When to consider an eating disorder:
- Unexplained weight loss or drop off in weight percentile
- Weight loss more than expected in given period of time (if trying to lose weight or needs to lose weight)
- Menstrual irregularity/amenorrhea
- New bradycardia
- Unexplained electrolyte disturbances
- Increased focus on exercise
- Parental concern
When to consider more intensive Eating Disorder treatment:
- Patient not making progress with recommendations (i.e., cannot gain recommended weight, unable to cut back on exercise)
- Family stress not resolving with support
- Physician unable to provide desired medical or psychiatric monitoring
- Lack of good resources for multidisciplinary treatment or unable to establish solid outpatient treatment team
- Weight loss ongoing or stagnant
- Bradycardia, hypothermia, electrolyte disturbances not improving with outpatient treatment
- Needs more than 1x/week monitoring
Tips for Working with Patients with Eating Disorders
Many adult patients with Eating Disorders do better if they do not know their weight early in treatment. Desensitization to weight is difficult and most Eating Disorders come with a fear of fat, preoccupation with body checking and rejection of natural body weight targets. Exposure to weight can precipitate restriction and increase dangerous behavior.
Recommendation: Weigh in gown, do not share weight with patient, and communicate info with outpatient therapy team.
If you know a patient has an ED, it is not typically helpful to say that the weight is “fine” or that you don’t see why they need treatment.
Remember – EDs can cause medical complications at any weight. It is important to understand that a severe energy imbalance along with electrolyte abnormalities, hypoglycemia, and poor cardiac out- put all contribute to ill health.
Remember – Even overweight patients may restrict, vomit, or use laxatives.
- Don’t over focus on lab results as a sign of medical stability. Patients may misread this as a green light to continue dangerous behaviors.
- Dietitians who work with ED patients should have special training in eating disorders to help address food rituals, screen for macro/ micronutrient deficiencies, set weight targets, and guide refeeding.
Remember – Many patients with AN need higher calories to even maintain weight, sometimes greater than 4000 calories per day.
- Comments such as “That’s a lot of calories” aren’t helpful. It is best to explain the possible reasons for this apparent hypermetabolic state.
- Do not assume that high weight patients are over eating or need cut back on fat. Many are eating very little fat and are already restricting calorie intake.
- Weight loss for overweight patients is difficult even for those are very motivated.
- Asking about typical eating strategies and exercise load is the best way to understand barriers to change.
Recommendation: Attend a weight sensitivity training. Help reduce weight based shaming.