Eating disorders are classified as a psychological illness, but what makes them extremely complex and dangerous is that they also have significant medical consequences. 

1. Death: Eating disorders have the highest mortality rate of any mental illness. 

2. Cardiac: Chest pain, arrhythmia, low heart rate, heart failure

3. Hormone imbalances: Amenorrhea (loss of menstrual period), irregular menses, low libido, issues with blood sugar regulation, abnormal thyroid functioning

4. Infertility: If a person isn't having periods their body is saying it can't sustain a healthy pregnancy.

5. Cancer: Purging via vomiting can cause damage to the cells in the esophagus, including a condition called Barrett's esophagus which is a precursor to a deadly type of esophageal cancer.

6. Dermatological: Lanugo (a fine hair covering the body to help regulate body temperature), poor wound healing, hair loss, dry or cracked skin, discolored skin, scars on the knuckles from inducing vomiting

7. Bones: Decreased bone density leading to osteoporosis, increased risk of bone fractures

8. Electrolyte imbalances: Vomiting and laxative abuse can cause abnormal electrolyte levels and cardiac arrest, refeeding (increasing food consumption after a period of restricting) can also cause electrolyte imbalances that can be deadly

9. Body temperature regulation: Low body temperature, feeling cold all the time. Without sufficient stores of body fat the body loses it's ability to regulate temperature and thus slows down metabolism to conserve energy.

10. Digestive problems: You name it and it can happen – early satiety, bloating, nausea, vomiting, constipation, diarrhea, gastroparesis, reflux, hemorrhoids, even death of the large colon (from laxative abuse)

The sad thing is that physicians are poorly trained in eating disorders and often don't know what signs to look for our how to interpret tests in the context of the ED.  This often causes highly competent doctors to write off or miss medical issues that need to be addressed. 

The Academy of Eating Disorders has created a guide for the medical detection and management of eating disorders that needs to be in the hands of every physician.