Warning Signs of Eating Disorders: A Clinician’s Guide

Warning signs of eating disorders

Eating disorders are far more common than most people think, and carry with them tremendous implications for life-altering health conditions and even death. For these reasons, it is expected that many healthcare providerswill find themselves confronted by patients experiencing health conditions associated with eating disorders at some point. 

Unfortunately, the warning signs associated with someone battling an eating disorder are not always obvious. Patients can become quite savvy in hiding physical characteristics such as extreme weight loss, and often express firm denial of there being any problem at all. Even when it’s clear there’s a problem, nurses may have to fill in a lot of blanks when deciding on a course of action.

Because nurses and dental professionals are so often a first point of contact, acting as active members of the care team to recognize the warning signs of eating disorders in order to support early intervention is a critical skill that needs to be developed and refreshed throughout a nursing career. 

Understanding Eating Disorders

There are often common misconceptions when it comes to eating disorders, and chief among them is that they only affect young women and involve calorie restriction. The reality is, eating disorders can manifest in many different categories of people, including men, women and children of all ages.  

Mitigating the impact of eating disorders begins with understanding the range of issues and primary drivers behind them. Treatment may require addressing physical health, but eating disorders are nearly always associated with mental health complexities that also need to be addressed. Management of eating disorders is often as much about creating emotional wellness as it is about a healthier body. 

Anorexia Nervosa

Anorexia nervosa is a condition where people severely restrict food, eat very small quantities, or simply avoid foods altogether. Patients with anorexia may also weigh themselves repeatedly, and even when dangerously underweight they see themselves as overweight. Anorexia nervosa can lead to serious medical complications and can even be fatal if not treated.

Bulimia Nervosa

Bulimia nervosa is defined by recurrent and frequent episodes of eating—often of large amounts of food—with a perceived lack of control. Binging is then followed by behavior like forced vomiting, excessive use of laxatives or diuretics, fasting, extreme exercise, or a combination of these behaviors resulting in symptoms such as:

  • Chronically inflamed and sore throat
  • Worn tooth enamel and decaying teeth
  • Acid reflux disorder
  • Intestinal distress and irritation from laxative abuse
  • Dehydration from fluid loss
  • Electrolyte imbalance

Binge-Eating Disorder

A binge-eating disorder occurs when people have recurring episodes of eating unusually large amounts of food. Unlike bulimia nervosa, periods of binge eating are not followed by purging. People with binge-eating disorders are commonly overweight, and binge-eating disorder is the most common eating disorder in the U.S.

Avoidant/Restrictive Food Intake Disorder (ARFID)

Avoidant restrictive food intake disorder (ARFID) is a condition centered around limiting the amount or type of food eaten. With ARFID, people do not have a distorted body image or extreme fear of gaining weight like with anorexia. Many children go through phases of picky eating, but a child with ARFID does not eat enough calories to grow and develop properly. An adult with ARFID does not eat enough calories to maintain basic body function.

Signs and Symptoms to Be Aware of

Eating Disorders are associated with both physical and emotional challenges, which means the warning signs of eating disorders will include symptoms manifesting through both physical and emotional mechanisms. Because there are many potential signs and symptoms of eating disorders, it’s important to take a holistic view of a patient to develop a picture of the most likely diagnosis. 

The potential symptoms of an eating disorder are plentiful, and may include any of the following:

Physical Changes

  • Erosion of the tooth enamel on the tongue side- seen only during a dental exam
  • Weakness
  • Poor wound healing
  • Brittle nails
  • Dry skin
  • Thinning hair
  • Feeling cold often
  • Sleep disturbances
  • Fainting
  • DIzziness
  • Difficulties concentrating
  • Stomach cramps or other non-specific gastrointestinal complaints
  • Extremely underweight 

Emotional and Behavioral Challenges

  • Dramatic weight loss
  • Dressing in layers to hide weight loss or stay warm
  • A preoccupation with weight, food, calories, fat grams, and dieting
  • Denying feeling hungry
  • Cooking meals for others without eating
  • Consistently makes excuses to avoid mealtimes or situations involving food
  • Maintains an excessive, rigid exercise regimen despite weather, fatigue, illness, or injury 
  • Has intense fear of weight gain or being “fat,” even though underweight
  • Shows inflexible thinking

What To Do If You Suspect A Patient Has an Eating Disorder

Knowing the warning signs of eating disorders may provide clues for a patient’s potential diagnosis, but assessment and observations are only half the battle. Nurses and dental professionals need to be able to take action to improve health outcomes. 

In some cases, it may be appropriate to initiate a conversation with the patient to get an idea of what their overall challenges may be. As previously mentioned, eating disorders are as much about the emotional as they are about the physical. It’s important to avoid any triggering comments by identifying any specific components of their behavior as “good” or “bad”, while also making sure to avoid anything that can be perceived as blame or shame.

If conversation leads to a better understanding of the patient’s situation and they are open to treatment, it may be appropriate to recommend consultation with an eating disorder specialist. Eating disorders can be complicated to treat, and specialists are equipped to facilitate an interdisciplinary approach to managing both physical and emotional needs.

Treating Eating Disorders

Once recognized, the treatment of eating disorders quickly evolves in a partnership between different health disciplines, and successful management has strong interprofessional implications. The combination of mental health professionals, medical professionals, dietary professionals, and the patient’s family and loved ones is critical to a successful recovery.

The road back to health from an eating disorder is a long one, and comes with a variety of challenges. Everyone involved in the care of the patient needs to benefit from clear communication so the plan of care can be adjusted if needed and remain goal-directed for an optimal outcome.

It is also important for the patient to take an active role in their recovery. Effective therapy, nutritional support, and attention to potentially serious medical needs will be impossible without a patient-centered approach fostering patient accountability.

Become Familiar With the Warning Signs of Eating Disorders

Awareness of the warning signs of eating disorders is the first step in identifying patients at risk for serious medical complications, and establishing a keen sense of awareness is dependent on growing professionally through education and learning.

Educational opportunities offered by Premiere such as Eating Disorders—Interprofessional Implications by Megan Arbour, PhD, RN, CNM, CNE, Associate Professor, Frontier Nursing University, and Grant Hunsicker, DDS, General Dentist, Hunsicker Family Dental, provide healthcare professionals with an in-depth look at the challenges of identifying eating disorders and providing effective treatment. All courses by Premiere are created by leading industry professionals, and allow you to keep current and informed online with a schedule that works for you.

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