It is vitally important that someone suffering from an eating disorder ensures that they are getting the best possible treatment they can. That there is a network of support around the individual (see downloadable bubble chart).
Of that network your GP must play a part in your recovery by monitoring the medical side of your condition.
An Eating Disorder is a mental health illness with physiological complications. It is vital that the psychological needs are balanced with the physical needs. If a person deteriorates to a severe or critical level, then their medical needs become the priority over their emotional needs.
It does vary in geographical areas, but if a person has a low BMI of 16.0/15.0, then that person may not be considered for therapy, as cognitively, the brain would not be able to rationalise or process that therapy as someone of a higher BMI would.
BMI
What do we mean by a BMI? (Body Mass Index)
- BMI is a (ratio of weight/height) proxy measure of medical risk in anorexia
- But they are inadequate as a standalone markers
- BMI is not critical with regards to risks associated with fluids and electrolytes
- The recommendations are that a BMI calculation should be combined with an examination of:- Muscle strength, blood pressure, pulse rate, peripheral circulations and core temperature
BMI must not be a stand alone assessment.
- A BMI does not take into account whether a person is a male or female.
- Neither does it account for a person’s age criteria.
- Whilst BMI is an indication to what level an adult may be at in their illness (mild, moderate, severe, critical or life threatening) it would perhaps better to use a child centile growth chart as a more accurate assessment in the case of a younger person.
BMI – South London and Maudsley Eating Disorder Clinic Guidelines:
- 20.0 – 18.5 Normal ‘Healthy’ Weight
- 18.5 – 17.5 Underweight
- 17.5 – 15> Anorexia Nervosa
- 15.0 – 13.5 Severe Anorexia
- 13.5 – 12.0 Critical Anx: Organs fail
- <12 Life Threatening
What is meant by ‘what level’ is a person at with their Eating Disorder?
Mild Anorexia/Bulimia
GP oversight, counselling, self help. Still managing to continue with day to day activities
Moderate Anorexia/Bulimia
GP oversight, self help, counselling, maybe CBT (Cognitive Behavioral Therapy) – continuing to respond well to therapy and still able to attend school or place of work.
Severe Anorexia/Bulimia
Closer monitoring by the GP, psychology/psychiatry, self help.
Critical
Close GP involvement, Hospitalisation in a general ward, a psychiatric unit or in-patient in a specialised eating disorder unit.
Life Threatening
Hospitalisation in a General Hospital/Tube Feed.
How does medical risk arise?
- A combination of compensatory behaviours – When someone is vomiting and taking laxatives excessively. When behaviours are excessive and binge/purge cycles are extreme.
- Excessive exercise and low weight – If low weight and exercise are combined, all organs may be compromised and the heart will struggle to cope.
- Blood in vomit – This can be life threatening and may indicate the oesophagus has ruptured.
- Inadequate fluid intake – Dehydration is a key factor in any age group. If dehydrated, the kidneys may fail and other organs may be compromised.
- Rapid weight loss – All organs may be compromised if weight loss is rapid.
- Disrupting food rituals (eg: journey, holiday, exam). This can compromise the body’s vital organs if someone is already very underweight due to an eating disorder and they go without food or drink.
- Low potassium levels due to excessive vomiting/laxatives. Again, this may be a medical risk factor. If compensatory behaviours are out of control and someone is vomiting or using laxatives in excess then the heart may be damaged.
- Potassium – Bloods need to be taken in the case of someone suffering from Anorexia (BET) 3.5 to 5.2 is regarded as normal. Anything below 3 creates the circumstances to admit that person to hospital.
Low Potassium
Potassium is a mineral that regulates the heart, helps lower blood pressure and decreases the risk of a stroke. If you are experiencing: chest pain; tingling in arms; pins and needles; leg cramps or muscle twitching in arms/legs, it may be that your potassium levels are low and it is important that you seek medical advice as soon as possible.
In extreme cases of severe chest pain, go immediately to the nearest A & E Department. Low potassium levels may occur if someone sufferers from bulimia or takes large amounts of laxatives.
It may be necessary for the GP to prescribe potassium supplements.
The following foods are high in potassium: bananas, tomatoes, oranges, grapes, lentils and peaches .
Coffee also contains potassium.