Pulmonary Complications Associated With Eating Disorders: Medical Recommendations

Patients with severe eating disorders are at risk for multiple pulmonary complications including respiratory failure. Both food restriction and purging behaviors can impact the lungs, at times leading to pneumonia, emphysema and other types of dysfunction. By seeking treatment in a dedicated eating disorder treatment center, individuals have the best chance of recovering and regaining normal function.

Pulmonary complications & eating disorders

Pulmonary complications relating to or affecting the lungs are less commonly recognized than gastrointestinal or cardiovascular effects of eating disorders, but they can still occur, particularly in individuals with severe or prolonged illness.

Both significant food restriction and behaviors such as self-induced vomiting can affect the lungs and respiratory system, with potential complications including:

• Weakened respiratory muscles
• Reduced lung function
• Increased risk of aspiration and respiratory infections
• Changes in breathing regulation

Respiratory symptoms may be subtle at first but can become more clinically significant as medical instability progresses.

How can eating disorders affect the lungs?

By understanding how eating disorders impact lung health, clinicians can identify complications earlier.

Self-induced vomiting

Repeated self-induced vomiting primarily affects the lungs through aspiration, which happens when stomach contents enter the airway. Exposure to acidic vomit can irritate lung tissue and lead to aspiration pneumonitis, pneumonia or chronic inflammation, especially with frequent vomiting episodes common in eating disorders like bulimia nervosa or the purging subtype of anorexia nervosa.

Food restriction and malnutrition

Severe malnutrition from prolonged food restriction can weaken the respiratory muscles, including the diaphragm, as the body breaks down muscle tissue for energy. This can reduce lung expansion and ventilation efficiency, sometimes leading to hypoventilation, carbon dioxide retention or respiratory fatigue in extreme cases.

Lung problems from eating disorders

Years of food restricting and purging with eating disorders can cause a host of serious pulmonary complications.

Aspiration pneumonitis and pneumonia

Patients who engage in self-induced vomiting are at risk of aspiration pneumonia, a serious lung infection caused by breathing in foreign materials. Inhaling vomit during purging can lead to lung tissue inflammation (pneumonitis) or pneumonia.¹

Collapsed lung

A collapsed lung (pneumothorax) can result from both purging and restricting behaviors. It may cause shortness of breath and, in severe cases, can be life-threatening.²

Malnutrition can also cause collections of air on the outer surface (blebs) or within the lung tissue (bullae), increasing the risk of spontaneous pneumothorax.²

Pneumomediastinum

The increased intrathoracic and intra-alveolar pressures from retching can cause air to enter the chest cavity, known as pneumomediastinum.² Research indicates that this air may originate from the intestines and move up to the chest cavity.³

Diaphragm atrophy and dysfunction

Malnutrition from food restriction can lead to muscle loss, including the diaphragm muscle, resulting in diaphragm atrophy and dysfunction.^2,4 Several studies have shown decreased maximal inspiratory (inhalation) and expiratory (exhalation) pressures as indicators of respiratory muscle weakness in individuals with anorexia nervosa.²

Nutritional emphysema

Some studies suggest emphysema can develop in patients with eating disorders, regardless of smoking history.² In emphysema, the lungs’ air sacs become damaged and ruptured, creating large pockets instead of smaller sacs. This reduces the surface area available for oxygen to be absorbed into the bloodstream and carbon dioxide can be removed. This can cause:

• Shortness of breath
• Coughing
• Fatigue

High concentrations of CO₂

Weakness of the diaphragm muscle can cause insufficient ventilation, leading to high CO₂ levels in the blood (hypercapnia) and causing:

• Shortness of breath
• Headache
• Dizziness
• Fatigue
• Confusion

One study demonstrated that individuals with anorexia nervosa have a diminished response to hypercapnia, which also suggests impaired respiratory regulation.²

Respiratory failure

Patients with severe eating disorders are also at risk of respiratory failure. During the refeeding process, patients may develop refeeding-induced hypophosphatemia (low serum phosphorus), which can lead to diaphragmatic muscle fatigue and respiratory failure.⁵

Identifying and treating pulmonary complications

Eating disorders are frequently accompanied by severe, even life-threatening complications. Medical monitoring is essential to address pulmonary issues.

Chest x-ray

A chest x-ray is recommended for all patients with eating disorders who have respiratory symptoms to help diagnose or monitor conditions like pneumonia.²

Nutritional rehabilitation

Nutritional rehabilitation is a key component of recovery from an eating disorder. Adequate nutrition support allows the body to begin repairing the physical damage caused by prolonged malnutrition and disordered behaviors. As patients become weight-restored, many organ systems, including the heart, lungs and gastrointestinal tract, can gradually regain normal function.

Medical stabilization

Through careful monitoring and treatment, such as correcting electrolyte imbalances, managing dehydration and addressing respiratory issues, medical stabilization helps prevent further damage from an eating disorder. Stabilizing acute medical risks is crucial to protect organ function and allow the body to start recovering from severe malnutrition.

Find help for a severe eating disorder

If you are experiencing breathing problems or other lung symptoms related to an eating disorder, seeking specialized care early can make a meaningful difference. Medical stabilization and nutritional rehabilitation can help address complications such as respiratory muscle weakness, infection risk and aspiration. With the right medical support and treatment, many physical symptoms can improve.

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References

1. Nitsch, A., Dlugosz, H., Gibson, D., & Mehler, P. S. (2021). Medical complications of bulimia nervosa. Cleveland Clinic Journal of Medicine, 88(6), 333–343. https://www.acute.org/medical-complications-bulimia-nervosa
2. Nitsch, A., Kearns, M., & Mehler, P. (2023). Pulmonary complications of eating disorders: A literature review. Journal of Eating Disorders, 11, Article 12. https://www.acute.org/publications/pulmonary-complications-eating-disorders-literature-review
3. Schulman, A., Fataar, S., Van Der Spuy, J., Morton, P., & Crosier, J. (1982). Air in unusual places: Some causes and ramifications of pneumomediastinum. Clinical Radiology, 33(3), 301–306. https://doi.org/10.1016/s0009-9260(82)80271-7
4. Inci, K., Aydın, E. M., Aygencel, G., & Türkoğlu, M. (2024). Association between nutritional risk status and both diaphragmatic dysfunction and diaphragm atrophy in medical intensive care unit patients. Nutrición Hospitalaria, 41(2), 286–292. https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0212-16112024000300003&lng=en
5. Mehler, P. S., & Andersen, A. E. (2022). Eating disorders: A comprehensive guide to medical care and complications (4th ed.). Johns Hopkins University Press.