Eating disorders are frequently characterized by medical complications that at times can be severe. Because of this, the medical assessment of patients with eating disorders is an important part of the evaluation process. Frequent complications include cardiovascular problems, including a decrement in heart rate variability that is a known risk factor for cardiac arrhythmias. Skeletal system changes, particularly the risk for osteoporosis and osteopenia, are common in patients with anorexia nervosa. Gastrointestinal complications can be quite prominent. In particular, there is a risk for gastric dilatation and gastric rupture in patients who binge eat. A variety of endocrine changes have also been described and there appears to be an association with eating disorders and poor control of diabetes mellitus.