41 recognising factors that may contribute to developing of an eating disorder . Your role may also include :
• Evaluating and monitoring eating disorder-related risks .
• Helping to prevent the progression of the illness .
• Being the first point of contact for a person with an eating disorder .
• Making a referral for specialist treatment .
• Signposting to support services .
• Supporting service transitions and shared care .
Beat , NHS England and the RCPsych recently launched free eating disorder training for nurses and healthcare staff . 6 This training is designed to help nurses at every stage of the process , including managing medical risk , communicating sensitively with patients and creating care plan pathways .
If an eating disorder is suspected , a history and physical examination of the person should be undertaken , including establishing capacity and consent . Taking a history involves investigating mental and physical health concerns as well as eating concerns . One way to determine the presence of eating concerns is by using screening tools , such as the SCOFF tool or the Binge Eating Disorder Screener-7 ( see Resources ).
Mental health concerns should include investigating common comorbidities such as obsessive-compulsive disorder and substance misuse . Physical assessment should include weight , blood pressure , muscle strength , temperature , pulse , hydration , general health and appearance , and the presence of , or changes in , other physical health conditions , such as type 1 diabetes and disordered eating ( T1DE ). In certain situations , urgent blood tests and investigations such as ECG or a bone scan may be needed . To help healthcare professionals to assess and manage risks associated with eating disorders , in 2022 the RCPsych created Medical Emergences in Eating Disorders guidance ( MEED ). 7
Following this process and discussion with the patient , the next step is to refer to a community-based , age-appropriate eating disorder service for further assessment or treatment as soon as possible . This must be done in accordance with the evidence-based NICE or SIGN guidelines . 8 , 9 While a patient is on the waiting list , nurses can provide psychoeducation , support and follow-up to continue managing risk , using the resources mentioned throughout this article .
Recognising early-warning signs The warning signs of eating disorders are not always obvious , and the person can appear physically healthy . NICE guidelines 7 recommend being alert to the following potential signs :
• Unusually low or high BMI or body weight for their age .
• Dieting or restrictive eating behaviours that are worrying the person , their carers or professionals .
• Social isolation or withdrawal .
• Disproportionate concerns about weight and shape .
• Problems managing an illness that affects diet , such as diabetes or coeliac disease .
• Menstrual or endocrine disturbances , or unexplained gastrointestinal symptoms .
• Unexplained electrolyte imbalance or hypoglycaemia .
• Signs of malnutrition , such as poor circulation , dizziness , palpitations , fainting .
• Activities carrying a high risk of eating disorders , such as professional sport , fashion , dance , modelling or acting . You may also identify that the person :
• Has rituals around food .
• Has low confidence and self-esteem .
• Has anxiety / distress .
• Avoids activities involving food or eating with others .
• Avoids or compulsively checks mirrors and scales .
• Has difficulties with concentration and / or sleep .
• Eats food in secret or at irregular times .
• Engages in self-harm behaviour .
We ’ d urge all healthcare professionals to keep in mind that while rapid weight loss in a patient should raise concern , weight is not the only factor to consider . Anyone of any weight can have an eating disorder .
What causes an eating disorder ? The harmful stereotypes relating to eating disorders include the perception that they are just difficulties with eating , a form of attention seeking , or something that only impacts young women and girls . On the contrary , eating disorders are serious mental illnesses that signal emotional distress . They can affect anyone of any age , gender , background , ethnicity and weight . They do not discriminate , and they are not a choice .
Their development is likely to involve a combination of genetic , biological , psychological , social and environmental factors . Difficulties with self-esteem , perfectionism and loneliness can contribute to an eating disorder , as can stressful life events like transitions , rapid change , illness , loss , conflict and trauma .
The more of these factors that a person experiences , the greater their risk of developing an eating disorder . Often , eating disorder behaviours act as a maladaptive mechanism to cope with difficult situations or feelings , or to feel more in control , although the person may not be aware of the purpose behind their behaviour .
Sensitive communication It can feel incredibly difficult to support someone with a possible eating disorder for the first time . Understandably , it can be a sensitive topic for the patient , and it ’ s normal to worry about saying the wrong thing , giving unhelpful advice or inadvertently triggering negative emotions .
It will require all the skills you use as a nurse to build a therapeutic alliance : compassion , trust , respect , active listening , validation , mutual engagement and shared decision-making . Be aware there may be anxieties , ambivalence towards recovery and resistance to change .
Ask open-ended questions , listen without judgement and make the person feel heard and supported . There may also be considerations around comorbid mental health difficulties , age , cognitive impairment because of starvation , or additional communication needs . You may not get it right all the time , but remember we are all human and mistakes are an opportunity to talk and learn .
DNAs and follow-up Talking about eating disorders can save lives , and we regularly hear from people who really valued the support from their healthcare team and who have gone on to live long , healthy lives away from their eating disorder .
Early identification is key . We would urge you to follow up on any concerning behaviour .
Ensuring that a robust protocol is in place for non-attendance of agreed follow-up appointments should help safeguard against undetected deterioration , or prevent those at high risk of ‘ slipping through the net ’. If an appointment is missed , the person coordinating the person ’ s care should be told , as well as the wider care team , and new appointment made . It may be helpful to ask if the person needs support to enable them to attend , such as writing a letter for their employer .
Always reach out to eating disorder experts for guidance and support if you need it .
References 1 Royal College of Psychiatrists . Hospital admissions for eating disorders increased by 84 % in the last five years . 2022 . tinyurl . com / RCP-eating . 2 Beat . How many people have an eating disorder in the UK ? 2022 . tinyurl . com / Beat-2hours 3 Beat . Training for nurses . 2017 . tinyurl . com / Beat-training 4 Beat . Worth more than 2 hours . 2022 . tinyurl . com / Beat-1-25m 5 Beat . Delaying for years , denied for months . 2017 . tinyurl . com / Beat-denied 6 NHS England . Eating disorder training for health and care staff . tinyurl . com / NHSE-training 7 Royal College of Psychiatrists . Medical emergencies in eating disorders ( MEED ). 2022 . tinyurl . com / RCP-MEED 8 NICE . Eating disorders : recognition and treatment . 2020 . nice . org . uk / ng69 9 SIGN . Eating disorders . 2022 . tinyurl . com / SIGN-164
Resources
• Beat . beateatingdisorders . org . uk
• Beat . Types of eating disorder . tinyurl . com / ED-types
• SCOFF questionnaire . tinyurl . com / scoff-tool
• Binge Eating Disorder Screener-7 . tinyurl . com / BEDS7-screen