VCU news

By Malorie Burkett and Suzanne Mazzeo

RICHMOND, Va. – Many young women seeking outpatient treatment for eating disorders have more severe symptoms than patients had a decade ago before changes in the U.S. healthcare system made it more difficult to get referrals to eating disorder specialists, according to a study by a team of researchers led by Virginia Commonwealth University.

The study, which will be published in the August 2003 issue of Eating Behaviors, found that an increasing number of women with the eating disorder anorexia nervosa are more likely today than in the past to have a dangerously low Body Mass Index (BMI), below 15, suggesting severe underweight and malnourishment. Those with bulimia nervosa are demonstrating more psychological problems, including problems with relationships, than they did in the past.

"Treatment for eating disorders such as anorexia and bulimia has been altered dramatically in the past several years by changes in the mental healthcare delivery system," says Suzanne E. Mazzeo, Ph.D., assistant professor of psychology at VCU. "The trend is away from lengthy psychiatric hospitalization of patients with eating disorders toward either short hospital stays or, more likely, outpatient treatment.

"Our study indicates that some of these changes may have resulted in some young women being sicker before they obtain treatment for their eating disorders. Women may be losing more weight before seeking help, and the treatment programs are more limited now than they were in the past."

The study, which included researchers from the University of Illinois at Urbana-Champaign and Bloomington Hospital in Bloomington, Ind., reviewed data from 334 women with an average age of 22 who sought treatment for eating disorders at a Bloomington Hospital clinic between 1988 and 1998. It showed that patients who sought treatment in the second half of the time period studied were much more likely than those in 1988-1992 to have a dangerously low BMI, a measure of body fat based on height and weight. A BMI of less than 18.5 generally is considered underweight for an adult. Patients with bulimia scored higher on several measures of personality associated with eating disorders, including interpersonal distrust, as time went on.

Anorexia is characterized by starvation, compulsive exercising and often by the absence of menstrual cycles. Bulimia is characterized by episodes of binge eating – eating unusually large amounts of food in a short time and feeling out of control, compensatory behavior such as self-induced vomiting and laxative abuse and over-concern about body shape and weight.

"The information from this study is relevant to clinical providers who are struggling to provide appropriate, cost-effective treatment in a continuously changing practice environment," said Mazzeo.