Physical health monitoring

We ask that physical monitoring and management is completed by the GP. We will write to the GP with personalised requests for each patient.

The types of physical health monitoring we may ask for are detailed below.

We are happy to liaise with GPs regarding any results.

Blood Tests

The blood tests we recommend include FBC, U+Es, LFTs and bone profile. Results of concern that we often see in low weight patients include:

• Low Hb, WCC (low platelets of more concern)
• Low glucose
• Low potassium (due to purging)
• Low sodium (due to fluid overload)
• Low albumin, protein, creatinine
• High LFTs (more concerning, can rise rapidly)

Frequency for underweight patients

We recommend:

• Weekly blood monitoring when a patient’s BMI is below 15.
• Fortnightly blood tests when a patient’s BMI is between 15 and 17. This can be reduced if weight is being restored and there are no abnormalities.
• Monthly blood tests when a patient’s BMI is between 17 and 18.

Blood tests can be stopped if the results are within the normal range for three months.

Patients with a stable BMI above 18 do not need routine blood tests, unless clinically indicated.

Frequency for patients who are self-inducing vomit

• Please complete monthly blood tests for someone within a healthy weight range vomiting once a day.
• Please increase the frequency of blood tests if vomiting is more frequent
• Please increase the frequency of blood tests if the patient is experiencing physical symptoms. For example, heart palpitations, dizziness, feeling lightheaded, chest pain.
• If the patient is taking potassium supplements, please repeat blood tests at least twice a week

Blood tests can be stopped if the results are within the normal range for three months.

Prescribing multivitamins

Please advise patients with a BMI under 17.5 to take multivitamins and minerals, omega 3 and calcium.

Conducting ECGs

Please complete an ECG for patients with a BMI under 15 who are taking medication.

DEXA scans

Please refer patients with the following for a DEXA scan:

• Patients whose BMI has been below 17.5 for six months to one year

For women and non-binary people:

• Patients who were once menstruating and have had a loss of menstruation for six months to one year

Please repeat DEXA scans every 2 years.