Medical Evaluation of Eating Disorders

By: Allison Haener MSN, FNP-BC

Where do I start?

Seeking help if you or a loved one suffers from an eating disorder can seem like an overwhelming task. In addition to being mentally and emotionally challenging, there can be logistical challenges. The good news is, many eating disorders can be treated in an outpatient setting.

Where do you start? With a medical evaluation, because having an eating disorder can cause medical complications and even life-threatening conditions.1 A medical provider, such as your primary care provider or pediatrician, can complete the initial evaluation to both establish a diagnosis of an eating disorder, while excluding co-occurring diagnoses.1

How do I advocate for myself?

Talking with a medical provider can sometimes feel intimidating. However, always remember you are the expert on your body. You are the only one who truly knows the entire history and experience of your physical and emotional self! This is empowering! Take confidence in knowing this truth.

Prior to your appointment, it is helpful to write down what your concerns are. After listing your concerns, identify your top concerns, to make sure these are addressed during your appointment. It can be helpful to bring a friend or family member to the appointment for support. Prior to the appointment, consider explaining to this person how they can best support you during the appointment. Maybe just their presence or smile will help you. Or, you may need them to play a role during the appointment, such as taking notes or making sure you are getting your needs met. Consider bringing a notebook to write down the provider’s recommendations.

Before your appointment is over, ask the provider if you can repeat back to them what their plan and follow up recommendations are. This will help you and the provider feel like you are on the same page. Don’t be afraid to disagree with your provider, ask questions, clarify if you are confused, or seek a second opinion. You deserve to feel heard, comfortable, and confident with your medical provider.

What tests should I expect or ask for?

When seeking help from a medical provider for an eating disorder, you should expect initial lab work to be ordered. Eating disorders can affect every organ system.2 The lab work will screen for medical complications, which have the potential to be serious.2 The following are the current recommended lab studies: a complete blood count (CBC); serum electrolytes including calcium, magnesium, glucose; thyroid testing; cholesterol levels; liver transaminases, urinalysis.1,2 Screening for specific vitamin and mineral deficiencies may be indicated, based on your nutritional history.2 The vitamin and mineral deficiency screening could include: vitamin D, thiamine, vitamin B12, iron, and zinc.1,2

An EKG (electrocardiogram) may also be recommended, if there are certain abnormalities in your lab work, significant weight loss, or if your provider finds your cardiovascular assessment to be abnormal.2 Orthostatic vital signs may be completed during your office visit, which can be part of the cardiovascular assessment.1 This is the measurement of your blood pressure and heart rate in the laying, sitting, and standing positions. If there is a history of no menstrual period for over 6 months, or a history of a stress fracture, your medical provider may order a bone density scan (DEXA).2 A bone density scan measures the thickness and strength of your bones by taking an x-ray, usually in the hip and spine.3

Who will be on my team?

Established guidelines support the ideal outpatient treatment team as: an experienced therapist, dietician, and a clinician who is knowledgeable about eating disorder specific medical evaluations.1 The medical provider you currently follow with, may or may not have experience in the evaluation of someone who has an eating disorder. There are established research based guidelines that your provider can reference. You can also make yourself familiar with the guidelines. The following links will take you to these guidelines from the American Academy of Family Physicians.
After your medical provider completes a history, physical exam, and testing, they will determine the level of care you need. Most eating disorders are treated in an outpatient setting, however if there is an imminent threat to your health, hospitalization could be recommended.1 If your medical provider determines you need close professional supervision and structure, the following are options based on the level of care needed: residential treatment (constant care), partial hospitalization (day program), or intensive outpatient treatment (partial day).1
If outpatient treatment has been recommended, your treatment team should also include an experienced therapist and a dietician who are knowledgeable about eating disorders.1 If your medical provider is not familiar with local providers, ANAD can help if you submit a request for a treatment referral.

References

1. Klein DA, Sylvester JE, Schvey NA. Eating disorders in primary care: Diagnosis and management. American Family Physician. https://www.aafp.org/pubs/afp/issues/2021/0101/p22.html#afp20210101p022-b60. Published January 1, 2021. Accessed February 3, 2023.
2. Hornberger L, Lane M, Bruener C, Alderman E, et al. Identification and Management of Eating Disorders in Children and Adolescents. Publications.aap.org. https://publications.aap.org/pediatrics/article/147/1/e2020040279/33504/Identification-and-Management-of-Eating-Disorders?autologincheck=redirected. Published January 1, 2021. Accessed February 3, 2023.
3. Radiation in healthcare: Bone Density (Dexa Scan). Centers for Disease Control and Prevention. https://www.cdc.gov/nceh/radiation/dexa-scan.html#:~:text=DEXA%20. Published October 20, 2021. Accessed February 3, 2023.