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Medical Support in the Treatment of Eating Disorders

By Philip S. Mehler, MD, CEDS, FACP, FAED
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.

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? 

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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.


Dr. Philip Mehler will be presenting at our FREE Virtual Symposium, "It's Complicated: Innovative Treatment for Eating, Mood and Anxiety Disorders," where he'll provide an update on a number of medical issues relevant to patients with anorexia, bulimia and ARFID, in addition to new findings and medical implications associated with atypical anorexia nervosa. Join him, Dr. Stephanie Setliff and Dr. Ellen Astrachan-Fletcher on April 24, 2020, from the comfort of your own home to earn up to 5 CME/CE credit hours and get your questions answered.

RSVP to reserve your spot today!

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Written by

Philip S. Mehler, MD, CEDS, FACP, FAED

Dr. Philip Mehler, prior to joining Eating Recovery Center, served as the Medical Director of Denver Health and Hospital Authority a position he held up until his retirement in 2014. Dr. Mehler began his career at Denver Health nearly 35 years ago and was formerly its Chief of Internal Medicine, and was the first-ever Chief Medical Officer (CMO) of Denver Health for 10 years. He is the Distinguished Glassman Professor of Medicine at the University of Colorado School of Medicine and has conducted research into the optimal treatment of the most severe cases of Anorexia Nervosa and Bulimia. Dr. Mehler is also the Founder and Chief Executive Officer of ACUTE at Denver Health, the nation’s center of excellence, medical stabilization unit, for those suffering with extreme forms of eating disorders.

Dr. Mehler has authored nearly 500 publications, including 4 textbooks. Medical Complications of Eating Disorders, published by The Johns Hopkins University Press, is now in its fourth edition. Dr. Mehler was the recipient of the Academy of Eating Disorders 2011 Outstanding Clinician Award, has been recognized among the “Best Doctors in America” for the past 23 years in a row, and was voted the “Top Internist in Denver” multiple times by 5280 magazine. He is the recipient of University of Colorado Medical School’s Silver and Gold Award, the highest award bestowed on an alumnus and the Florence Nightingale Award for distinguished service to improve the healthcare for the State of Colorado. Dr. Mehler is a member and fellow of the Eating Disorders Research Society and the Academy of Eating Disorders, as well as a member of the editorial board of the International Journal of Eating Disorders and many other medical journals. He has lectured extensively on a national and international level as the leading medical expert on the topic of medical complications of eating disorders.

Eating Recovery Center and Pathlight Mood and Anxiety Center are accredited through the Joint Commission. This organization seeks to enhance the lives of the persons served in healthcare settings through a consultative accreditation process emphasizing quality, value and optimal outcomes of services.

Organizations that earn the Gold Seal of Approval™ have met or exceeded The Joint Commission’s rigorous performance standards to obtain this distinctive and internationally recognized accreditation. Learn more about this accreditation here.

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