Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Clinical Signs of Eating Disorders:
- An unusually low or high body mass index (BMI) or body weight for their age NICE NG69.
- Rapid weight loss NICE NG69.
- Dieting or restrictive eating practices that cause concern to the individual, family, or professionals NICE NG69.
- Changes in eating behaviour reported by family members or carers NICE NG69.
- Social withdrawal, particularly from situations involving food NICE NG69.
- Disproportionate concern about weight or shape NICE NG69.
- Problems managing chronic illnesses affecting diet, such as diabetes or coeliac disease NICE NG69.
- Menstrual or other endocrine disturbances, or unexplained gastrointestinal symptoms NICE NG69.
- Physical signs of malnutrition, such as poor circulation, dizziness, palpitations, fainting, or pallor NICE NG69.
- Physical signs of compensatory behaviours, including misuse of laxatives or diet pills, vomiting, or excessive exercise NICE NG69.
- Abdominal pain associated with vomiting or dietary restrictions, not fully explained by a medical condition NICE NG69.
- Unexplained electrolyte imbalance or hypoglycaemia NICE NG69.
- Atypical dental wear, such as erosion NICE NG69.
- Participation in activities with a high risk of eating disorders, such as professional sport, fashion, or dance NICE NG69.
- In children and young people, faltering growth or delayed puberty may also be present NICE NG69.
- Mental health problems commonly associated with eating disorders, including depression, anxiety, self-harm, and obsessive-compulsive disorder NICE NG69.
- Possibility of alcohol or substance misuse NICE NG69.
- Medically unstable individuals may appear deceptively well, but changes indicating rapid decline in mental and physical health must be identified and addressed early NICE CKS.
Supporting Someone with a Suspected or Diagnosed Eating Disorder:
- If an eating disorder is suspected, refer immediately to an age-appropriate eating disorder service for assessment and treatment; a watchful waiting strategy should not be used NICE NG69,NICE CKS.
- Urgency of referral depends on the clinical situation and judgement; seek advice from specialist services if unsure NICE CKS.
- While awaiting specialist assessment, arrange regular reviews to monitor physical and mental health risks and consider the need for urgent admission or further investigations NICE CKS.
- Ensure clear agreement between primary care and specialist care regarding monitoring responsibilities NICE CKS.
- Provide support and care for individuals with anorexia nervosa, including psychoeducation, monitoring of weight, mental and physical health, and risk factors, with a multidisciplinary and coordinated approach NICE NG69.
- Ensure the person and their family/carers have access to information and support NICE CKS.
- Assess the need for support for family/carers, including practical support and emergency plans if the person is at high medical or psychiatric risk NICE CKS.
- Respect the wishes of children and young people regarding family involvement (Gillick competence) NICE CKS.
- Consider the possibility of complications and monitor/manage appropriately, seeking specialist advice when indicated NICE CKS.
- Ensure individuals with co-morbidities or those who are pregnant have specialist input, as increased monitoring and treatment alterations may be required NICE CKS.
- When prescribing medication, consider the impact of malnutrition and compensatory behaviour on effectiveness and the risk of side effects, particularly cardiac effects NICE CKS.
- For binge eating disorder, explain that psychological treatments focus on binge eating and not weight loss, and advise against trying to lose weight during treatment NICE NG69.
- For bulimia nervosa, explain that psychological treatments have a limited effect on body weight NICE NG69.