Eating Disorder Informed Medical Care
Eating disorder informed medical care is a comprehensive, multidisciplinary approach that incorporates medical, psychiatric, psychological, and nutritional expertise to effectively assess, treat, and monitor patients with eating disorders, with the primary goal of reducing morbidity and mortality while improving quality of life. 1
Core Components of Eating Disorder Informed Care
Assessment and Screening
Comprehensive initial evaluation including:
- Complete weight and height history (maximum/minimum weights, recent changes)
- Assessment of restrictive eating, food avoidance, binge eating behaviors
- Evaluation of compensatory behaviors (purging, excessive exercise)
- Percentage of time preoccupied with food, weight, and body shape
- Prior treatment history and response 1
Physical examination focusing on:
- Vital signs (temperature, heart rate, blood pressure, orthostatic measurements)
- Height, weight, and BMI calculation
- Signs of malnutrition or purging behaviors 1
Laboratory assessment including:
- Complete blood count
- Comprehensive metabolic panel with electrolytes
- Liver and renal function tests 1
Cardiac evaluation with ECG for patients with:
- Restrictive eating disorders
- Severe purging behaviors
- Patients taking medications that prolong QTc intervals 1
Treatment Planning and Coordination
Person-centered treatment plan that is:
Team composition typically includes:
Disorder-Specific Approaches
Anorexia Nervosa
- Individualized goals for weekly weight gain and target weight
- Eating disorder-focused psychotherapy addressing fear of weight gain and body image disturbance
- Family-based treatment for adolescents and emerging adults 1, 2
Bulimia Nervosa
- Eating disorder-focused cognitive-behavioral therapy (CBT)
- Consideration of serotonin reuptake inhibitors (e.g., fluoxetine 60mg daily)
- Family-based treatment for adolescents with involved caregivers 1, 2
Binge-Eating Disorder
- Eating disorder-focused CBT or interpersonal therapy
- Consideration of antidepressants or lisdexamfetamine for adults who prefer medication or haven't responded to psychotherapy 2, 4
Avoidant/Restrictive Food Intake Disorder (ARFID)
- Graded exposure therapy within a cognitive behavioral framework
- Nutritional rehabilitation
- Addressing underlying anxiety or sensory issues 2
Medical Monitoring and Management
Regular monitoring of vital signs, weight, and laboratory values
Careful attention to electrolyte abnormalities (hyponatremia, hypokalemia)
Monitoring for bradycardia and cardiac complications
Assessment of bone density and reproductive hormone status when indicated 4
Hospitalization criteria for patients with:
Common Pitfalls to Avoid
Misdiagnosis by failing to distinguish between different eating disorders
Overlooking comorbidities such as anxiety, depression, or gastrointestinal conditions
Reinforcing avoidance through inappropriate elimination diets
Inadequate monitoring of physical health parameters
Focusing solely on weight rather than comprehensive biopsychosocial functioning 2
Delayed treatment due to failure to recognize early warning signs, which can lead to increased mortality and morbidity 6
Special Considerations
Diabetes management requires special attention as insulin omission for weight loss is common in patients with type 1 diabetes 1
Mental health comorbidities should be addressed, as eating disorders have high rates of comorbid depression, anxiety, and increased suicide risk 4
Technology-based interventions may be considered as adjuncts to traditional treatment, especially for prevention or to support carers of eating disorder patients 1
Eating disorder informed care requires specialized knowledge and skills. Clinicians should be aware of their limitations and refer to specialized eating disorder programs when necessary, while maintaining coordination of care to ensure optimal outcomes and reduce the significant mortality and morbidity associated with these conditions.