Labs say you're fine, doctor says you're sick: What's going on?

Dear Readers,

                What are parents to do when they're pretty sure their child has an eating disorder yet all lab tests and the usual medical markers of health come back within normal ranges?

                This is a situation that Marcia sees a lot, most recently in the case of a young college-aged patient. The student reported that although she knew she had an eating disorder, she was told by her doctor that her labs, weight, blood pressure and heart rate were all fine. The girl and her parents were left baffled and confused.

                The same thing happened to Marcia as a young girl of 15 struggling with anorexia. In our book, we relate the story of the time when Marcia's grandmother, who was worried about Marcia's plummeting weight, took her to see their family doctor. He found no cause for alarm, despite the fact that Marcia was five-foot-six inches and 100 pounds. "He recommended that I put olive oil in my dry and brittle hair," recalls Marcia, "when he should have told me to add the olive oil to my food."

                Even though doctors are far more educated today about the hazards of eating disorders than they were when Marcia was a teen (an extreme case like hers would most likely be noticed by even an obtuse doctor now), eating disorders are still often missed. Patient and family are eager to accept this poor but reassuring advice; after all they don't really want to admit that there is a problem. The professional in the white lab coat is giving them permission to look the other way, and it's just too convenient sometimes.

                The reason this scenario -- normal lab results despite clear-cut anorexia – occurs so often­ is that the body works very hard and very effectively to compensate for starvation. The ups and downs of human evolution have ensured that the body is well-adapted to surviving famine. Usually labs will stay normal until the patient is in very serious medical trouble, and then things go downhill so fast families have no time to process what is happening.

      In the recent case of the young college-aged girl, Marcia advised her and her parents that it was vitally important to treat her eating-disordered behaviors regardless of her normal lab results. Marcia also referred the patient to a doctor who specializes in eating disorders, someone she knew would use the misleading lab results to educate their patient about the dire consequences of an untreated eating disorders.

 

Take care, and for parents, stay vigilant,

Marcia and Nancy

Comments

[Kim Hooper]

In all my 12 years recovering from anorexia, with some very bad times in there, my labs have always been "normal." Labs are not a good indicator of what's really going on, that's for sure. Thanks for writing about this! I know it's a confusing topic for many patients and family members.

[Marcia Herrin]

Kim, we are glad you found our blog about the difficulty assessing laboratory findings in eating disorder helpful. It is confusing when you know something is seriously wrong but the labs come out normal. Thanks for writing.

Marcia

[_______]

In my case, labs didn't say I was fine for a while. When labs started to say I was fine, I lost all insurance coverage.

[Nancy]

This can be a real problem. Health insurers are great at using any information they get to deny a claim on the basis that treatment is not medically necessary. Normal labs, despite still being very sick, are a perfect excuse for the insurer. I recommend you check out the National Eating Disorder Association’s Toolkit for Parents: Navigating and Understanding Health Insurance Issues (http://www.nationaleatingdisorders.org/uploads/file/
toolkits/NEDA-TKP-C01-InsuranceIssues.pdf ), which has very helpful information. If the link doesn't work, please paste it in to your web browser.
Good luck!
Nancy