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Understanding eating disorders in adolescence

Criteria and diagnosis

Patients can be medically stable and have normal lab tests, but they may still have a serious eating disorder. Taking a complete clinical history is the most powerful tool for diagnosing eating disorders.

Pritts, S. D., & Susman, J. (2003). Diagnosis of eating disorders in primary care. American Family Physician, 67(2), 297-304.

  1. Physical Exam

Vitals

Blood pressure and heart rate should be measured at every appointment*:

  • low weight, recent weight loss, or concerns about inadequate weight gain over time, if vital signs are concerning, if parent is concerned about a possible eating disorder or if patient has symptoms or signs of an eating disorder. Measure orthostatic vitals (compare HR and BP lying down AND standing)
  1. When to Refer

Identified concerns with insufficient nutrition, preoccupation with weight and/or shape and evidence of:

  • Orthostatic changes in pulse are >30 BPM
  • Orthostatic change in systolic blood pressure are >20 mmHg
  • HR ≤ 50bpm daytime
  • HR ≤ 45bpm overnight

Weight

Weight should be measured in a consistent way:

  • Best to weigh in a gown with no undergarments with patient’s back to the scale.
  • Remind patients that weight is just one piece of data used to monitor health and progress towards recovery.

Determining a Treatment Goal Weight (TGW):

  • Attempt to establish the patient’s previous baseline trajectory using data from their growth chart
  • Consider other relevant information including current and history of menstrual status, degree of eating disorder symptoms, and physical activity
  1. Diagnostic and Laboratory Considerations: What to look for

Download PDF (According to the AED Report 2016)

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