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Caring for your patients with potential eating disorders

Published Date
Author Providence Pulse Content Team

Authors: Rodney Reid, M.D., Ph.D., medical director, Providence Adolescent Eating Disorders Program
Barb Oyler, PMHNP, manager, Providence Adolescent Eating Disorders Program
 

Eating disorders are complex problems with emotional, behavioral and physical dysfunction resulting from the maladaptive response to a variety of life challenges. All providers, especially those in primary care, are key partners in assessing, diagnosing and caring for these patients.

As a result of the public health response to the pandemic, there is limited access to our Providence Adolescent Eating Disorders Program, although the wait time has improved in recent months. Primary care providers provide a valuable safety net by monitoring and caring for patients who are at risk for, or are experiencing, eating disorders or disordered eating.

Last month we conducted a virtual pediatric grand rounds presentation (“Caring for Teens with Eating Disorders: What Your Patients Want You to Know”) for providers and care teams, with strong attendance and participation. Feel free to share these resources with colleagues:

Highlights from the grand rounds presentation include:

Medical evaluations are key

Primary care providers are key partners in helping to recognize, evaluate and diagnose a patient with an eating disorder or disordered eating. (Note: Although related, “eating disorders” and “disordered eating” have different characteristics and treatments.)

Patients with a potential eating disorder may present with:

  • Weight loss or slowed growth
  • Nutritional deficiency
  • Interference with psychosocial functioning
  • Abnormal vital signs (bradycardia or orthostatic pulse changes)
  • Initial evaluation symptoms that include dizziness, fatigue, cold intolerance, amenorrhea and hair loss

Urgent issues to watch for include:

  • Unstable vital signs
  • Severe starvation as evidenced by marked weight change or low BMI
  • Hypokalemia
  • Cardiac arrythmia
  • Prolonged QT interval
  • Altered consciousness

In addition, there are significant emotional and behavioral issues associated with eating disorders, including a high comorbidity with anxiety, depression, OCD, trauma and substance use.

Potential long-term issues include:

  • Osteoporosis/osteopenia
  • Starvation-related brain changes
  • Height restriction
  • Slowed GI tract

Treatment must include family members

Family involvement is absolutely paramount in treating patients with eating disorders. This is especially true for adolescent patients. Families need guidance and support throughout the often-lengthy treatment process.

Parents sometimes feel guilty about the emergence of symptoms in their child. As a provider, you can encourage parents and guardians to adopt a more neutral or “agnostic” view.

Parents may not understand the complex nature of the illness; they may minimize the disease or think that it will go away quickly.

Patients and families sometimes struggle with their own and others’ judgment, as well as simplistic efforts to help (e.g., scare tactics or “just eat”).

As a primary care provider, you already have a relationship with your patient and/or their families. You will be an important member of the care team in helping families to better understand the complexities of successful treatment.

To access Providence St. Vincent Medical Center’s partial hospital program

  • Epic E consult process for both adults and adolescents
  • Free weekly information group, 4:30-5:15 p.m., Wednesdays, Suite 987, East Pavilion, Providence St. Vincent Medical Center
  • To schedule evaluations, have patients/families call 503-215-9396.

Additional resources