To identify parent reasons for lack of return to a weight management program, a questionnaire was sent to 85 families who attended two or fewer visits; 43 families completed the questionnaire. A total of 37% reported that the program was not what they were looking for. Specifically, they were dissatisfied with the staff or treatment focus. Other reasons for nonreturn were distance to program (23%), scheduling conflicts (21%), and lack of insurance for weight management (21%). High body mass index z score was associated with return, but age, gender, race, and medical condition were not. Matching program structure, location, and time to parent preference might improve retention.

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Five to twenty percent of patients with anorexia nervosa die from their illness. One half of those patients die of medical complications (Steinhavsen, 2002). Malnutrition, dehydration, and electrolyte abnormalities may precipitate death by inducing heart failure or fatal arrhythmias. Patients and their families commonly call upon physicians to evaluate acute and ongoing risks of malnutrition and purging behaviors. Concerns about medical compromise currently tend to determine or influence insurance coverage of medical and psychiatric treatment of patients with eating disorders. There is very limited published data to guide clinicians in the evaluation, ongoing monitoring, or treatment. Surprisingly, no consensus exists regarding recommendations for either the ongoing evaluation of cardiac parameters or the clinical implications of common findings.

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