March 26, 2020

Medical Support in the Treatment of Eating Disorders - Philip Mehler, MD, FACP, FAED, CEDS

Dr. Mehler, founder and Executive Medical Director of the ACUTE Center for Eating Disorders at Denver Health, is widely recognized as the world’s foremost expert in the medical treatment of eating disorders and is a noted administrator, researcher and author.

He believes strongly in the important role of the outpatient treatment professional in advocating for effective and timely treatment of their patients’ medical complications related to eating disorders and malnutrition. Below, Dr. Mehler explains why understanding common medical complications is crucial to helping patients achieve the medical stability necessary to engage fully in the recovery process.

What is the role of the outpatient treatment provider in the medical treatment of their patients’ eating disorders? 

Bad medical experiences may leave a scar in the psyches of patients with eating disorders. The next time they suffer from the same (or new) uncomfortable medical symptoms, they’re reticent to seek treatment.

Regardless of your level of training, basic information about the common medical complications and basic medical care of eating disorders will help you be a better advocate for your patients so they can access the medical treatment they need. 

Mental health and dietary clinicians can effectively use medical knowledge in eating disorders treatment to help promote patient safety and improve outcomes without delivering any medical treatment. Patients feel heard and validated, and it reinforces trust in the patient/clinician relationship.

Clinicians can also motivate recovery through objective clinical evidence. An example of how to use medical facts as leverage—I showed a bone scan to a 26-year-old patient and explained to her that she has the bones of an 80-year-old woman. With the support of eating disorder clinicians, objective information like this can resonate with patients and motivate them to get better.

Therapists, dietitians and other recovery professionals can serve these crucial functions:

1. Identify medical problems related to Bulimia Nervosa, with particular understanding of how to safely “detox” from bulimia and purging behaviors.

Note: Ineffective management of the medical complications of purging detox results in a predictable constellation of pathology that usually compels the patient to return to purging behavior. When you have a patient who is actively purging, tell them, “We need to engage in expectant treatments if you’re committed to ceasing to purge. We have to avoid failure.”

If you don’t educate them about this up front and engage them throughout medical treatment, they’re going to be shocked and angry two days later when they have horrible abdominal pain after stopping their laxatives or they gain significant weight from edema, causing the clinician to lose credibility.

Upon abrupt stopping of any purging behavior, edema results as a consequence of chronic severe volume depletion from loss of fluids (Pseudo-Bartter’s Syndrome). This syndrome is severely worsened by overuse of IV saline fluids in medical settings (for treatment of low blood pressure, dehydration, hypokalemia and alkalosis). This complication can lead to heart failure and rapid severe weight gain.

2. Identify medical problems related to Anorexia Nervosa.

3.  Identify medical problems related to malnutrition and other unspecified eating or feeding disorders, like Atypical Anorexia, ARFID and an eating disorder with co-occurring Type 1 Diabetes.

4. Recognize when a patient needs a higher level of care for ongoing management of medical problems; develop referral relationships with reputable centers of excellence for the medical treatment of eating disorders.


Note: For the most medically unstable and extremely ill patients, medical stabilization may be necessary prior to admission to an eating disorder program. ACUTE at Denver Health is the country’s premier Center of Excellence for the medical stabilization of patients with eating disorders.

ACUTE stabilizes patients (with an average length of stay of approximately 20 days) with psychiatric support from eating disorder treatment experts. Both male and female patients from the age of 15, regardless of how low their BMI is, are accepted at ACUTE. Many of ACUTE’s admissions are air-ambulance transfers from medical hospitals or referrals from residential treatment centers due to them being too low-weighted or them having significant medical complications. Once medically stable and once they have achieved a BMI of 14, ACUTE collaborates with referring providers to discharge patients back to an eating disorder program to continue recovery.
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