of anorexia nervosa and bulimia.
University of Colorado, BA, Phi Beta Kappa, Biology.
University of Colorado, M.D, Alpha Omega Alpha.
University of Colorado, Internship and Residency in Internal Medicine.
University of Colorado, Chief Medical Resident Department of Medicine.
Selected Honors and Awards
2013. Florence Sabin Award for Outstanding Contributions to Medical Research. University of Colorado School of Medicine.
2012. Outstanding Clinician, Lifetime Achievement Award. Academy of Eating Disorders.
2012. Best Doctor for Executives-Internal Medicine. ColoradoBiz Magazine.
2011. US News Top Doctors. (Top 1% Tier).
2011. President Award for Patient Safety. National Association of Public Hospitals (NAPH).
2011. Physician of the Year. Denver Health Foundation.