A waif-like teen, weighing in at 85 pounds; a painfully large woman, tipping the scales at 500 pounds. They have little in common, right?

Not so fast. While their bodies may appear vastly different, they share many underlying characteristics and potentially life-threatening conditions that require the care of not only physicians but qualified therapists specializing in eating disorders. Let's take a look at some of the common threads that bind these two seemingly opposite individuals:

The heart: Overworked hearts are common to both the super-obese (also referred to as "malignant" obesity) and the acutely underweight individual. In both of these types of patients it is common to encounter issues like angina (chest pain), atherosclerosis (hardening of the arteries caused by a buildup of plaque), heart attack and heart failure to occur.

Bone health: The skeletal systems of anorexic and/or bulimic patients suffer as a result of chronic malnutrition; osteoporosis ("brittle bones") can often occur, resulting in a predisposition to bone fractures or bone deterioration.

Obese patients often suffer joint pain in the knees and ankles as a result of the stress of accommodating excess weight. These patients may suffer back pain as well for similar reasons. There is also reason to believe that obese patients are at increase risk for osteoporosis as well.

Hormonal imbalances: Obese patients are at high risk for developing diabetes, a condition in which the body no longer properly produces or uses insulin, a hormone secreted by the pancreas. Left untreated, diabetes can lead to other serious medical complications, including heart disease, retinopathy (blindness), neuropathy (nerve damage) and nephropathy (kidney damage). Polycystic ovary syndrome, or PCOS, is also a common diagnosis among obese women that can lead to hirsutism (excess facial hair), menstrual problems and infertility.

Severely underweight patients may also experience the absence of periods, hyper- or hypo-glycemia (high or low blood sugar), and diabetes as a result of chronic malnutrition and stress to the body's systems.

The mind: Anorexia and bulimia have long been recognized by the medical community as psychiatric illnesses that require intense therapy by qualified health-care providers. It is not uncommon for anorexic and/or bulimic patients to require inpatient hospital stays in order to properly manage their physical condition along with the psychiatric illness. Skilled psychotherapy is required for these patients to address their distorted perceptions of body image, depression, and emotional/behavioral triggers.

Similarly, it is widely understood that the super-obese medical intervention to manage their health - but psychiatric services are less often considered for this population. Those who chose to undergo weight reduction surgeries, like gastric bypass or lap-band procedures, will receive complete psychological assessments to determine their candidacy for this type of treatment; yet ongoing counseling is not commonly offered to this population. Some obese patients who are under the care of physicians specializing in bariatric medicine will have regular visits with counselors and/or therapists to help address the issues associated with their eating patterns. Overeaters Anonymous, a 12-step program for compulsive eaters, does offer some variety of support and counsel, though obviously not in a medically controlled and monitored environment.

Clearly, anorexic and bulimic patients fall at an entirely different end of the spectrum than obese patients do - and yet these are all individuals who can be classified as having eating disorders. Therapy and medical management are essential to the recovery of any patient suffering with an eating disorder.


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