TUESDAY, March 11, 2003 (HealthDayNews) -- People who starve themselves in the pursuit of super-thinness are no more likely to die than others of the same age and sex, claims new research.
This finding, in the March issue of Mayo Clinic Proceedings, seems to fly in the face of previous studies that have shown those who have anorexia nervosa have much higher death rates.
About one in 100 girls and one in 1,000 boys have the eating disorder, and up to 20 percent of anorexics starve themselves to death, according to the National Eating Disorders Association.
The difference in the latest research: The 208 people studied were in the general population and not in special care, explains study co-author Dr. Alexander R. Lucas, emeritus professor of psychiatry at the Mayo Medical School.
"What [this study] says is that in the community, you have a whole spectrum of people, and many of them get well," Lucas says. On the other hand, he stresses, that should not minimize the risks of severe anorexia.
"I don't want the study to be misinterpreted to seem that this is a benign disorder," he says.
Dr. L. Joseph Melton III, an epidemiologist at the Mayo Clinic and a study co-author, adds that hospitals or referral centers see "the severest patient" and "almost all of the [research] comes from referral centers."
However, Douglas W. Bunnell, president-elect of the National Eating Disorders Association, fears this study may be used by some patients to avoid dealing with the risks of their behavior.
"Patients with this disease often will minimalize the potential impact on their health," Bunnell says.
In the study, the researchers looked at the patient records of primary-care doctors in Rochester, Minn., from 1935 through 1989. If the patients met at least two of four criteria, they were classified as "definite," "probable" or "possible" cases of anorexia. The 193 women and 15 men who met the criteria were followed for up to 63 years and their survival rates were compared with white Minnesota residents of like age and sex.
More than 90 percent of the people the researchers diagnosed as anorexic were still alive 30 years after they first went to a doctor with symptoms of the disorder.
During the period of the study, 17 of the 208 people died; one died from complications of anorexia, two committed suicide and six died of complications of alcoholism. Other causes of death, such as heart attack, were normal for age and sex. The expected number of deaths in the other group was 23.7, according to the study.
Deaths due to alcoholism are common among people with eating disorders but have not been studied much, despite the fact the alcohol dependence is "over-represented among patients with anorexia nervosa," says the study.
Lucas says the medical records, in fact, showed only 39 percent of the group had defined anorexia, but he stands behind his diagnoses.
"The information may not have been on the charts for some of them," he says, noting, for instance, that one of the criteria was a fear of fatness or loss of control of eating. "I'm quite confident that they all had at least a mild form of anorexia nervosa." Few of the people studied were hospitalized or treated in a specialized outpatient center, and most of them recovered during the study period.
Lucas says he is not telling people they shouldn't get formal treatment, and he is advising doctors and people in general not to get complacent about this disease just because his study seems to say it's not as harmful as some other researchers have found.
Bunnell adds much larger studies are needed to prove these results before the findings can be generalized across the population.
"Culturally, these [eating disorder] diseases are seen as fairly frilly -- not all that important," Bunnell adds. "[But] these are very serious illnesses with serious long-term effects."
More information
Visit the National Eating Disorders Association or the Harvard Eating Disorders Center. The National Institutes of Health details symptoms and consequences of the disorder.
