Should PTs Screen for Eating Disorders?

Upon reading an article regarding the physical stress theory, I couldn't help but think about how important understanding basic science is. I remember so many times throughout undergrad thinking "how is this even important?"However, it comes down to the fact that basic science is essential, and we need to remind ourselves when we are working in the clinics of the 'basics' when considering the source of our patients' problems.

In this article on physical stress theory, I was drawn to a section regarding how physiological factors influence the ability of our tissues to adapt to physical stress. This authors covered medication, age, pathologies, and obesity, yet much to my surprise they failed to mention the other extreme: low weight as a result of disordered eating.

A 2008 study by Barrack et al reports that there is an association with increased dietary restraint and low bone mineral density. This study included 93 female cross country runners ranging from age 13-18. Cross country runners cause moderate to high stress on their bones daily (regularly,) and the addition of dietary restrictions could potentially lead to injuries and decreased ability of the tissue to handle that stress.

My point being that there is a significant amount to consider regarding basic sciences when treating patients like these. For example, Gonzalez et al. mentions that people with low weight/eating disorders commonly have an abnormal variation in electrolytes, low blood sugar, and decreased calcium due to these dietary restrictions. Well, we all know when we take the time to consider our basic sciences that our muscles require ATP(comes from things that increase our blood sugars) to contract and relax. Low electrolytes can lead to an alteration in the sodium potassium ion channels. Lastly, calcium has a direct effect on muscular contraction considering its interaction with the sarcoplasmic reticulum, trasverse T-tubules, troponin, and tropomyosin. Aside from muscles, calcium is also a key component to the bones.

Presumably, this can be overwhelming to keep into perspective at times, but when we are managing patients in the clinic it is important to decipher the hints they are throwing at us. Caloric restriction and disordered eating ARE problems that can go undiagnosed. If left unchecked for long enough they can be damaging to the musculoskeletal, integumentary, cardiopulmonary, and neuromuscular systems. For example, a person who is restricting his or her caloric intake is picking and choosing certain foods with little thought about which nutrients he is going to get that day. A weight paranoid person is going to cut out calories however she can. Dairy products can be high in fat and calories and therefore neglected all together. Patients may forego drinking calcium rich milk when they know they can drink water with zero calories. If we consider basic science, isn't it possible that this lack of calcium from dairy products will affect bone regeneration and muscular function in the musculoskeletal system? How then will this patient's tissue respond to the stress of a work out?

When we look at the integumentary system, we know that a basic component of skin is protein. Therefore when our patients are restricting sources of protein is it reasonable to think this would have a negative effect on wound healing? Prolonged nutrient deprivation can also have serious effects on the cardiovascular system. A common problem that occurs with eating disorders is bradycardia. Long term disordered eating can also lead to cardiac failure. What if we push our patients to get better and their heart cannot handle the extra strain? The neurological system is affected at an even deeper level. Commonly, depression is associated with eating disorders. Depression alters the flow of chemicals within the brain. Most of us have seen the pharmaceutical television commercials which state, "depression hurts". Additionally, many times there is a lack of energy which can lend itself to inactivity and lead to muscular atrophy. Depression can also be a part of a vicious cycle which causes a person to not eat.

I am not sure that I would say that eating more or less than normal is unhealthier than the other. If taken to the extremes both are extremely unhealthy and create a new category of stresses put upon the tissues in each of the systems. The key is good nutrition and the input of proper physical stress. I think my main point of all of this is that regardless if your patient is young, old, eating too much, eating too little, on medications etc. it is important that physical therapists get 'back to the basics.' Rehabilitation is still dependent upon minute factors such as these. So here's my question: If we are what we eat or what we do not eat… shouldn't we be screening for eating disorders in our patients? How do we know if we are inputting the proper amount of physical stress? Are we even looking and considering how a patient's personal nutritional situation impacts the results of their therapy? How can we truly help our patients if we do not know for sure... if we are not asking the questions? It's food for thought!

Stormie Prather, SPT

^1st Year DPT student