Follow-up: History of disordered eating and why it changes the conversation posts 61–82

Summarising the History of disordered eating thread so far, since it is long and the answer is buried: the first reply has the method, the fourth has the correction to it, and the rest is people agreeing at length.

Disordered eating history: a history of anorexia nervosa, bulimia, or other eating disorders changes the risk-benefit calculation because appetite suppression might trigger relapse. This population requires specialist input.

The honest answer on History of disordered eating is that it depends, and the useful part is the list of what it depends on. Four items, in rough order of how much they matter.

Most people get the first two right and then argue about the fourth.

Adding a data point of agreement rather than a data point.

History of disordered eating is a question about a distribution, not about a value, and treating it as a value is what produces the confident wrong answers.

Post-surgical populations, particularly after procedures affecting the gastrointestinal tract, interact with a delayed-emptying mechanism in ways that need specialist input.

Second-hand, so weight it accordingly.

On post #64 — agreed on the reasoning, with one qualification.

Pancreatitis history: the compounds can rarely trigger pancreatitis. A history of pancreatitis makes monitoring for recurrence more important during titration.

Posting it because the silence on this was starting to look like agreement.

I read the earlier replies on History of disordered eating twice before writing this, because I had assumed the opposite and wanted to be sure I was disagreeing with what was said rather than what I expected.

Medullary thyroid carcinoma history: an absolute contraindication because of the preclinical findings in rodent toxicology. The history (personal or family, especially multiple endocrine neoplasia type 2) is an important screening question.

This is where my knowledge stops and I would rather mark the edge than blur it.

Everything in post #67 holds. The case it does not cover is the one I have.

History of disordered eating is one of those subjects where the general answer and the answer for a specific case diverge, and the thread will go in circles until someone says which one is being asked for.

Narrowing post #71, because the general version has more than one answer.

I disagree with the framing of History of disordered eating above, and I think it is a substantive disagreement rather than a terminological one. Setting out why, so it can be checked.

The reasoning depends on an assumption that is doing a lot of work and is never stated. If the assumption holds, the conclusion follows. I do not think it holds generally.

Extrapolating a point estimate to somebody well outside the enrolled range should be described as an extrapolation every time it is done.

If anyone has run this properly I would rather read that than my own guess.

Clear enough that I do not think I have a follow-up, which is unusual.