Physicians must be able to recognize eating disorders and understand their potential complications, which can include death from severe malnutrition, electrolyte abnormalities and suicide in depressed patients. The earlier an eating disorder is diagnosed, the better the patient will do. The first clue to anorexia or bulimia nervosa may be subtle (see Table 1). For example, women may present with amenorrhea caused by weight loss, with fractures from estrogen deficiency-related osteoporosis, or with esophagitis or loss of tooth enamel from repeated vomiting. When patients with eating disorders present with weight loss, the physician must consider other disorders such as hyperthyroidism, diabetes mellitus, malabsorption, and malignancy. However, the excessive and unrealistic fear of fatness in patients with anorexia nervosa differentiates it from other psychiatric and medical conditions causing weight loss.

Overweight is a risk factor for many important disorders, including hypertension, hypercholesterolemia, diabetes mellitus, and, in women, endometrial carcinoma. Morbid obesity, a weight greater than twice normal, can lead to potentially fatal cardiopulmonary disease. Obesity is typically multifactorial. In addition to excessive eating, common contributing factors are genetic predisposition, social class norms, nutrient availability and density, basal and exercise-dependent energy expenditure, and, occasionally, underlying medical, neurologic, or psychiatric disorders. In general, the more severe the weight abnormality and the earlier it manifests, the more likely genetic or medical factors are involved. Binge-eating disorder is present in approximately 25% of obese individuals.

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