Treatment for eating disorders is based on psychotherapy, improving the relationship with food and restoring physical health. During the active phase of the condition, acute medical complications may arise. However, it is important to distinguish these from physical effects that can persist after clinical recovery, when the person no longer has active symptoms.
Eating disorders can affect almost every organ in the body. Malnutrition, hormonal imbalances and purging behaviours place the body under continuous stress, which can lead to long-term effects. According to a study published in BMJ Medicine, these effects are wide-ranging, involve nearly all body systems and may persist for up to a decade after diagnosis.
The risk of serious complications such as diabetes, kidney failure, osteoporosis or cardiovascular disease is particularly high during the first year after diagnosis, especially while the condition is active. In some cases, however, certain effects may persist despite clinical recovery, highlighting the need for long-term, multidisciplinary medical follow-up.
Systemic impact: when the whole body is affected
Eating disorders affect the body’s overall functioning. If the body does not get enough energy, it is forced to prioritise vital functions and “switch off” non-essential systems, creating a chain reaction that can have long-lasting effects.
Below are the main physical effects that may persist over the long term, even years after recovery from an eating disorder.
Cardiovascular complications
The heart and circulatory system are among the organs most affected. Some cardiovascular effects are seen during the active phase of the condition and they usually improve with nutritional recovery. In the long term, however, some population-based studies show that five years after diagnosis, the risk of heart failure is 1.8 times higher than in the general population.
When energy intake is very low, the body activates mechanisms to conserve it, such as slowing the heart rate. This can lead to sinus bradycardia (heart rate below 60 beats per minute, and sometimes even below 40) and persistent low blood pressure. These effects usually improve with weight restoration and better nutritional status.
During the active phase of the disorder, people with purging behaviours (such as vomiting or the use of laxatives) are at high risk of serious arrhythmias due to significant potassium loss. Once these behaviours stop, this risk usually decreases, although overall cardiovascular risk may remain higher than in the general population.
Bone and rheumatological effects
The skeletal system is one of the most affected, with bone-related effects often being the most persistent, long-term and, in some cases, irreversible—especially if the condition develops during adolescence.
Undernutrition and low body weight can reduce the production of oestrogen and testosterone (a condition known as hypogonadism). Because oestrogen plays a key role in protecting bone, its absence—together with high levels of cortisol (the stress hormone) and very low levels of IGF-1 (a growth factor)—can lead to rapid bone density loss.
The long-term impact can also be significant. The risk of developing osteoporosis is 6.1 times higher five years after diagnosis. Weakened bones also increase the risk of fragility fractures by up to 7 times, compared with a healthy person, and this increased risk can persist for more than a decade.
For this reason, it is not uncommon for people who have recovered from anorexia to continue to be monitored by a rheumatologist for residual osteoporosis years later.
