COLUMBUS, Ohio -- Family physicians dramatically under-diagnose bulimia among their patients, a new study suggests.
Researchers here surveyed nearly 600 Ohio family physicians about the number of bulimic patients they had treated in their careers. They found that almost one-third of family physicians had never diagnosed bulimia in a patient and that 60 percent said they had no bulimic patients at the time of the survey.
"Recent studies show that the lifetime prevalence of eating disorders among women is about 5 percent. Thus, one might expect that virtually all family physicians would have patients who are bulimic," said Lawrence L. Gabel, professor of family medicine and allied medical professions at Ohio State University and a co-author of the study. "The results of this survey suggest that family physicians aren't giving as much attention as they should to a problem that is actually fairly prevalent."
Bulimia is an eating disorder characterized by recurrent consumption of large quantities of food in a short period of
time -- binging -- followed by purging. Purging can take the form of vomiting, diuretic or laxative abuse, stringent dieting or extreme exercise.
Gabel conducted this research with Marian Stager Bursten, an Ohio State medical student at the time of the study; John A. Brose, professor of family medicine and assistant dean of clinical research at the Ohio University College of Osteopathic Medicine; and John S. Monk, associate director for instructional research at Ohio State. The group's work was published in a recent issue of the Journal of the American Board of Family Practitioners.
For their study, Gabel and his colleagues surveyed a random sample of Ohio M.D.s and osteopathic physicians who identified themselves as family or general physicians. The survey asked physicians to indicate the total number of bulimic patients they'd treated in their careers and how many they were treating currently. In addition, the survey asked physicians whether they'd referred their bulimic patients to other physicians and whether they'd ever had out-of-office contact with a person who was bulimic or anorexic. Respondents to the survey also indicated their sex, age, type of training, years of medical practice and number of patients seen per week.
These results clearly call for improved detection and treatment of bulimia by family physicians, Gabel said. However, he said, like many things, that's easier said than done.
"Bulimia can be almost invisible," Gabel said. "Unlike anorexics, bulimics keep their weight stable, so it's hard to notice any physical change. Plus, very few patients reveal this disorder to their family physicians. In most cases, if a physician asks a patient about it directly, she denies it." In fact, Gabel said, in one study of 277 female patients, researchers found that although 45 women had a history of vomiting and laxative abuse, only one had mentioned it to her family physician.
There is, however, a way around this problem. A simple, two- question screening test that does not ask directly about bulimic behaviors has been found to be effective in identifying patients with bulimia, Gabel said. The two questions are: Are you pleased with your eating behavior? Do you ever eat in secret?
Gabel believes this screening test should be part of the medical care of all people at risk for bulimia. Those at particular risk include girls and women age 14 to 49, especially dancers, athletes and those predisposed to depression.
"Because screening is quick, inexpensive and straightforward, all at-risk patients should be screened for bulimia," Gabel said. "Beyond preventing the human suffering associated with the disease, screening can also help control medical costs. Expensive and complicated workups of the reproductive and gastrointestinal system may be better focused when the diagnosis of bulimia explains a patient's complaints."
Contact: Lawrence L. Gabel, (614) 292-1400; Gabel.firstname.lastname@example.org
Written by Kelly McConaghy Kershner, (614) 292-8308; Kershner.email@example.com
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