What is the necessary follow-up care in primary care for a teenage patient with a history of eating disorder after discharge from an eating disorder clinic?

Primary Care Follow-Up After Eating Disorder Clinic Discharge

Primary care clinicians must establish a structured, multidisciplinary monitoring system focused on medical stabilization, nutritional rehabilitation, weight restoration, and ongoing mental health support—with regular reassessment intervals at 1 week post-discharge, then every 3-6 months for goal weight adjustments based on growth parameters. 1

Immediate Post-Discharge Assessment (Within 1 Week)

• Verify medical stability by checking vital signs including temperature, resting heart rate, blood pressure, and orthostatic changes to detect cardiovascular complications 1, 2
• Document anthropometric measurements including height, weight, and BMI percentile for age, comparing to previous growth charts to establish weight trajectory 2
• Assess for physical complications including electrolyte abnormalities (hypokalemia, hypochloremic alkalosis from purging; hyponatremia/hypernatremia from fluid manipulation), even though most patients will have normal lab results 1
• Screen for endocrine disorders including hypothyroidism, hypercortisolism, hypogonadotropic hypogonadism, and amenorrhea (which carries long-term risk of osteopenia and osteoporosis) 1
• Evaluate gastrointestinal symptoms such as constipation requiring symptomatic relief 1

Ongoing Medical Monitoring Schedule

• Reassess goal weight every 3-6 months based on changing age, height, stage of puberty, premorbid weight, and previous growth charts—this is critical for growing adolescents 1
• Continue regular monitoring of weight status (percent below ideal body weight and BMI), types and frequency of any purging behaviors (vomiting, laxatives, starvation) 1
• Track medical stabilization and nutritional rehabilitation as these are the most crucial determinants of short- and intermediate-term outcomes 1

Mental Health Integration and Co-Management

Establish or maintain collaborative care with mental health specialists through negotiated roles and responsibilities, with designated case coordination to prevent fragmentation 1

• Screen for comorbid psychiatric conditions including depression, anxiety, obsessive-compulsive disorder, which may be comorbid, causative, or consequential to the eating disorder 1
• Assess suicidal ideation at every visit, as eating disorders carry significant mortality risk with cardiac complications responsible for at least one-third of deaths 1, 2
• Evaluate history of trauma including physical or sexual abuse or violence 1
• Monitor family dynamics as parental denial or disagreement about treatment approaches may exacerbate the illness 1

Psychosocial Assessment Components

• Evaluate degree of obsession with food and weight, understanding of diagnosis, and willingness to receive help 1
• Assess functional status at home, school, and with peers to identify areas requiring support 1
• Coordinate with school systems to establish individual education plans providing supports for the teenager in the school setting 1

Treatment Continuation and Coordination

Individual and family therapy must continue as these are crucial to long-term prognosis, especially when working with younger patients 1

• Maintain contact with specialty eating disorder providers even after discharge, with clear communication pathways and points of contact 1
• Provide active support and monitoring including psychoeducation, supportive counseling, facilitation of patient and family self-management, and referral for peer support 1
• Connect to community resources including online or in-person support groups and advocacy organizations 1

Critical Pitfalls to Avoid

• Do not rely solely on laboratory results to determine severity—normal test results do not exclude serious illness or medical instability 1
• Do not assume patients meeting only partial DSM criteria require less attention—more than half of adolescents with eating disorders don't meet full criteria but experience the same medical and psychological consequences 1
• Do not discontinue monitoring prematurely—early intervention and aggressive treatment provide the best prognosis, and relapse risk remains elevated 1, 2
• Ensure primary care remains involved even when specialty care is ongoing, as fragmentation of care is a major gap in managing chronic disorders in young people 1