Have there been weight changes since the last visit? (gain or loss) 

1. A reminder that EDs do not discriminate based on weight, size, shape, gender, race, ethnicity, age, etc.

2. Due to this, the patient may see nothing wrong with these behaviors and may be seeking validation, particularly if they are experiencing weight loss.

3. Inquire whether or not the patient has noticed these changes. If so, ask if the weight change was intentional or unintentional.

For adolescent clients, regardless of BMI: have they fallen off the growth curve? Experiencing slowed height velocity? Stagnant growth curve?

1. Shifts up could indicate binge-eating, while shifts down and a stagnant curve could indicate restriction.

2. Shifts up or down could indicate purging.

3. Weight loss in childhood throughout teenage years is not normal.

Changes in food intake and behavior: Has your patient mentioned dieting behaviors such as cutting out food groups, counting calories, fasting, suddenly following a vegetarian/vegan diet or self-proclaiming food allergies/intolerances?

1. Navigating diet behaviors is extremely challenging given the pervasive normalization of ‘wellness’ and weight loss in our culture.

2. Because of this, the patient may see nothing wrong with their behavior and is seeking positive affirmation from you, particularly if the client is in a larger body and losing weight.

3. Even though patients may present positive health intentions, it is NOT normal for most people to cut out food groups, obsessively count calories, or abide by rigid food rules. These signs may be warnings that something else is going on or that the client has a skewed relationship with food.

Are there compensatory behaviors around food or “guilt” associated with eating?

1. Patients often do not disclose compensatory behaviors. It is 100% within your scope of practice to ask direct questions regarding this.

2. Compensatory behaviors include: purging by vomiting or laxative, Diuretic or diet pill use, insulin abuse, restriction, and exercising to ‘burn-off’ food.

3. Folks with EDs tend to find that their thoughts throughout the day are often preoccupied by food. Research suggests this preoccupation with food results from restriction-type behaviors.

4. Having the “good” vs “bad” attitude towards foods (Do you label food good vs bad?)

Do your clients report frequent GI discomfort or describe very restrictive diets to manage their GI symptoms?

1. Folks with EDs frequently experience GI related medical complications; these complications can potentially increase severity of symptoms.

2. Behaviors such as restricting, binging, purging, laxative abuse, or diuretic use, will generally disrupt normal digestion creating issues such as slowed gastric emptying, constipation, bloating, or general abdominal pain.

3. GI distress could lead to disordered eating behaviors especially if they are following a very restrictive diet

Do your patient’s vital signs and physical findings suggest medical instability or abnormalities?

1. Bradycardia, tachycardia, high/low blood pressure, alopecia, cold or bluish extremities, pallor, enamel erosion or enlarged parotid glands (signs of purging), lanugo, Russell sign (callous on knuckles from purging), decreased bowel sounds, palpable stool, yellow tint of the skin, swelling of lower extremities, decreased mobility, and muscle wasting in the temporal, clavicular, or scapular region, are all physical signs of EDs.

2. Eating disorders can lead to a variety of abnormal lab values including, but not limited to, low: B12, electrolytes, iron, and white blood cell count; as well as elevated: liver enzymes (AST & ALT), amylase, BUN (indicative of dehydration), and cholesterol levels. 

3. You can read more about physical signs of eating disorders and how physicians can screen for them in a blog by Dr. Jennifer Gaudiani.