A specific ED dietary assessment can be undertaken when a young person’s health is at risk due to food restriction and sustained weight loss. This can provide an estimate of nutritional intake: calories, protein, vitamins and minerals, from questions such as how much and how often foods are eaten. How severely (in relation to daily needs for age) and for how long the food restriction has been happening, and the loss of weight over time are assessed. Additional behaviours such as purging or excessive exercise put a young person at further risk of physical harm. The body compensates by shutting down non-essential functions eg. temperature regulation, wound healing, hair growth, menstruation. In severe and prolonged restriction compensation affects essential functions including organ function eg. heart muscle and breathing. Discussion around physical symptoms eg. loss of periods, bowel habits, body sensations, bruising etc. are therefore part of this assessment. A physical examination by your GP is essential and includes blood pressure, blood testing, aspects of mental health and physical examination. Weight and height history is needed to consider the relative risks of for each person and includes :
- Weight change over a specified time period
- Calculation of % weight loss
- Calculation of % weight for height or BMI
Estimates of exercise intensity and duration helps provide information about calories used up in physical activity, and what impact this has, and how this balances with caloric intake from food. Young people may not think that they are at risk, or that their health is in danger, and difficult as it may be, it’s important to be honest about these matters, and get the right help as early as possible. Detailed advice is not offered at this first assessment appointment, however general information is provided to stabilise regular eating, weighing and self-monitoring: these are the first essentials. Do see the downloadable resources below. More specific ED dietary treatment is outlined in my assessment report. I typically use a guided programme Overcoming Disordered Eating, and offer a monthly 60 minute F2F review with fortnightly 15 minute check-in to work through ED dietary treatment. ED treatment focusses on changing patterns of thinking and behaviour, and you will need regular psychological support.
Eating disorders are the result of patterns of thinking and beliefs, in which over-evaluation of appearance is central, resulting in changes of behaviour around eating. Psychological support is essential. Eating disorders pose significant risks to physical health, and working with behaviour change takes time, support and commitment. This is best undertaken by a team of professionals which may include a psychologist, family or systemic therapy, dietitian, nurse, GP and in some instances a psychiatrist. Communication between professionals is vital to support the individual and/or family; this includes the GP and therapist. Should engagement with ED dietary treatment, and progress towards regular eating through increasing awareness, challenging beliefs and patterns of thinking not be possible for whatever reason, a referral to CAMHS ED service via the GP would be discussed.