If you’re worried about a patient who has signs of an eating disorder, the right course of action isn’t always clear. You know the outcome you want—namely, for your patient to get better—but it can be difficult to know what they need to get there. Can you continue to treat them while keeping a close eye on their symptoms, or do you need to refer them to a specialist? Are they “sick enough” to go to a treatment program, or can they get better with light guidance from their regular healthcare providers?
Answering these questions becomes even more fraught when you consider how serious eating disorders are (they have the second highest mortality rate of all mental illnesses) and add in the complex emotional, relational, and logistical dynamics at play. After all, eating disorders don’t just affect the patient but also their family and loved ones, and any treatment recommendation you make will have implications on the entire unit.
Some good news: with the right treatment, eating disorders are 100% treatable for all people. As a practitioner, how can you know when it’s time to make that recommendation? Dr. Lauren Hartman, Medical Director at Equip, answered some of the most common questions providers have about referring patients to eating disorder treatment.
What factors should I consider when deciding whether or not to refer a patient to eating disorder treatment?
The most important factor to consider is that early intervention is key. Unfortunately, the longer someone struggles with an eating disorder, the sicker they become and the harder it is for them to recover from it. Connecting them to treatment as soon as you—or they, or their loved ones—are concerned will help them have the best prognosis for recovery. Remember that for someone with an eating disorder, there is no such thing as “not sick enough” for treatment.
What are the signs that indicate a patient needs to go to eating disorder treatment? Are there any telltale red flags that indicate, without a doubt, that treatment is needed?
Signs of an eating disorder may include changing eating habits, cutting out food groups, and skipping meals. A person may also start hiding or discarding food that is being given to them. Exercise may become more compulsive or excessive. People may also start eating large amounts of food in a short period of time. They may start using the bathroom more frequently, particularly after eating. There may also be mood changes: people struggling with an eating disorder may become more withdrawn, or develop increased irritability, depression, or anxiety.
Some physical signs that someone needs eating disorder treatment include rapid or excessive weight loss. For your pediatric patients, this may also include not growing or gaining weight at a time when they should be. Patients may present with syncope or presyncope, bradycardia, hypotension, or abnormal postural pulse changes. For patients with ovaries, there may be irregular periods or loss of the menstrual cycle completely. You may also see stress fractures in patients resulting from no or minimal trauma.
One telltale red flag is rapid or severe weight loss. Since eating disorders are a diagnosis of exclusion, I’d always recommend first ruling out other medical causes of weight loss (like thyroid disease, diabetes, inflammatory bowel disease, etc). If there aren’t other causes to explain the weight loss, treatment is indicated. This is particularly true and urgent for a pediatric patient who is at a critical time of growth and development.
What level of care should I recommend to my patient and their family? Should I simply refer them to an eating disorder specialist, send them to a program, recommend they’re admitted as an inpatient, etc?
There are published guidelines that provide criteria for when a patient should be medically hospitalized (we recommend the guidelines from The American Psychiatric Association and the Society for Adolescent Health and Medicine).
If a patient does not meet criteria for medical hospitalization, then I’d recommend a comprehensive outpatient eating disorder treatment program for them. Comprehensive outpatient programs like Equip allow for minimal disruption to the lives of patients and their families, while still being appropriate for patients needing all levels of care (except those who are medically unstable). In fact, four out of five Equip patients meet criteria for residential treatment.
Once I refer my patient to eating disorder treatment, will I continue to be involved in their care?
Yes. Most eating disorder programs, including Equip, continue partnering with referring doctors. Of course, since eating disorder programs are providing specialty care and not primary care, you will also continue to be involved to provide primary care to your patient.
- Arcelus J, et al. Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders: A Meta-analysis of 36 Studies. Arch Gen Psychiatry. 2011;68(7):724–731. doi:10.1001/archgenpsychiatry.2011.74
- Crone, C et al. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Eating Disorders. American Journal of Psychiatry, volume 180, number 2, pages 167-171, 2023, https://doi.org/10.1176/appi.ajp.23180001
- The Society for Adolescent Health and Medicine, Position Paper of the Society for Adolescent Health and Medicine: Medical Management of Restrictive Eating Disorders in Adolescents and Young Adults, Journal of Adolescent Health 56 (2015) 121e125, ttps://doi.org/10.1016/j.jadohealth.2014.10.259