Medical Assessment of Eating Disorders

I hope that you are in the practice of asking all of your eating disorders patients to have a complete medical exam as they begin treatment. This is an essential aspect of comprehensive treatment and it should never be overlooked. Many eating disorders specialists, myself included, are explicit about the necessity of ensuring proper medical management of eating disorders, both as a patient begins treatment, as well as during the recovery process. In fact, many of my colleagues include a physician care agreement in their intake paperwork or initial interview (for a sample agreement, Click Here: Download doctors_care_agreement.pdf) .

If your patient has had a RECENT thorough physical exam, conducted by someone who is knowledgeable about eating disorders - great! Then it is incumbent upon you to be in contact with that physician about your patient's health and treatment progress (after obtaining your patient's permission, of course). But what if your client has not had a recent exam? Or what if his or her physician is not knowledgeable about which laboratory tests to include in screening for eating disorders? Perhaps you are a physician, nurse, or P.A. yourself, interested in knowing which tests to include in the medical assessment of ED's...

The following is a list of laboratory tests that are commonly ordered to assess for eating disorders. In addition, guidelines for medical indications for inpatient hospitalization can be found on the pdf attached here: Download medical_screen_for_ed.pdf

In addition to routine vital signs (height, weight, temperature, supine & standing blood pressure and heart rate), examine skin for lanugo (fine, downy hair that may grow as the result of malnutrition) and/or scars on hands from self-induced vomiting, check for enlargement of parotid gland, erosion of dental enamel, and consider including the following tests:

• CBC
• Glucose
• Liver Function
• Amylase
• Thyroid Function
• Serum HCG, prolactin (only if galactorrhea is present), or refer to a gynecologist
• EKG
• Analysis of electrolyte levels, BUN, creatinine & albumin (blood and urine). Monitor ketones.
• Bone density tests.
• Hormone level assessments (for both males and females).
• Drug use screening, as indicated.
• GI, as indicated
• Other tests as indicated, including pregnancy test, chest X-Ray, Heart stress test, MRI.
• Additional tests of adrenals, pituitary, if indicated.

Additional Resource: Mehler, P. & Anderson, A.E. (2000) Eating Disorders: A guide to medical complications Baltimore: The Johns Hopkins University Press.

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