Eating Disorder Informed Medical Care
Eating disorder informed medical care is a comprehensive, person-centered approach that coordinates care through a multidisciplinary team including mental health professionals, medical specialists, registered dietitians, and psychotherapists with eating disorder expertise to address the complex biopsychosocial aspects of eating disorders. 1
Core Components of Eating Disorder Informed Care
Comprehensive Initial Evaluation
- Complete weight and height history
- Assessment of restrictive eating, food avoidance, and binge eating behaviors
- Evaluation of compensatory behaviors (purging, excessive exercise)
- Assessment of food/weight preoccupation
- Prior treatment history and response 1
Physical Examination and Laboratory Assessment
- Focused vital sign monitoring (including orthostatic measurements)
- Height, weight, and BMI calculation
- Evaluation for signs of malnutrition or purging behaviors
- Laboratory assessment including:
Cardiac Evaluation
- ECG recommended for patients with:
- Restrictive eating disorders
- Severe purging behaviors
- Those taking medications that prolong QTc intervals 1
Multidisciplinary Treatment Approach
Team Composition
- Psychiatrist/mental health professional
- Medical physician specialists
- Registered dietitian/nutritionist
- Psychotherapists with eating disorder expertise 1
Treatment Strategies
- Individualized weight restoration goals (2.2-4.4 lbs per week when needed) 2
- Eating disorder-focused psychotherapy:
- Cognitive-behavioral therapy (CBT) as first-line for many eating disorders
- Family-based treatment for adolescents and emerging adults 1
- Pharmacotherapy considerations:
- Serotonin reuptake inhibitors for bulimia nervosa
- Lisdexamfetamine for binge-eating disorder
- Note: No effective medications currently exist for anorexia nervosa 3
Special Considerations
Medical Complications Monitoring
- Electrolyte abnormalities (hyponatremia, hypokalemia)
- Bradycardia
- Reproductive hormone disturbances
- Decreased bone density 3
Comorbidity Management
- High rates of depression (49.5-76.3% lifetime prevalence)
- Increased suicide risk (25% of deaths in anorexia nervosa) 3
- Diabetes management (insulin omission for weight loss is common in type 1 diabetes) 1
Common Pitfalls to Avoid
- Misdiagnosis by failing to distinguish between different eating disorders
- Overlooking psychiatric and medical comorbidities
- Reinforcing avoidance behaviors
- Inadequate monitoring of physical health parameters
- Focusing solely on weight rather than comprehensive biopsychosocial functioning 1
- Delayed intervention (early intervention decreases risk of long-term pathology) 2
- Poor coordination between healthcare providers 4
Treatment Escalation Criteria
Care escalation should be based on:
- Health status (acute food refusal, uncontrollable behaviors)
- Weight patterns and trends
- Available outpatient options
- Social support systems 2
- Serious medical complications requiring hospitalization (bradycardia, suicidality) 3
Eating disorder informed care requires specialized knowledge and sensitivity to effectively navigate the complex interface between primary and specialty care, ensuring appropriate and timely interventions that can significantly improve outcomes for individuals with these potentially life-threatening conditions.