Risks highest within first 12 months, but remain high for years afterwards
Findings highlight need for integrated health service provision and continued monitoring
The health impacts of eating disorders, such as anorexia, bulimia, and binge eating, are not only complex, affecting many different organ systems, but long-lasting, finds a large tracking study, published in the open access journal BMJ Medicine.
The risks of serious conditions, such as diabetes, renal and liver failure, fractures, and premature death, are particularly high within the first 12 months of diagnosis. But these heightened risks persist for years, highlighting the need for timely integrated multidisciplinary health services and continued monitoring to improve outcomes, conclude the researchers.
UK rates of eating disorders have risen significantly since the COVID-19 pandemic restrictions, note the researchers. But while the detrimental mental and physical consequences are well known, the long term effects are less well understood, they add.
To strengthen the evidence base, the researchers scrutinised anonymised medical records in the Clinical Practice Research Datalink, linked to Hospital Episode Statistics and death certification data for people across England over a 20 year period (1998 to 2018 inclusive).
Some 24,709 people, aged 10-44, with a diagnosed eating disorder, were matched for age, sex, and GP practice with up to 20 others without these disorders (493,001 in total), and their mental and physical health tracked for 10 years.
Most (89%) of the entire sample was female. And among those with eating disorders, 14.5% (3577) had anorexia; 20.5% (5085) had bulimia; 5% (1215) had a binge eating disorder; and in 60% (14,832), the eating disorder was unspecified.
Analysis of the data revealed that eating disorders were associated with substantially higher risks of poor physical and mental health, and premature death.
Within the first year of diagnosis, people with eating disorders were 6 times more likely to be diagnosed with renal failure and nearly 7 times more likely to be diagnosed with liver disease, as well as being at significantly heightened risks of osteoporosis (6 times as high), heart failure (twice as high), and diabetes (3 times as high).
The risks of renal failure and liver disease were still 2.5 to nearly 4 times higher after 5 years, with 110 and 26 more cases than would be expected, respectively, per 10,000 people at 10 years.
Similarly, the risks of poor mental health were significantly higher 12 months after an eating disorder diagnosis: the risks of depression were 7 times higher, with 596 additional cases per 10,000 people, while those of self-harm were more than 9 times as high, with an additional 309 cases/10,000. And although they were lower, these heightened risks persisted after 5 years.
The risk of death from any cause within the first 12 months of diagnosis was also more than 4 times as high, and for unnatural deaths, including suicide, it was 5 times as high. After 5 years, these risks were still 2 and 3 times higher, corresponding to 43/10,000 extra deaths from all causes and 184/100,000 extra deaths from unnatural causes.
And 10 years after diagnosis, the equivalent figures for additional deaths amounted to 95/10,000 and 341/100,000, respectively. The risk of suicide was nearly 14 times higher in the first year but was still nearly 3 times higher after 10 years, accounting for 169 additional deaths/100,000 people.
The researchers acknowledge that the medical records data didn't include the severity of the eating disorder, making it impossible to link severity to worse outcomes.
But they say: "Our data describe the substantial long term effects of eating disorders and emphasise the potential opportunity for primary care to have a greater role in offering support and long term monitoring for individuals who are recovering from an eating disorder."
They suggest: "A closer and more cohesive management approach in primary and specialist care may also be needed, for both physical (nephrology, cardiology, and endocrinology) and mental health services to provide this support."
They add: "A potential gap exists in provision where patients' difficulties are too complex for low intensity brief interventions, but not complex enough for specialist teams."
And they conclude:"Raising awareness among healthcare providers about the lasting effects of eating disorders and the need for ongoing support in managing current symptoms and recovery is essential."
In a linked editorial, Dr Jennifer Couturier and Ethan Nella of McMaster University, Ontario, Canada, point out that despite the high prevalence of eating disorders, "their consequences are under-recognised."
They add: "Earlier studies have illustrated the limited education given during medical training on the topic of eating disorders, and the current study emphasises the importance of disseminating this knowledge to all healthcare professionals.
"Medical education should place greater emphasis on the recognition and management of eating disorders, to equip primary care providers, specialists, and allied health professionals with the tools to identify early warning signs and monitor ongoing risks associated with eating disorders."
They conclude: "Multiple organ systems are affected by eating disorders, which then requires an integration of care to adequately treat patients. This situation places primary care providers in an ideal position for leading and coordinating [their] care, and suggests that primary care settings would be apt for early and ongoing intervention."
