Eating disorders Flashcards
When should you suspect an eating disorder
Unusually low or high BMI for their age Rapid weight loss Change in eating behaviour Mental health problems Concern about body weight or shape Menstrual or other endocrine disturbances Physical signs of malnutrition
Physical signs of malnutrition
Poor circulation Dizziness Palpitations Fainting Pallor Compensatory behaviours such as laxative misuse, vomiting or excessive exercise
Occupations/recreational activities associated with a greater risk of eating disorders
Professional sport
Fashion
Dance
Modelling
Definition of low weight
Less than minimally normal in adults(typically BMI less than 18.5) or minimally expected in children and young people(typically BMI-for-age less than the 5th percentile on an appropriate growth chart)
Clinical features of bulimia nervosa
Recurrent episodes of binge eating occurring on average at least once a week for 3 months
Recurrent inappropriate compensatory behaviour to prevent weight gain
Psychological features of bulimia nervosa
Over-evaluation of self-worth in terms of body weight and shape
Fear of gaining weight
Mood disturbance and symptoms of anxiety and tension
Persistent preoccupation and craving for food
Self-harm, often by scratching or cutting
Physical symptoms of bulimia nervosa
Bloating Fullness Lethargy GORD Abdominal pain Sore throat(from vomiting) Russell's sign Dental enamel erosion Salivary gland enlargement
What is russell’s sign
Knuckle calluses from inducing vomiting
Questions in the SCOFF questionnaire
Do you ever make yourself sick because you feel uncomfortably full?
Do you worry that you have lost control over how much you eat?
Have you recently lost more than one stone in a 3 month period?
Do you believe yourself to be fat when others say you are too thin?
Would you say that food dominates your life?
Which assessment and management tool can be used for anorexia nervosa
MARSIPAN checklist
Physical examination of an individual with an eating disorder
BMI and compare with previous
Vital signs
SUSS test
Red flags in a physical examination of an individual with an eating disorder
Hypothermia Bradycardia(<50 bpm) Postural tachycardia Hypotension or orthostatic hypotension Sit up-squat-stand test scores of 2 or less
Management of a suspected eating disorder in primary care
Refer immediately to an age appropriate eating disorder service(CMHT or CAMHS)
When should you consider emergency admission in suspected eating disorder
Severely compromised physical health(red flags)
Risk of refeeding syndrome
Acute mental health risk
Lack of support at home
What increases risk of refeeding syndrome
Rapid weight loss Fasting for over five days BMI less than 16kg/m2 Compensatory behaviours(laxative misuse or vomiting) Dehydration Use of diet pills or diuretics Water loading or excessive exercise
