Nursing Care for Patients with Eating Disorders

Eating disorders are often romanticized by pop culture and the media. While media often encourages unhealthy body standards and eating patterns, the explosion of social media and societal expectations continues to perpetuate body image issues and eating disorders. What do nurses need to know about caring for patients with eating disorders? 

Relate: Current Eating Disorder Trends in Adolescents 

What nurses should know about common eating disorders 

In the United States, an estimated 9% of the population will develop an eating disorder in their lifetime. About 10,200 people die each year because of an eating disorder.  

Each person struggling with an eating disorder faces unique challenges and a range of signs and symptoms. However, these three types of eating disorders have been identified as the most common: 

Anorexia Nervosa 

The DSM-5 criteria for anorexia nervosa includes an intense fear of gaining weight, severe calorie restriction that leads to significantly low body weight in relation to sex, age, height, and physical health, and a disturbance in the way a person’s shape or body weight is experienced.  

Anorexia nervosa has the highest mortality rate among all mental health disorders. Only about 21% of those diagnosed with anorexia nervosa make a complete recovery.  

Bulimia Nervosa 

Individuals suffering from bulimia nervosa have a pattern of eating that involves eating a large amount of food in a short period followed by purging behaviors. Binge eating behavior is typically associated with feeling a loss of control. Purging behaviors may include self-induced vomiting, use of laxatives, or excessive exercise to “make up for” the binging episode.  

Bulimia nervosa is more common than anorexia and can be more difficult to identify. Many people suffering from bulimia nervosa have a healthy body weight.  

Binge eating disorder 

Binge eating disorder is like bulimia nervosa, where the person experiences a feeling of loss of control and engages in extreme overeating in a short period. However, people with binge eating disorder do not participate in the purging behaviors associated with bulimia nervosa. Typically, eating is done in secret to avoid embarrassment or shame associated with the binging episode 

Often, overeating results in rapid weight gain, and can eventually lead to obesity. People with binge-eating disorder may still be malnourished since they typically binge on foods with very little nutritional value.  

Related: Childhood Obesity in the 21st Century 

Adolescent and childhood eating disorders 

The American Academy of Pediatrics states that the mean age of children with eating disorders is just 12.5 years old. This makes early identification and prevention an important part of pediatric care.  

Treatment plans for adolescent patients with eating disorders 

Adolescent patients with eating disorders often suffer from other mental health conditions such as depression, anxiety, and obsessive-compulsive disorder. It is important to remember that while eating disorders do have physical consequences, they are primarily mental health issues.  

Multiple studies show that treatment for eating disorders requires a multidisciplinary approach and heavy family involvement in the treatment plan. Treatment for teens struggling with eating disorders should include:  

Psychotherapy 

Since eating disorders are primarily a mental health issue, it is vital to get patients to see a therapist as soon as possible. A therapist can help those struggling with eating disorders to identify triggers, explore why they participate in harmful behaviors, and improve their sense of self-worth regardless of their shape and size.  

It may take several tries to find a therapist that is a good fit for a specific patient. Encourage adolescents with eating disorders to remain open to seeing a few different therapists if they struggle to connect with any provider.  

Peer support 

Duke University School of Medicine recommends peer support for patients with many different types of mental health and substance abuse disorders, including patients with eating disorders.  

Family support 

The American Academy of Pediatrics encourages parents to avoid weight teasing or weight talk in the home. For children and adolescents who need to either gain or lose weight, extra pressure from parents can make the problem worse.  

Families can support their children at home by silently changing the home environment. Making healthy food options readily available, making regular exercise part of the family routine, and avoiding discussions about how weight affects a person’s appearance can be helpful.  

Parents should communicate frequently with their child’s care team to track progress and report any concerning behavior. The entire care team should work together to monitor and encourage eating disorder recovery.  

Inpatient treatment 

Sometimes, at-home treatment and outpatient therapy appointments are not enough. If a child or adolescent begins to show extreme behaviors or dangerous health problems, a nursing professional may need to refer them to a treatment center.  

Nursing care for eating disorders in children and adolescents   

Nurses working in pediatrics play a huge role in identifying at-risk children and adolescents and getting them into treatment early. Report any concerns of an eating disorder to the physician immediately.  

Assessment  

Signs and symptoms to watch for include:  

  • A change in growth rate that is slower than expected 
  • Unexplained weight loss 
  • Brittle nails or thinning hair 
  • Dry skin and mucous membrane 
  • Patients who are extremely concerned about getting weighed or measured during their appointment 
  • Children or adolescents ask frequent questions about calorie intake, laxative use, or weight loss strategies 
  • Tooth decay or sores in the mouth 

Pediatric care providers can help children and their parents by offering education about having healthy discussions and establishing good eating habits at home early. Parents and care providers should remember that any child, regardless of gender, age, or socioeconomic background can develop an eating disorder.  

Treatment 

Nurses caring for adolescents suffering from eating disorders should remain patient, but firm. Remember that just like all other illnesses, the patient did not choose to have an eating disorder. Using therapeutic communication such as listening with empathy can help build trust between the patient and the care provider.  

Patients with eating disorders often fear recovery, since recovery from the eating disorder usually means they will gain weight or lose control. Nurses may get push-back from adolescents in recovery and must remain calm and empathetic when a patient has trouble following a treatment plan.