“About six weeks after we started seeing the doctor, Anita lost a couple of pounds,” recalls Lucinda. “I was a worried wreck. ‘I am eating more,’ she’d insist. The doctor told me that anorexia may distort an individual’s interpretation of what constitutes ‘more.’

He also suspected that she was exercising more than he had recommended and that, like many young athletes, she might have the misconception that the less she weighed, the better she’d perform.

In talking to us about sports, he highlighted the role of nutrition in sustaining energy and in keeping the muscles strong. He explained that when the body confronts a fuel shortage, it may burn muscle to meet energy needs. Underfed muscles may get smaller, weaker, and less capable of meeting athletic challenges.

He added that restricting Anita’s exercise was not a punishment; its purpose was not to deprive her of sports, but rather to make sure she was well enough to participate.”

One reason primary care doctors and pediatricians monitor patients with anorexia and bulimia closely is that acute medical problems stemming from these illnesses can strike suddenly, without warning. Anita’s doctor discussed the heart as a muscle that pumps life-sustaining oxygen and nutrients throughout the body.

Just as the muscles of the arms and legs get weaker when undernourished, so can the heart. Gesturing toward a plastic anatomical heart model on his desk, he addressed the topic of pulse. While it is true that a low heart rate can be a part of physical fitness, a rate that is healthy for one person can be less so for another. That’s why it is important for a patient with an eating disorder who exercises regularly to talk about her pulse with her primary care doctor; sometimes a cardiologist is involved in this discussion as well.

When a heart beats too slowly or when a potassium level is abnormally low, life-threatening heart rhythms can develop. Levels of potassium and other electrolytes are followed closely in patients with eating disorders. Electrocardiograms (EKGs), which record the rhythm of the heart, may be performed and monitored as well.

Some with eating disorders misuse ipecac and similar medications that induce vomiting. Ingesting large amounts of these substances places individuals at risk for muscle weakness and unpredictable cardiac events.

In addition to the life-threatening aspects of eating disorders, a number of other medical consequences exist. Using imaging techniques, such as magnetic resonance imagery (MRI) and positron emission tomography (PET), scientists have identified abnormalities in brain structure and function in individuals with anorexia.

Some patients demonstrate problems with attention, concentration, and memory, and these often resolve with improved nutrition. Regarding her schoolwork, Anita recalls, “Projects that other kids completed with ease came harder to me when I had anorexia.

I compensated by working lots of extra hours to keep my grades high. But all that studying took a lot out of me and kept me from having fun on weekends.”

Many of our patients have reported abdominal discomfort.