Eating Disorders: What to Look for and How to Help

Yolanda Evans, MD, MPH, FAAP
Associate Professor – University of Washington Department of Pediatrics & Seattle Children’s Hospital
Clinical Director – Division of Adolescent Medicine

Eating disorders aren’t a passing fad or a lifestyle choice. These serious illnesses result from a complex interaction of genetic, biological, behavioral, psychological and social factors.

And they don’t discriminate – eating disorders affect males and females, young and old, and people of any socio-economic status. Even people with BMI in the normal or higher range can have eating disorders.

Screen at every visit

Check your patients’ height, weight and BMI at every visit with an eye toward trends that are concerning, such as rapid weight loss.

Asking questions like the ones below can help surface disturbances in people’s eating behaviors and related thoughts and emotions:

  • How do you feel about your body, its shape, size? Have you tried to change it? What did you try?
  • What do you eat in a typical day? What have you eaten in the last 24 hours?
  • Do you count calories? Are there foods that you avoid?
  • Have you used any diet pills, laxatives, appetite suppressants, herbals, or other things to lose weight?
  • How do you feel about eating? Do you eat in secret? Do you binge eat?
  • Do you ever purge after eating (vomiting, exercise)? How often? When was the last episode?
  • Does anyone in your family have a history of eating disorders?

Other symptoms to consider

Physical symptoms to consider include dizziness, fatigue, hair loss, cold intolerance and menstrual irregularities (if applicable).

Depression and anxiety are co-morbidities with eating disorders, so you might also ask about non-suicidal self-injury, suicidal ideation, anxiety and substance use.

How to help/when to refer

The treatment for eating disorders involves medical, nutritional and mental health support. If you suspect your patient has an eating disorder, tell them your concern and help them put a treatment team in place.

There are two recognized treatment approaches:

  • Traditional treatment includes working with a therapist and dietitian with expertise in eating disorder treatment.
  • Family-based treatment (FBT) includes working with a therapist trained in FBT and actively engaging the patient’s parents.

A referral to a specialty medical clinic is beneficial if you have access to specialists with expertise in eating disorders. Immediate referral to the local emergency department is indicated if a patient is medically unstable, e.g., hypotensive, bradycardic, or has EKG or electrolyte abnormalities.