Professional Support (A GP's perspective)

Dr Deborah Waller, GP at 19 Beaumont St

Eating disorders such as anorexia nervosa and bulimia nervosa are common problems among young people in Britain. They can cause great misery and suffering, affecting both physical and psychological well-being as well as ability to enjoy life and to study effectively. The GP is in a special position to offer help to sufferers and to intervene early in the development of their disorder. However, GPs often have difficulty spotting eating problems and patients may be reluctant to ask for help.

What can the GP do to help? Most GPs these days are aware of eating disorders and understand how difficult it is for patients to seek help. If presented with the problem, they are likely to be very sympathetic and nonjudgemental. The GP will need to ask some details and may suggest the patient keeps an eating diary for a week to get a clearer picture of the patient's eating pattern. Especially if the patient is underweight, it is important to check weight and the GP may suggest a clinical examination if medical complications are suspected.The GP may want to arrange some blood tests (repeated vomiting can cause potentially dangerous imbalance of blood salts and there may be a risk of low blood sugar in very underweight people).

Treatment Options

Education: This is an important initial step irrespective of the eating disorder diagnosis. In anorexia nervosa, patients first need to accept that they have a recognised problem that requires professional help. This can take some weeks and requires sensitivity on the part of the doctor. With all eating disorders, education serves to counter misconceptions about eating and weight as well as providing information about the eating disorder. Reliable educational information may be obtained from various sources including national eating disorders organisations, certain books and websites. However, indiscriminate use of the internet is not advisable as there are websites that actively promote eating disorders.

Drug treatments: There is no current evidence to support the use of any drug for anorexia nervosa. In bulimia nervosa, the antidepressant drug fluoxetine (Prozac) in high dose may have a specific antibulimic effect, reducing the frequency of binges at least in the short term. Psychological treatments (talking therapies) are more effective than antidepressants, but there may be a place for medication as well, especially if the patient is depressed.

Anorexia Nervosa: This is a serious, potentially life-threatening disorder. Treatment is likely to be prolonged and intensive and early referral for specialist help is generally indicated. In Oxford, we are fortunate to have a specialist centre for the treatment of eating disorders as well as an active research team looking at improving treatment for all eating problems.

Bulimia Nervosa and Binge Eating Problems: Cognitive behaviour therapy (CBT) is probably the best treatment we currently have for bulimia nervosa and binge eating problems.It produces substantial improvement in the frequency of binge eating and purging and reduces concerns about shape and weight in at least two-thirds of patients. It involves about 20 weekly sessions with the therapist over 5 or 6 months.GPs can refer patients to a psychologist for CBT, though the current waiting time for treatment on the NHS in Oxford is between 6 and 9 months. At present, it is also possible to take part in a research study offering CBT to people with all eating disorders, run by Prof Christopher Fairburn and his research group in Oxford. There is no waiting list for this and it is open to students. Alternatively, it is possible to treat yourself by following a self help treatment programme based on CBT.