# Eating Disorders — GCMD Library living collection

Everything in the library about eating disorders — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 39 cited statements

## Episodes
### Diagnosis & Workup
- [Identifying & Managing Eating Disorders in Pediatric Obesity Treatment: Current Practices in Weight](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13885) — video · 0:53 · [machine version](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13885.md)
- [Identifying & Managing Eating Disorders in Pediatric Obesity Treatment: Current Practices in Weight](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13886) — video · 0:53 · [machine version](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13886.md)

### In-Depth Reviews
- [Eating Disorders in Adolescence](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333) — video · 39:27 · [machine version](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333.md)

## Chapters
- [0:02](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=2) Updated DSM-5 Diagnostic Criteria and Atypical Anorexia (Ep 1)
- [4:23](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=263) Screening, Diagnosis, and Overweight Patient Considerations (Ep 1)
- [11:20](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=680) Treatment Approaches and Inpatient Criteria (Ep 1)
- [19:40](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=1180) Amenorrhea Evaluation and Contraception Counseling (Ep 1)
- [25:00](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=1500) Contraceptive Method Selection in Eating Disorders (Ep 1)
- [28:35](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=1715) Hormone Replacement Therapy for Bone Health (Ep 1)
- [34:40](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=2080) Alternative Hormone Therapy and Clinical Implementation (Ep 1)
- [0:00](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13885?t=0) Eating Disorder Screening Gaps in Pediatric Weight Management (Ep 2)
- [0:00](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13886?t=0) Eating Disorder Screening Gaps in Pediatric Weight Management (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Eating disorder prevalence has doubled in the last 10 years to about 7.8% — Erica (epidemiological) [Ep 1 · 0:02](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=2)
- About 40% of eating disorders occur in adolescents aged 15 to 19 years — Erica (epidemiological) [Ep 1 · 0:02](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=2)
- Among psychiatric disorders, eating disorders have one of the highest mortality rates at 5 to 6%, primarily from suicide and medical complications — Erica (epidemiological) [Ep 1 · 0:02](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=2)
- DSM-5 removed the requirement for low BMI and amenorrhea from anorexia nervosa diagnosis criteria that existed in DSM-4 — Erica (guideline) [Ep 1 · 2:12](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=132)
- Atypical anorexia diagnosis applies to patients with all cognition and behavior of anorexia nervosa but at normal or above normal BMIs, with very similar medical complications — Erica (clinical) [Ep 1 · 2:12](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=132)
- Female athlete triad terminology is being replaced with relative energy deficiency in sports for more inclusive language covering all genders and exercise contexts — Erica (guideline) [Ep 1 · 2:12](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=132)
- Overweight adolescents have higher rates of body dissatisfaction and more weight concern compared to normal weight peers — Erica (clinical) [Ep 1 · 11:20](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=680)
- In Rastogi study, 31% of eating disorder patients had a history of overweight, with prevalence of eating disorders in those with overweight/obesity history between 11 and 36% — Erica (epidemiological) [Ep 1 · 11:20](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=680)
- Overweight patients with eating disorders are less likely to be hospitalized even with same degree of symptoms and similar medical presentation due to weight bias — Erica (clinical) [Ep 1 · 11:20](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=680)
- Previously overweight patients resume menses at younger age and higher BMI than peers, suggesting individualized rather than absolute BMI threshold for menstrual return — Erica (clinical) [Ep 1 · 11:20](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=680)
- Overweight patients return to menses 11 kg below maximum weight compared to 2 kg below for normal weight patients, representing higher BMI threshold — Erica (clinical) [Ep 1 · 11:20](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=680)
- Family-based therapy has the strongest evidence for eating disorder recovery and is the first-line approach — Erica (guideline) [Ep 1 · 15:00](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=900)
- CBT is generally more helpful in bulimia and binge eating disorder for working through compulsion to purge or compensate — Erica (clinical) [Ep 1 · 15:00](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=900)
- Inpatient management criteria include BMI less than 75% median, dehydration, electrolyte abnormalities, EKG abnormalities, unstable vital signs, acute food refusal, uncontrollable binging/purging, failing outpatient treatment, acute medical complications, and significant comorbid conditions — Erica (guideline) [Ep 1 · 15:00](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=900)
- Eating disorders primarily result in hypothalamic hypogonadotropic hypogonadism due to imbalance in energy intake/expenditure, stress, and loss of fat mass — Erica (clinical) [Ep 1 · 19:40](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=1180)
- Anorexia nervosa has 60-80% rate of amenorrhea compared to about 40% in bulimia — Erica (epidemiological) [Ep 1 · 19:40](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=1180)
- Self-induced vomiting alone has 3 times higher rate of irregular menses, and binge eating alone causes menstrual irregularity — Erica (clinical) [Ep 1 · 19:40](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=1180)
- Return of menstrual function is an important marker of physiologic recovery, serving as a natural test of endocrine system function — Erica (clinical) [Ep 1 · 19:40](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=1180)
- Endocrine Society guidelines recommend pregnancy test, prolactin, TSH for exclusionary causes, plus FSH, LH, estradiol, CBC, BMP, and AMH for functional hypothalamic amenorrhea evaluation — Erica (guideline) [Ep 1 · 19:40](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=1180)
- Functional hypothalamic amenorrhea shows low or normal FSH, low LH, and low estrogen — Erica (clinical) [Ep 1 · 19:40](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=1180)
- Patients with eating disorders are malnourished and not in good physiologic condition to carry pregnancy, making contraception discussion critical — Erica (clinical) [Ep 1 · 19:40](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=1180)
- Combined oral contraceptives should not be used for sole purpose of regulating menses — Erica (guideline) [Ep 1 · 19:40](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=1180)
- Women in recovery from eating disorders have significantly higher rates of unplanned pregnancy than general population — Erica (epidemiological) [Ep 1 · 25:00](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=1500)
- Mirena and Kyleena IUDs have no negative effect on bone mineral density — Erica (clinical) [Ep 1 · 25:00](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=1500)
- Nexplanon shows mixed results on bone mineral density with either no effect or slight decrease, but is still considered first-line therapy — Erica (clinical) [Ep 1 · 25:00](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=1500)
- For combined oral contraceptives, recommend at least 30 mcg ethinyl estradiol for better bone accretion compared to 20 mcg — Erica (clinical) [Ep 1 · 25:00](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=1500)
- Vaginal ring and patch don't negatively affect bone mineral density based on available studies — Erica (clinical) [Ep 1 · 25:00](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=1500)
- Depo-Provera is not best option for eating disorder patients because it is associated with decreased bone mineral density — Erica (clinical) [Ep 1 · 25:00](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=1500)
- Patients with anorexia who have amenorrhea for 20 months have 92% rate of osteopenia and 38% rate of osteoporosis — Erica (epidemiological) [Ep 1 · 28:35](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=1715)
- Rates of osteopenia are higher for those who have eating disorder in adolescence, a critical time for bone health development — Erica (clinical) [Ep 1 · 28:35](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=1715)
- Resumption of menses is critical for lumbar spine bone mineral density, while weight gain is more critical for hip bone mineral density — Erica (clinical) [Ep 1 · 28:35](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=1715)
- Combined oral contraceptives are ineffective for increasing bone mass in adolescents with anorexia nervosa, shown by multiple studies in 2000s — Erica (clinical) [Ep 1 · 28:35](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=1715)
- Hepatic metabolism of ethinyl estradiol down-regulates IGF-1, a factor anabolic to bone growth, explaining oral contraceptive ineffectiveness — Erica (clinical) [Ep 1 · 28:35](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=1715)
- Endocrine Society 2017 guidelines recommend short-term transdermal estradiol with cyclic progestin after 6-12 months of behavioral, nutritional, and psychological intervention — Erica (guideline) [Ep 1 · 30:42](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=1842)
- 2011 study by MSR et al at Boston Children's showed transdermal patch increased bone mineral density at all skeletal sites (lumbar spine and hip) — Erica (clinical) [Ep 1 · 30:42](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=1842)
- Transdermal estrogen patch bone mineral density improvement was not related to changes in weight or fat mass — Erica (clinical) [Ep 1 · 30:42](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=1842)
- Estrogen patch itself doesn't cause weight or body composition changes, which can be used as discussion point to improve patient compliance — Erica (clinical) [Ep 1 · 30:42](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=1842)
- Boston Children's 18-month trial of DHEA plus combined oral contraceptives in 80 anorexia nervosa patients showed stabilization of bone mineral density compared to placebo, controlling for weight gain — Erica (clinical) [Ep 1 · 34:40](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=2080)
- DHEA plus combined oral contraceptive therapy showed improved bone geometry in addition to bone mineral density stabilization — Erica (clinical) [Ep 1 · 34:40](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=2080)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- A national survey examined pediatric weight management programs across the US regarding eating disorder screening practices — Lizzie Lee summarizing a resource [Ep 2 · 0:08](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13885?t=8)
- Most programs are screening for eating disorders but not in a standardized way — Lizzie Lee summarizing a resource [Ep 2 · 0:14](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13885?t=14)
- About 60% of programs perform some form of eating disorder screening — Lizzie Lee summarizing a resource [Ep 2 · 0:19](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13885?t=19)
- Much of the screening is informal, using homegrown questionnaires or clinical judgment rather than validated tools — Lizzie Lee summarizing a resource [Ep 2 · 0:19](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13885?t=19)
- Providers are generally comfortable with screening for eating disorders — Lizzie Lee summarizing a resource [Ep 2 · 0:29](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13885?t=29)
- Medical providers lag behind behavioral health specialists by a wide margin when diagnosing conditions like binge eating disorder — Lizzie Lee summarizing a resource [Ep 2 · 0:29](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13885?t=29)
- Clinicians report not being trained enough as a barrier to eating disorder management — Lizzie Lee summarizing a resource [Ep 2 · 0:39](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13885?t=39)
- Clinicians report not knowing how to manage eating disorders they identify as a barrier — Lizzie Lee summarizing a resource [Ep 2 · 0:39](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13885?t=39)
- Clinicians report lacking clear treatment pathways for eating disorders as a barrier — Lizzie Lee summarizing a resource [Ep 2 · 0:39](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13885?t=39)
- Medical providers may need more training for diagnosis and treatment of eating disorders in pediatric obesity settings — Lizzie Lee summarizing a resource [Ep 2 · 0:47](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13885?t=47)
- A national survey of pediatric weight management programs across the US was conducted — Lizzie Lee summarizing a resource [Ep 3 · 0:08](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13886?t=8)
- Most programs are screening for eating disorders, but not in a very standardized way — Lizzie Lee summarizing a resource [Ep 3 · 0:14](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13886?t=14)
- About 60% of programs are doing some form of screening — Lizzie Lee summarizing a resource [Ep 3 · 0:19](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13886?t=19)
- A lot of screening uses informal, homegrown questionnaires or just clinical judgment rather than validated tools — Lizzie Lee summarizing a resource [Ep 3 · 0:19](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13886?t=19)
- Providers are generally comfortable screening for eating disorders — Lizzie Lee summarizing a resource [Ep 3 · 0:29](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13886?t=29)
- When it comes to diagnosing binge eating disorder, medical providers lag behind behavioral health specialists by a wide margin — Lizzie Lee summarizing a resource [Ep 3 · 0:29](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13886?t=29)
- Clinicians report not being trained enough as a barrier to eating disorder diagnosis and management — Lizzie Lee summarizing a resource [Ep 3 · 0:39](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13886?t=39)
- Clinicians report not knowing how to manage eating disorders they find as a barrier — Lizzie Lee summarizing a resource [Ep 3 · 0:39](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13886?t=39)
- Clinicians report lacking clear treatment pathways for eating disorders as a barrier — Lizzie Lee summarizing a resource [Ep 3 · 0:39](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13886?t=39)
- Medical providers may need more training for diagnosis and treatment of eating disorders — Lizzie Lee summarizing a resource [Ep 3 · 0:47](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13886?t=47)
- Endocrine Society guideline 3.6 specifies transdermal E2 therapy with cyclic oral progestin, not oral contraceptives or oral ethinyl E2 — Erica summarizing a resource [Ep 1 · 30:42](https://origin-library.globalcastmd.com/watch/eating-disorders-in-adolescence-7333?t=1842)

## Changelog
- Sep 22: 3 items added automatically

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