The risks for serious physical illness, psychiatric conditions, and premature death are sharply elevated in people with eating disorders long after their initial diagnosis, a new study showed.

Risks for renal or liver failure, fractures, diabetes, heart failure, and death are highest within the first 12 months but persist for 5-10 years after diagnosis. Investigators said the findings point to the need for earlier detection, long-term follow-up, and an interdisciplinary approach to patient care.

“Eating disorders affect every major body system,” lead author Catharine Morgan, PhD, with The University of Manchester, Manchester, England, told Medscape Medical News. “Malnutrition, rapid weight change, and purging can cause long-term damage to the heart, kidneys, liver, and bones. At the same time, many people have underlying vulnerabilities — such as depression, anxiety, or difficulties coping with stress — that persist even after eating improves.”

The study was published online on November 18 in BMJ Medicine.

Tough on the Body and Mind

Eating disorders affect about 30 million people in the US — roughly 9% of the overall population — and have the second-highest mortality rate of any psychiatric illness.

Despite an increase in global prevalence, investigators said eating disorders are widely understudied, and data on long-term effects is especially lacking.

Morgan and colleagues evaluated the short- and longer-term risks associated with eating disorders. They matched 24,709 people who received a diagnosis of anorexia nervosa, bulimia nervosa, or other eating disorder between 1998 and 2018 with up to 20 control individuals without an eating disorder (n = 493,001).

Most (89%) participants in each group were women and two thirds were aged 10-24 years. Among those with eating disorders, about 15% had anorexia, 21% had bulimia, 5% had a binge eating disorder, and 60% had an unspecified eating disorder.

Median follow-up was 4 years, with more than 10 years of follow-up for 20% of all participants.

Within the first year after diagnosis, people with an eating disorder were six times more likely to develop renal failure and nearly seven times more likely to develop liver disease. These risks remained twofold to threefold higher after 5 years.

People with an eating disorder were also six times more likely to develop osteoporosis, twice as likely to suffer heart failure, and three times more likely to develop diabetes.

An eating disorder diagnosis also took a toll on mental health, with patients seven times more likely to have depression and more than nine times as likely to engage in self-harm in the first year following diagnosis. These risks persisted at 5 years, although at a lower level.

The risk for suicide was nearly 14 times higher in the first year after diagnosis and remained nearly threefold higher at 10 years.

The risk for premature death was also elevated in those with an eating disorder. In the first year, the risk for dying from any cause was more than fourfold higher than control individuals and was fivefold higher for unnatural deaths. After 5 years, these risks were still two and three times higher, respectively.

Multidisciplinary Care Essential

It’s “essential” to raise awareness among healthcare providers about the lasting effects of eating disorders and the need for ongoing support, the authors wrote.

“Health services potentially need to treat eating disorders as long-term conditions,” Morgan told Medscape Medical News.

“That means regular physical health checks (heart, kidneys, liver, bone health, blood tests) for years after diagnosis; ongoing mental health monitoring, including screening for depression and self-harm; clear shared-care plans between GPs [general practitioner] and specialist services so nobody falls through gaps; potential rapid re-referral pathways if symptoms return; and extra support during high-risk periods, such as the first year after diagnosis and transitions between services,” Morgan said.

Despite the high prevalence of eating disorders, their consequences are “underrecognized,” Jennifer Couturier, MD, and Ethan Nella, MSc, with McMaster University, Hamilton, Ontario, Canada, pointed out in a linked editorial.

They noted that there has been “limited education given during medical training on the topic of eating disorders, and the current study emphasizes the importance of disseminating this knowledge to all healthcare professionals.”

“Medical education should place greater emphasis on the recognition and management of eating disorders, to equip primary care providers, specialists, and allied health professionals with the tools to identify early warning signs and monitor ongoing risks associated with eating disorders,” Couturier and Nella concluded.

This study had no commercial funding. Morgan, Couturier, and Nella had no relevant disclosures.