Endocrine Abstracts

Objectives: To evaluate the prevalence of eating disorders (ED) at an Endocrinology outpatient clinic (EOC); with the use of Bulimia Investigatory Test of Edinburgh (BITE).

Methods: Descriptive analysis of clinical characteristics and BITE scores from patients with suspicion of ED at a first appointment in an EOC with an average of 128 new patients/year. Data was collected from January-2021 to December-2022. The main suspicion criteria were: self-reported anxiety toward food or eating, and/or body dissatisfaction. Results are expressed as means and proportions.

Results: Sixty patients performed a BITE test: 78.33% women, 34.38±14.87 years old, mean body mass index 38.26±5.72 kg/m². The vast majority consulted for obesity (88.33%), followed by thyroid pathology (6.66%) and diabetes mellitus (5.01%). More than half (68.33%) received pharmacological treatments: GLP1-R analogues (51.22%), SGLT-2-inhibitors (29.27%), metformin (14.63%), orlistat (2.44%) and others (2.44%). BITE symptom scores were: 20% had an absence of abnormal behaviors (<10pts), 26.67% had abnormal behaviors, not necessarily bulimia (10-15pts), 18.33% had possible subclinical bulimia (15-20pts) and 35% had possible bulimia nervosa (>20pts). Thirty-seven percent used fasting to attempt weight control, 33.33% used over-the-counter weight-loss pills more than once a day, 6.67% used diuretics, 5% used laxatives, and 3.33% used auto-induced vomiting. Seventy-five percent admitted suffering from binge eating; from occasionally up to several times per day. Regarding severity of abnormal behaviors: 78.33% of patients reported no severity (<5pts), 18.33% clinically significant severity (5-10pts) and 3.33% a high degree of severity (>10pts). A subgroup analysis for adolescents 16-21 years old (n=16), showed similar results for general clinical characteristics and BITE symptom scores but with higher severity scores: low in 62.5%, significant in 31.25% and severe in 6.25%. Twenty-nine (48.33%) patients were referred to a psychiatry ED unit for diagnosis and treatment. Twenty-two received a psychiatric diagnosis: binge-eating disorder 11.67%, adaptive disorder 10%, major depression 8.33%, not-otherwise-specified ED 5% and bulimia nervosa 1.67%. The referral was proposed and refused by 19.44% of patients.

Conclusions: A high frequency of anxiety related to food or eating and body dissatisfaction were present in this sample. After BITE screening about half of these patients were referred to an ED unit. A significant number of patients refused the referral, possibly in relation to stigma. These results highlight the importance of ED screening at EOCs and the need for multidisciplinary care teams. Prospective studies are required to evaluate the best practices for screening protocols and patient outcome optimization.