August 2011  << Back  

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Medical Management of Eating Disorders. Second Edition

Deepak Prabhakar, MD, MPH

Wayne State University, Detroit, MI, USA

By C. Laird Birmingham and Janet Treasure; Cambridge University Press: New York, NY; 2010; ISBN: 978-0-521-72710-5; pp 264; $69 (paperback).

Eating disorders treatment underscores the importance of multidisciplinary collaborative care. The second edition of Medical Management of Eating Disorders by C. Laird Birmingham and Janet Treasure is intended for psychiatrists, medical practitioners, pediatricians, and general practitioners. In all this book includes contributions from 10 authors from Australia, Canada, and the United Kingdom. The text consists of preface, 26 chapters divided into 7 sections, and a section on protocols and algorithms. The authors intend this book to act partly as a reference textbook and partly as a consultation manual.

The book begins with the authors pointing towards the “orphan” nature of eating disorders with no clinical faculty assuming “overall responsibility” for care of patients suffering from these disorders. Morbidity ensuing from eating disorders traverse through serious physical ailments such as cachexia, electrolyte abnormalities, and nutritional deficiencies; culturally congruent behaviors such as restricted eating and obligatory exercise; and psychiatric manifestations of moderate anorexia nervosa, bulimia, and binge eating disorders. The authors encourage readers to identify these facets of eating disorders in order to effectively treat these disabling conditions.

The first section deals with definitions and prevalence of eating disorders. The authors use DSM and International Classification of Diseases-10 (ICD) classifications to define subtypes of eating disorders. Section 2 has a chapter on causal and maintaining factors for eating disorders. This chapter discusses the role of cultural, environmental, and genetic factors in causality of eating disorders. The discussion is interesting; however, it lacks depth. For example “teasing” is mentioned briefly as one of these factors. Readers would benefit from a detailed perspective on bullying and negative peer pressure. The authors effectively use reader-friendly charts in explaining causal and maintenance factors of eating disorders.

Chapters on history and physical examination, complications by systems, complications of nutritional therapy, and laboratory testing are pieced together in the third section. Critical aspects of history and physical examination specific to eating disorders are discussed in detail. Above all I liked the description on correct measurement of skin folds and the use of the Durnin and Womersley table. Quite often these simple but critical tools can be subject to measurement errors. In the chapter on complications by system the authors adhere to the all-inclusive theme by trying to incorporate all complications associated with eating disorders. Although this approach is informative, I would have preferred a detailed description of a few important complications and the relatively infrequent complications grouped together in a table. The chapter on “complications of nutritional therapy” is particularly informative. The authors remind readers blood levels of nutrients might not accurately reflect body stores and nutrient deficiencies may exist even when serum levels are normal. This distinction is critical in appropriate management of eating disorders. The authors draw parallels with a university student’s finances in an effort to simplify the mechanisms inherent to development of nutrient deficiencies. Readers will find the discussion on “refeeding syndrome” interesting as well as informative. The chapter on laboratory testing delineates important investigations that form the backbone of eating disorders workup.

In section 4, differential diagnoses and Münchausen’s syndrome are discussed. However, the description is relatively concise and readers with a psychiatry background might have enjoyed a detailed discussion on Münchausen’s syndrome. Section 5 deals with the course and prognosis, goal weight, and risk of death in patients with eating disorders. This section underscores the relatively high standardized mortality rate of anorexia nervosa. The authors offer clinical decision analysis as a viable tool to help make critical treatment decisions. A real life example from the author’s clinical experience would have enhanced the discussion. For now, readers would benefit from reading more about this tool from a resource listed in the bibliography.

The next section focuses on treatment and comprises of 14 chapters. This section includes informative discussion on evidence-based treatment, psychological therapies, and medical management. The authors also discuss challenging aspects such as managing treatment refusal and medical complications in reasonable detail. The chapters on demographic subsections such as children and adolescents, males, and geriatrics offer information discussed in the previous chapters. The chapters on pregnancy and the chronic patient evoke interest; however, fail to offer substantial details enabling readers to develop new insights into 2 of the most challenging subgroups of patients with eating disorders. This section also includes a chapter on obesity. Given the current high prevalence of obesity, a discussion of this issue is warranted. Readers will benefit from the treatment algorithm described in this chapter.

The authors also have included discussion on family practice, nursing, and dietetics in the addendum. These chapters are written with focus on these respective fields; however, readers with other clinical backgrounds would find the discussion informative. After all, professionals from these faculties are an integral component of the team approach in effective management and accurate diagnosis of eating disorders. The book also includes protocols and algorithms addressing admission orders, treatment of anorexia nervosa, bulimia nervosa, and several complications of eating disorders. Readers also will benefit from color plates illustrating several pathognomonic abnormalities associated with eating disorders.

The authors acknowledge the “authoritarian and dogmatic format” (p xi) of this book in the Preface. This approach manifests in lack of appropriate referencing throughout the text. The authors choose pertinent references and compile them in the Bibliography. This proves detrimental to the stated goal of the authors for this book to serve “partly as a reference textbook” (p xi). However, the book still manages to appeal as a consultation manual with clinically relevant chapters. This book also has several chapters lacking depth and do not add to the clinical relevance of the material presented elsewhere in the book with reasonable details. Merging some of these chapters would have provided a more coherent flow to the text.

In summary, I found several chapters of this book clinically useful. Readers from varied backgrounds will find material clinically relevant to their respective fields. However, this book falls short of expectations by trying to include too many topics related to eating disorders for a diverse readership at the expense of detailed discussion.