Anorexia is a misnomer, because appetite remains unless the patient becomes cachectic. Patients are often manipulative, lying about food intake and concealing behavior, such as induced vomiting. Most also exercise excessively to control weight. Patients usually lose interest in sex. Other common findings include bradycardia, low BP, hypothermia, lanugo hair or slight hirsutism, and edema.
Depression is common.
Endocrine changes include prepubertal or early pubertal patterns of luteinizing hormone secretion, low levels of thyroxine and triiodothyronine, and increased cortisol secretion. In a severely malnourished patient, virtually every major organ system may malfunction, but cardiac and fluid and electrolyte disorders are the most dangerous. Cardiac muscle mass, chamber size, and output decrease. Sudden death, most likely due to ventricular tachyarrhythmias, may occur. The key to diagnosis is eliciting the central fear of obesity, which is not diminished by weight loss.