What are the signs of an eating disorder and how can I support someone who has o

Clinical Signs of Eating Disorders:

• An unusually low or high body mass index (BMI) or body weight for their age ¹.
• Rapid weight loss ¹.
• Dieting or restrictive eating practices that cause concern to the individual, family, or professionals ¹.
• Changes in eating behaviour reported by family members or carers ¹.
• Social withdrawal, particularly from situations involving food ¹.
• Disproportionate concern about weight or shape ¹.
• Problems managing chronic illnesses affecting diet, such as diabetes or coeliac disease ¹.
• Menstrual or other endocrine disturbances, or unexplained gastrointestinal symptoms ¹.
• Physical signs of malnutrition, such as poor circulation, dizziness, palpitations, fainting, or pallor ¹.
• Physical signs of compensatory behaviours, including misuse of laxatives or diet pills, vomiting, or excessive exercise ¹.
• Abdominal pain associated with vomiting or dietary restrictions, not fully explained by a medical condition ¹.
• Unexplained electrolyte imbalance or hypoglycaemia ¹.
• Atypical dental wear, such as erosion ¹.
• Participation in activities with a high risk of eating disorders, such as professional sport, fashion, or dance ¹.
• In children and young people, faltering growth or delayed puberty may also be present ¹.
• Mental health problems commonly associated with eating disorders, including depression, anxiety, self-harm, and obsessive-compulsive disorder ¹.
• Possibility of alcohol or substance misuse ¹.
• Medically unstable individuals may appear deceptively well, but changes indicating rapid decline in mental and physical health must be identified and addressed early ².

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 ¹,².
• Urgency of referral depends on the clinical situation and judgement; seek advice from specialist services if unsure ².
• While awaiting specialist assessment, arrange regular reviews to monitor physical and mental health risks and consider the need for urgent admission or further investigations ².
• Ensure clear agreement between primary care and specialist care regarding monitoring responsibilities ².
• 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 ¹.
• Ensure the person and their family/carers have access to information and support ².
• Assess the need for support for family/carers, including practical support and emergency plans if the person is at high medical or psychiatric risk ².
• Respect the wishes of children and young people regarding family involvement (Gillick competence) ².
• Consider the possibility of complications and monitor/manage appropriately, seeking specialist advice when indicated ².
• Ensure individuals with co-morbidities or those who are pregnant have specialist input, as increased monitoring and treatment alterations may be required ².
• When prescribing medication, consider the impact of malnutrition and compensatory behaviour on effectiveness and the risk of side effects, particularly cardiac effects ².
• 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 ¹.
• For bulimia nervosa, explain that psychological treatments have a limited effect on body weight ¹.