Eating disorders
Eating disorders are considered a persistent disturbance of eating or eating-related behaviour that leads to an altered intake or absorption of food and results in considerable damage to a person’s health and psychosocial functioning.
Article by Ian Peate
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Overview
Eating disorders can have destructive effects on individuals, families and communities. They affect both men and women, but are more prevalent in women (Stewart, 2023). The causes, effects and treatment options are similar for both genders. Although eating disorders can emerge at any age, the highest risk is in the ages of 13–17 years (National Institute for Health and Care Excellence (NICE), 2020). Eating disorders are associated with an unusually low (or sometimes high) body mass index (healthy range is 18–25kg/m2).
This article outlines different types of eating disorder and discusses the role of the nurse in identifying, understanding and diagnosing them. The complications that impact on people’s health and wellbeing are also discussed.
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Definition
Eating disorders are considered a persistent disturbance of eating or eating-related behaviour that leads to an altered intake or absorption of food and results in considerable damage to a person’s health and psychosocial functioning (Beat, 2023).
Eating disorders are defined by negative beliefs about body shape and weight and their consequent eating behaviours. Eating disorders have the potential to cause people to restrict their eating, to binge eat and to develop compensatory behaviours (for example, vomiting and excessive exercise) (Beat, 2023).
There are emotional and physical costs that come with these beliefs and maintaining the disorder, leading to a high mortality rate as a result of malnutrition, suicide and physical and/or physiological issues, including electrolyte disturbances (NICE, 2019). These are most common in those with anorexia nervosa. Other physical complications can occur as a result of the condition, for example, osteoporosis and psychiatric comorbidities such as anxiety disorders. These complications
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Symptoms
Anorexia nervosa
Anorexia nervosa is characterised by body image disturbance and an intense fear of gaining weight. Those with anorexia restrict their food intake or engage in behaviour that interferes with their ability to gain weight, leading to low body weight (NICE, 2019).
The course of anorexia nervosa is very variable. The longer the person has the illness, the less likely it is that they will make a complete recovery (Beat, 2023). Those who do not recover develop chronic anorexia nervosa. Relapse is common, the highest risk of relapse is during the first year after discharge. Anorexia nervosa brings with it the highest rate of mortality of all mental health disorders (NICE, 2019). The most common causes of death are cardiac complications, severe infection and suicide.
Bulimia nervosa
People with bulimia nervosa also have excessive concerns about body shape and weight, with recurring (at least weekly,
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Diagnosis
In suspected cases of an eating disorder, the patient should be referred to an age-appropriate eating disorder service for expert assessment and management. For anyone who has rapid weight loss and is deemed at risk of serious physical complications, suicide or serious self-harm the need for emergency medical or psychiatric admission should be considered. For all other people who are suspected of having an eating disorder, it is not recommended to use a watchful waiting approach for their management.
Urgency of referral will depend on the specific clinical situation and on clinical judgement. Advice should be obtained from specialist eating disorders services. In the interim period (while awaiting specialist assessment), the individual should be reviewed regularly, with the frequency related to the clinical situation. Moreover, the level of physical and mental health risk should be monitored. Urgent admission, further investigations, or increasing the urgency of referral may need to be
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Management
The role of the nurse
In the first few minutes of the encounter with person who may have an eating disorder, it is essential that the nurse gains the person’s trust and engagement. As a result of the sensitivity associated with an eating disorder, along with the vulnerability of the person, nurses must offer a judgment-free environment with the aim of creating a therapeutic relationship. Relationship building will require the nurse to understand the patients’ fears, efforts, aspirations and expectations before the development of a treatment plan (NICE, 2020).
All nurses have a key role to play in the detection of eating disorders, as often nurses are a first point of contact for those who access the health-care system. When making the most of the therapeutic nurse–patient relationship, making every contact count and recognising early symptoms, the nurse can promptly diagnose, manage and make appropriate patient referrals in order to
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NMC proficiencies
Nursing and Midwifery Council: standards of proficiency for registered nurses
Part 1: Procedures for assessing people’s needs for person-centred care
1.1.6 signs of self-harm and/or suicidal ideation
Part 2: Procedures for the planning, provision and management of person-centred nursing care
5. Use evidence-based, best practice approaches for meeting needs for care and support with nutrition and hydration, accurately assessing the person’s capacity for independence and self-care and initiating appropriate interventions
5.1 observe, assess and optimise nutrition and hydration status and determine the need for intervention and support
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Resources
Beat. Types of eating disorders. 2023
www.beateatingdisorders.org.uk/get-information-and-support/about-eating-disorders/types/ (accessed 20 November 2023)
Lifeworks. What is an atypical eating disorder? 2023. https://www.lifeworkscommunity.com/blog/what-is-an-atypical-eating-disorder (accessed 20 November 2023)
National Institute for Health and Care Excellence (NICE). Eating disorders. 2019. https://cks.nice.org.uk/topics/eating-disorders/ (accessed 20 November 2023)
National Institute of Health and Care Excellence (NICE). Eating disorders: recognition and treatment. 2020. www.nice.org.uk/guidance/ng69 (accessed 20 November 2023)
Stewart C. England: primary diagnoses of eating disorders 2020/21, by type and gender. 2023. https://www.statista.com/statistics/987218/england-eating-disorders-by-type-and-gender/ (accessed 20 November 2023)
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