Professional Resources and Additional Info

We are here to support where there is concern that a young person may have an eating disorder.

Eating disorders are common in adolescence. If they are detected early and there is access to specialist treatment the prognosis is very good. However, if left untreated, or treated inadequately, the disorder can become chronic and difficult to treat. Many adults with long term eating disorders developed their initial symptoms in the adolescent years.

Early signs of an eating disorder

• Physical – loss of weight, fainting/dizziness, loss of energy, muscle weakness, sleep disturbance, susceptibility to infection, loss of menstruation, constipation/bloating, repeated vomiting, swollen glands under the jaw or frequent dental problems (if there is repeated vomiting).
• Behavioural changes – counting calories, restricting the amount or range of food eaten, eating alone or missing meals, secretiveness, hiding food, frequent visits to the toilet, taking a long time to eat meals, cutting food into small pieces, excessive bodychecking, over-exercising, wearing baggy clothes.
• Psychological – preoccupation with food and eating, concerns about weight and shape, feeling compelled to restrict intake, fear of eating.

Non-specific signs that may accompany eating disorders

• Psychological – low mood, loss of interest, poor concentration, withdrawal, disturbed family relationships
• Social/educational – withdrawal from family and friends, loss of interest in activities, poor concentration, difficult family relationships

The non-specific signs may also be a feature of other mental health disorders such as depression or anxiety.

Diagnostic features

For Anorexia nervosa these are

• Weight loss at least 15% below the body weight expected (or BMI less than 17.5) or failure to gain weight as part of normal growth and development.
• Weight loss is self-induced by avoidance of “fattening “ foods
• Over-evaluation of weight or shape
• Abnormal hormonal function (loss of menstruation in females)

For Bulimia Nervosa these are

• Recurrent binge eating
• Purging (self-induced vomiting, laxative or diuretic abuse, restrictive dieting or over-exercise)
• Over-evaluation of weight and shape

Other specified feeding or eating disorder (OSFED)

• Eating disorder symptoms that do not meet all the above criteria although cause significant concern/impact (common in young people).

Assessments in primary care services

When assessing a young person. clarification of history and symptoms of eating disorders is required, along with a brief summary of family and personal background. Useful questions (some adapted from the SCOFF questionnaire) include:

• Are you trying to lose weight?
• Do you ever make yourself sick after eating?
• Do you worry about losing control of your eating?
• Do you think you are fat when others say you are too thin?
• Would you say that food dominates your life?

Physical assessment and investigations

If an eating disorder is suspected, by the referring clinician or GP, a physical assessment is required to exclude other causes of low weight and identify any physical consequences of the disorder.

This will include readings of weight and height, blood pressure and heart rate both sitting & standing as well as a more general examination to exclude other causes of weight loss. For those with a low pulse rate (under 50) an Electrocardiogram (ECG)  may be required to identify any serious cardiac abnormalities.

Recommended initial blood investigations include:

• FBC
• ESR/CRP
• Urea and electrolytes (including phosphate, Mg, Ca)
• Lver function tests
• Glucose
• Folate
• B12
• Iron
• Coeliac screen
• Thyroid function tests

Once the patient has been assessed and accepted by the CAMHS ED service, any further blood investigations will be ordered by the Eating Disorder Service and the patient asked to attend the phlebotomist at the local Hospital or the Paediatrics outpatients. In rare circumstances the GP may be asked to review the young person’s weight and physical health (if the patient with physical health risk concerns decline to  engage with CAMHS but is agreeing to be reviewed by the GP). This will be discussed directly with the GP first before agreeing the plan.

Websites

• The National Institute for Health and Care Excellence (NICE) guidance on eating disorders: recognition and treatment
• Beat is the UK’s leading eating disorder charity.
• Medical Emergencies in Eating Disorders provides guidance on how to approach the assessment and management of eating disorder conditions when they present as medical emergencies