On Good America a couple of weeks ago, meteorologist Ginger Zee openly discussed her history with eating disorders.   Giva Wilkerson, program director of Project Heal, also made it her goal to educate others that eating disorders DO affect many black men and women contrary to popular belief.  While I was attending college, I did witness numerous females struggle with their body image and the need to be an ideal body type.  Although I grew up immersed in the dancer and figure skating world, where “body type and self-image” are spoken about often, I didn’t see this struggle until college.  During childhood, I was not completely aware of the prevalence of this serious illness but I definitely took notice during my sophomore year after many of us gained the “freshman 15” or more.  It is so wonderful that celebrities like Ginger Zee, Hilaria Baldwin, actress Gabourey Sidibe, singers Demi Lovato and KESHA, model Beverly Johnson and so many other females have been vulnerable and shared their stories concerning their eating disorders. 


As a rheumatologist, I have encountered young men and women who have presented to me with a history of a fracture at an early age or have complaints of muscle aches, muscle weakness or atrophy.  I try to always be sensitive and aware that anorexia or bulimia can be causes for bone and musculoskeletal complaints.  There has been so much pressure in the world for so long to be “thin and have the perfect body” especially among young children and young adults.  I want to teach my daughter to love her body, be healthy and achieve the ideal body weight or body mass index (BMI) for her based on her height.  Check out these unbelievable statistics


Females who have eating disorders develop malnourishment and the body responds to hormonal signals that are sent to compensate for loss of nutrients.  Estrogen levels will decrease resulting in loss of menstrual periods, cooling of the body core temperature, and slowing down of the heart rate.  Estrogen loss in children and young females can result in reduced bone production and bone strength.  The brain also reacts to the body’s lack of nutrients and starvation state by telling the adrenal glands to secrete increase cortisol levels which also accelerates bone loss. Young adolescents/young adults with anorexia can develop early onset osteoporosis and sustain nontraumatic fractures.


It is important to recognize and discuss the complications from these disorders.  Chronic anorexia can affect multiple organs in your body and lead to these things:

  • Anemia
  • Hair thinning
  • Brittle hair and nails
  • Kidney stones or failures
  • Electrolyte imbalances with sodium, magnesium, potassium, calcium
  • Difficulty swallowing 
  • Constipation, abdominal pain and bloating
  • Easy bruising
  • Loss of menstrual periods (amenorrhea), problems getting pregnant
  • Palpitations, Heart failure
  • Low blood pressure (hypotension), slow heart rate (bradycardia)
  • Memory loss or brain fog, dizziness/fainting, Depression
  • Weak muscles, swollen joints, bone pain
  • Height loss, osteoporosis, fractures

Muscle wasting and atrophy can occur when the body doesn’t have the necessary vitamins, protein and fat needed to maintain a healthy status and starts feeding off itself.  Electrolyte abnormalities with potassium, sodium and calcium can result in seizures and muscle weakness since these electrolytes are crucial in sending electrical and chemical signals in the brain and muscles.


Bulimia can cause:

  • Depression, fear and anxiety over gaining weight, low self esteem
  • Cavities, erosion of the enamel, gum disease
  • Bad breath
  • Swollen salivary glands (parotid gland enlargement)
  • Gastric reflux/peptic ulcers
  • Throat irritation or soreness
  • Gastrointestinal bleeding from frequent vomiting
  • Seizures from hypoglycemia
  • Knuckle abrasion from vomiting
  • Anemia
  • Irregular heartbeat, low blood pressure and slow heart rate
  • Irregular bowel movements and menstrual periods
  • Dehydration
  • Electrolyte loss (low potassium, magnesium, sodium)


Individuals who have either disorder can have low self-esteem, anxiety and depression related to body image.  Exercise addiction can be seen.  Bone pain and fractures result from bone mineral deficiencies. Damage to the muscle and nerve from malnourishment can be detrimental.

Check out the diagram below:


Physicians must do a thorough history and physical exam.  It is so important to listen to each individual without judgement and be sensitive to clues in the history that points towards an eating disorder. Some tests to detect early bone loss, electrolyte abnormalities can include:

  1. DEXA scan (bone mineral density)
  2. Serum estradiol
  3. Calcitonin
  4. Sodium, potassium, calcium, magnesium levels
  5. Bone breakdown products
    1. Type 1 Collagen carboxy terminal propeptides
    2. Serum Type 1 collagen caroboxy terminal telopeptides

Thank you to all the brave individuals who have shared their stories and experiences about this important yet difficult topic.  Although we don’t typically think about our bones and muscles until we are older, please recognize that eating disorders can affect the musculoskeletal system at an early age.

Disclaimer:  This blog contains my personal opinion based on personal and clinical experience, tips from trainers, health coaches and lastly research.  This blog does not endorse specific treatments, procedures, products.  You should always consult with a doctor, nutritionist, or other healthcare professional to discuss your own health and lifestyle goals and regimen based on your medical history.  Thank you for reading!