National Eating Disorders Association

These steps are intended for use in a nonemergency situation. If the situation is a medical or psychiatric emergency and the person is at risk of suicide or is medically unstable, call 911 immediately.

Early detection, initial evaluation, and effective treatment are important steps that can help an eating disorder sufferer move into recovery more quickly, preventing the disorder from progressing to a more severe or chronic state. The following assessments are recommended as the first steps to diagnosis and will help determine the level of care needed for your family member. Receiving appropriate treatment is the first step towards recovery.

Patient Assessment

  • Patient history, including screening questions about eating patterns
  • Determination of medical, nutritional, psychological and social functioning (if possible, an eating disorder expert should assess the mental health of your child)
  • Attitudes towards eating, exercise, and appearance
  • Family history of eating disorder or other psychiatric disorder, including alcohol and substance use disorders
  • Family history of obesity
  • Assessment of other mental health conditions, such as depression and anxiety

Medical Exam

• Physical examination including height, weight, body mass index (BMI), growth chart assessment for children and adolescents, cardiovascular and peripheral vascular function, skin health, hair loss, evidence of self-injurious behaviors

  • Measurement of body temperature and pulse
  • Orthostatic blood pressure
  • Laboratory tests (see below)
  • Dental exam if self-induced vomiting is known or suspected
  • Establishment of diagnosis and recommendations for appropriate level of care

Laboratory Testing

  • Complete Blood Count (CBC) with differential urinalysis
  • Complete Metabolic Profile: sodium, chloride, potassium, glucose, blood urea nitrogen
  • Creatinine, total protein, albumin, globulin, calcium, carbon dioxide, aspartate transaminase (AST), alkaline phosphatase (ALP), total bilirubin
  • Serum magnesium, phosphate
  • Thyroid screen (T3, T4, TSH)
  • Electrocardiogram (ECG)

Special Circumstances

If uncertain of diagnosis

  • Erythrocyte sedimentation rate
  • Radiographic studies (computed tomography or magnetic resonance imaging of the brain or upper/lower gastrointestinal system)

If patient has been without her menstrual period for six or more months

  • Urine pregnancy, luteinizing and follicle-stimulating hormone, and prolactin tests

For individuals with persistent low weight, especially females who sustain amenorrhea, a work-up should include a Dual Energy X-ray Absorptiometry (DEXA) to assess bone mineral density.

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