Significance of screening for bulimia in family practice – adapted from the Journal of the American Board of Family Practitioners 1996;241:8 – Tips from Other Journals
Questions for Detection of Bulimia Nervosa
Indirect screening questions Are you pleased with your eating behavior? Do you ever eat in secret?
Other indirect but less specific questions Are you dissatisfied with your weight? Do you want to weigh less?
Direct questions Do you make yourself throw up? Do you use laxatives, water pills, fasting or several hours of exercise daily to control your weight?
From Bursten MS, Gabel LL, Brose JA, Monk JS. Detecting and treating bulimia nervosa: how involved are family physicians? J Am Board Fam Pract 1996; 9:241-8. Used with permission.
High-Risk Associations for Bulimia Nervosa
Patient characteristics Female Young to middle-aged adult Body-weight conscious Dieting Athlete, especially for whom low body weight is important (also true of males): dancers, gymnasts, runners, skaters, wrestlers
Complaints that increase index of suspicion Depression Fatigue Gastrointestinal complaints Paucity of menstruation Weight loss desired (especially more than 12 lb)
Very high-risk behaviors Bingeing and purging Purging alone
Other associations Alcohol or drug use Family history of depression Previous eating disorder Psychiatric comorbidity
From Bursten MS, Gabel LL, Brose JA, Monic JS. Detecting and treating bulimia nervosa: how involved are family physicians? J Am Board Fam Pract 1996; 9:241-8. Used with permission.
Significance of Screening for Bulimia in Family Practice
Bulimia nervosa is the intake of large amounts of food followed by episodes of purging, which occurs on at least two occasions each week for three months. Treatment with antidepressants and/or behavior therapy by family physicians may be helpful. The difficulty is often in detection of the condition since patients do not readily admit to bulimic behavior, although the prevalence has been reported to be 0.5 to 1.2 percent. Bursten and colleagues surveyed primary care physicians to evaluate their experience with diagnosis of bulimia.
A questionnaire was sent to 596 primary care physicians in one state. Information about each physician’s practice, number of patients with bulimia, referral patterns and contact with bulimic patients in a nonoffice setting was elicited.
A total of 272 questionnaires were completed, and 240 of these were usable. Most of the respondents had been trained in a three-year residency program, although one-quarter had received internship training only. Overall, women physicians were younger than male physicians and tended not to refer their bulimic patients. More than one-half (60 percent) of the physicians surveyed reported that they currently had no bulimic patients, and about one-third (32.5 percent) reported that they had one to three bulimic patients. Medical treatment was generally undertaken by the family physician, but almost all physicians (86.9 percent) referred patients for counseling. Only 3.4 percent of physicians managed both medical and counseling aspects of care. Physicians who knew bulimic patients in a nonmedical setting were significantly more likely than other physicians to report treating bulimic patients in their practices.
The authors conclude that primary care physicians should screen their patients for bulimia and recommend use of the questions shown in the accompanying table or detection. The index of suspicion for bulimia should be heightened in patients in the high-risk groups listed in the accompanying table on high-risk associations. (Bursten MS, et al. Detecting and treating bulimia nervosa: how involved are family physicians? J Am Board Fam Pract 1996;9:241-8.)
COPYRIGHT 1996 American Academy of Family Physicians
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