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Patient-Centered Summary of Evidence Report (PDF)

ECRI Institute's approach to producing this guide is unique in the field of patient information. From the outset, the work was guided by families' and patients' concerns about bulimia nervosa. In particular, the late Mrs. Hilda Davis, whose foundation funded much of this work, desired to benefit the public good by providing comprehensive, objective, and scientifically sound information about diagnosis and treatment to help families affected by bulimia nervosa. To do that effectively, ECRI Institute established an external advisory committee of patients and family members affected by bulimia nervosa. This committee also included a variety of clinicians and specialists who treat eating disorders, scientists who conduct research on eating disorders, health insurance representatives, and others who affect patient care for the disorder. The committee posed more than 150 far-ranging questions about bulimia nervosa, its prevalence, incidence, diagnosis, treatment, access to care, and insurance issues. ECRI Institute has made every effort to address these questions and more in the guide.

This guide is unique also because the section that discusses treatment effectiveness is based on results from ECRI Institute's comprehensive analysis (called a systematic review) of all the available evidence—published clinical studies—on treatments for bulimia nervosa. ECRI Institute pooled data from scores of clinical studies in an attempt to discern how well each type of treatment works and for whom it works best. This effort reflects the most comprehensive analysis done to date on bulimia nervosa. The results point out areas where more research is needed to address questions that can not yet be answered definitively. Part of the rigor of ECRI Institute's analysis included critical review of the preliminary draft by clinical members of the committee and other external experts on eating disorders. This review led to revisions to ensure the rigor and thoroughness of the report. Likewise, this guide underwent review by that committee and additional patients, families, and others familiar with the disorder to help ensure that we appropriately addressed questions and offered useful resources.

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Bulimia nervosa is an eating disorder in which a person engages in binge eating (eating a lot of food in a short time) followed by some type of behavior to prevent weight gain from the food that was eaten. This behavior can take two forms: self-induced vomiting, misuse of enemas, laxatives, diet pills (called purging) and excessive exercise, fasting, or diabetic omission of insulin (called non-purging). Some people with bulimia nervosa may also starve themselves for periods of time before binge eating again. Bulimia nervosa has important mental, emotional, and physical aspects that require consideration during treatment.

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