Eating disorders are an increasing concern among the American population. It is estimated that 9% of the U.S. population—or 28.8 million Americans—will have an eating disorder in their lifetime. This is significantly higher than the global average. For U.S. adolescents aged 13–18, the lifetime prevalence of eating disorders is 2.7%, with rates more than twice as high among females (3.8%) compared to males (1.5%). A 2023 study found a 93% increase in eating disorder-related medical visits by youth. In addition, eating disorders continue to have one of the highest mortality rates of any mental illness and in the US they directly cause an estimated 10,200 deaths each year, translating to one death every 52 minutes.
Eating disorders involve complex alterations in behavior with food based on multifactorial emotional and psychiatric conditions and can manifest into serious medical consequences. While they are often discussed in terms of psychological impact and nutrient deficiencies, the gastrointestinal system is one of the earliest and most significantly affected organ systems. Gastrointestinal symptoms often precede eating disorder behavior and can complicate refeeding, can decrease an individual’s willingness to embrace recovery, and can actually perpetuate eating disorder practices. Recent literature frames eating disorder-gastrointestinal interactions as bidirectional. They involve physiological changes due to malnutrition and purging behaviours as well as functional gut-brain processes that are influenced by anxiety and somatization.
Clinical treatment may need to go beyond restoring weight and/or alteration of food related practices and exercise habits. Improving gastrointestinal health is crucial for overall health with increasing nutrient absorption and establishing proper motility. In addition, diagnostics of preexisting conditions can potentially promote increased success with treatment and recovery. Clinical reviews indicate high rates of gastrointestinal symptoms among eating disorder cohorts with anorexic(AN) report of gastric complaints in 70-90% of the population of patients including constipation, early satiety, bloating, abdominal pain, and nausea. Bulimia(BN) has a greater association with reflux symptoms, esophagitis, and chronic laryngeal or oral changes from self-induced vomiting. Bulimia practices that involve laxative abuse results in reports of having dysmotility or slow digestion and/or diarrhea. Binge eating disorder(BED) has increased prevalence of GERD, IBS, or dyspepsia including upper gastric pain, bloating, and nausea.
A multidisciplinary care team that includes psychiatry/psychology, gastroenterology, dietetics and primary care is essential for patient recovery. However, integrative approaches including functional testing can be a positive addition to the treatment process and can help re-establish biologic balance. Nutrient testing and advanced stool testing can help determine nutritional deficiencies and microbiome imbalances that can interfere with establishing overall health and optimal gastrointestinal function. Obtaining additional information is beneficial in providing a comprehensive plan to heal, nourish and improve the gut -brain processes for overall wellbeing.
At Spruce MD, our team dives into the intricacies of eating disorders with a focus on healing the gut.
