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Anorexia Nursing Diagnosis

Anorexia Nursing Diagnosis and Nursing Care Plan

Last updated on January 27th, 2024 at 09:00 am

Anorexia Nursing Care Plans Diagnosis and Interventions

Anorexia NCLEX Review and Nursing Care Plans

Anorexia nervosa, better known as anorexia, is an eating disorder marked by low body weight, intense fear of gaining excess weight, and a misguided perspective about weight. Individuals with anorexia generally restrict their food intake to avoid gaining weight or continue losing weight.

They may limit their calorie intake by vomiting after eating or abusing laxatives, herbal or diet supplements, diuretics , or fleet enemas. They may also try to drop pounds by overexerting themselves. Thus, no matter how much weight is reduced, the individual is still afraid of gaining weight.

Furthermore, anorexia is not solely about food and nutrition. When individuals suffer from anorexia, they deal with emotional struggles in an unhealthy and fatal way to cope with it. They also frequently associate body shape with self-worth.

Moreover, like with other eating disorders, anorexia has the potential to take over someone’s life and be extremely tough to handle. However, patients can rediscover their identity with treatment, reintroduce healthier eating habits, and reverse some of anorexia’s significant complications.

Causes and Risk Factors of Anorexia

Anorexia’s actual cause is inconclusive. As with many disorders, it is most likely the combined effect of biological, psychological, and environmental variables.

  • Biological Factors. Although it is unclear which genes are involved, chromosomal irregularities may put some people at a higher risk of developing anorexia. Some individuals may have a hereditary tendency for perfectionism, sensitivity, and persistence, all of which are related to anorexia.
  • Psychological Factors. Some anorexics may have obsessive-compulsive qualities that make it easier to continue restrictive diets and avoid food even when hungry. They may have a strong desire for perfection, which leads them to believe they are never skinny enough. They may also experience significant anxiety and participate in restrictive eating to alleviate it.
  • Environmental Factors. Body image is given more importance in modern Western society. Becoming slim is frequently associated with success and self-value. Peer influence, especially among young girls, may contribute to the urge to be slim.

Related factors to Anorexia

Anorexia can strike anyone, irrespective of gender, age, or color. Certain circumstances, however, put some individuals at a higher risk of developing anorexia. Several factors of anorexia are explained below:

  • Age. Eating disorders, notably anorexia, are more prevalent in teenagers and young adults, but small children and elderly persons can acquire anorexia as well.
  • Gender. Women are more highly diagnosed with anorexia than the general population. It is crucial to note that men and boys can suffer from anorexia and may be inadequately diagnosed due to disparities in seeking medical help.
  • Family history. If patients have a parent or sibling (first-degree family) who has an eating disorder, they are more likely to acquire one.
  • Dieting. Excessive dieting can lead to anorexia.
  • Changes and trauma. Significant life changes, such as attending university, starting a career, or filing for divorce, as well as trauma, such as sexual assault or physical abuse, may precipitate the emergence of anorexia.
  • Certain occupations and sports activities. Celebrities, athletes, runners, boxers, and dancers are more vulnerable to eating disorders.

Signs and Symptoms of Anorexia

Physical manifestations of anorexia may include:

  • Excessive weight loss or failure to make planned developmental weight changes
  • Excessive slimness
  • Fainting or dizziness
  • Abnormal blood counts
  • Difficulty in sleeping
  • Delayed menstruation schedule
  • Hypotension
  • Hair that is thinning, breaking, or falling out
  • Constipation and abdominal discomfort
  • Skin that is flaky or yellowish
  • Dehydration
  • Teeth erosion and calluses on the knuckles as a result of induced vomiting
  • Cold intolerance
  • Abnormal heartbeats

Anorexia’s behavioral signs may include efforts to drop pounds by:

  • Dieting or fasting severely restricts food consumption.
  • Excessive exercise
  • Binge eating and inducing vomiting to get rid of food through laxatives, fleet enemas, diet, or herbal supplements.

Among the emotional and behavioral indications and symptoms are the following:

  • Food obsession sometimes includes preparing extravagant meals for others but not consuming them.
  • Skipping meals or refusing to eat regularly
  • Making reasons for not eating or denying hunger

Diagnosis of Anorexia

If the doctor suspects anorexia nervosa, he or she will usually do a series of tests and exams to narrow down a diagnosis, rule out possible factors for weight loss, and look for any associated issues. These exams and tests typically involve the following:

  • Physical examination. This procedure may include measuring the height and weight, monitoring the vital signs such as heart rate, blood pressure, and temperature, looking for abnormalities with the skin and nails, checking the heart and lungs, and assessing the abdomen.
  • Laboratory tests. A complete blood count (CBC) and more specialized blood tests to examine electrolytes and protein, as well as the function of your liver , kidney, and thyroid, may be performed. A urinalysis may also be performed.
  • Psychological assessment. A doctor or mental health expert will almost certainly inquire about a patient’s thoughts, emotions, and eating patterns. The patient may be requested to fill out psychological self-assessment questionnaires as well.
  • Other procedures. X-rays may be done to assess bone density, look for fractured bones, or rule out pneumonia or heart problems. Electrocardiograms may be performed to detect cardiac abnormalities.

Treatment for Anorexia

  • Psychotherapy. This treatment is a psychological therapy that focuses on modifying a person’s thinking (cognitive therapy) and conduct (behavioral therapy) to help them overcome an unhealthy relationship with food.
  • Medication. Certain tricyclic antidepressants may be used to assist in regulating anxiety and depression caused by an eating disorder and improve sleep and promote appetite.
  • Nutrition counseling. This strategy is intended to teach a healthy diet and lifestyle and to aid in the restoration of balanced eating patterns, and instill the value of nutrition and a well-balanced diet.
  • Group and family therapy. Family support is critical to the effectiveness of treatment.
  • Hospitalization. In some situations, the patient may require nourishment via a nasogastric tube or an IV.

Prevention of Anorexia

  • Create a positive self-image
  • Learn about eating disorders
  • Avoid excessive dietary restrictions
  • Do not falter to consult a health expert as soon as symptoms manifest and prevent them from getting worse.
  • Strengthen a support group that enables an individual to share their health concerns.

Anorexia Nursing Care Plans

Anorexia nervosa nursing care plan 1.

Deficient Knowledge

Nursing Diagnosis: Deficient Knowledge related to lack of comprehension about the health condition secondary to anorexia nervosa as evidenced by verbalization of the desire to learn new information about the disorder.

Desired Outcome: The patient will be knowledgeable enough about the eating disorder and will be able to manage it.

Anorexia Nervosa Nursing Care Plan 2

Impaired Parenting

Nursing Diagnosis: Impaired parenting related to family issues and history of deficient coping mechanisms secondary to anorexia nervosa as evidenced by unharmonious family relationships.

Desired Outcome: The patient will learn to cope appropriately with the family issues and resolve those.

Anorexia Nervosa Nursing Care Plan 3

Impaired Thought Process

Nursing Diagnosis: Impaired thought process related to mental health problems such as low self-esteem and a perceived sense of powerlessness secondary to anorexia nervosa as evidenced by perceptual abnormalities, including a failure to perceive hunger, fatigue, worry, and despair.

Desired Outcome: The patient will be knowledgeable about the cause of impaired thought processes and learn to deal with them

Anorexia Nervosa Nursing Care Plan 4

Imbalanced Nutrition: Less Than Body Requirements

Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements related to insufficient food intake and self-inflicted vomiting after eating secondary to anorexia nervosa as evidenced by appalling muscle tone and too much-lost body weight.

Desired Outcome: The patient will comprehend the importance of proper diet and nutrition. The patient will also learn to sustain healthy body weight.

Anorexia Nervosa Nursing Care Plan 5

Risk for Deficient Fluid Volume

Nursing Diagnosis: Risk for Deficient Fluid Volume related to insufficient consumption of fluids secondary to anorexia nervosa

Desired Outcome: The patient will learn the importance of adequate fluid intake.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020).  Nursing diagnoses handbook: An evidence-based guide to planning care . St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017).  Nursing care plans: Diagnoses, interventions, & outcomes . St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018).  Medical-surgical nursing: Concepts for interprofessional collaborative care . St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020).  Saunders comprehensive review for the NCLEX-RN examination . St. Louis, MO: Elsevier.  Buy on Amazon

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Nurse’s Guide to Caring for Patients With Eating Disorders

portrait of Jody Dugan, RN, BSN

Contributing Writer

Learn about our editorial process .

Updated May 3, 2022

Eating disorders can lead to serious health issues and be fatal. Find out how nurses can recognize warning signs and manage care to help patients successfully recover.

Are you ready to earn your online nursing degree?

Eating disorders (EDs) do not discriminate. People of all ages, ethnicities, backgrounds, and genders can suffer from an ED. They start from painful thoughts or emotions and, if left untreated, lead to severe health problems, even death. Early detection and proper treatment are critical to a successful outcome.

"Nurses interact with patients who might not otherwise be detected as having an eating disorder," Cassandra Godzik, the associate dean for Regis College School of Nursing states. "EDs are usually practiced in secrecy, behind closed doors of the bathroom, such as in binging/purging ED, because shame and guilt are associated with this mental health illness."

She continues, "Patients might show up in the physician's office, and nurses are the first to ask patients questions about their holistic health (think appetite, sleep, exercise behaviors, etc.)."

Explore this guide to learn more about EDs and your role as a nurse.

Fast Facts About Eating Disorders

  • 28.8 million Americans will experience an eating disorder in their lifetime.*
  • Approximately 10,200 deaths were associated with eating disorders between 2018 and 2019.**
  • Of people with an eating disorder, less than 6% are medically diagnosed as "underweight."

The Role of Nurses When Caring for Patients With Eating Disorders

Nurses play an essential role in identifying destructive eating patterns and providing physical and emotional care for patients from detection to recovery. The goal is to have a manageable multidisciplinary, holistic approach to care.

Monitoring nutritional status, electrolyte balance, weight, and activity, while keeping watch over diuretic/laxative use, make up important aspects of a nurse's role.

Patients also need emotional support, as they face deep pain and traumatic thoughts. Nurses can gain trust through active listening, empathy, and positive reinforcement. They can foster independence and educate patients and loved ones.

Establishing goals to ensure the patient maintains awareness, practices healthy coping techniques, and adopts a positive body image and sense of self-worth is a priority.

Godzik identifies the role of the nurse when caring for patients with EDs to include:

  • Active listening
  • Availability and being present
  • Open, honest communication
  • Time for the patients to reflect on the best approach for recovery
  • Multidisciplinary approach to care and serving as an advocate
  • Staying nonjudgmental

How to Recognize an Eating Disorder

Nurses are often the initial point of contact for patients. As a result, they can recognize an ED through routine assessments of vital signs, weight, and dietary/eating trends.

Physical and emotional signs can warn nurses of eating disorders. Physical presentations include cardiac irregularities, elevated blood pressure, hair loss, weight fluctuations, fainting, tooth decay, skin breakdown, and bruised/callused knuckles.

Emotional or behavioral indicators may include depression, impulsiveness, obsessiveness, perfectionism, isolation, bathroom visits after meals, stashing food, excessive exercise, or concealed eating.

Who Is at Risk of Developing an Eating Disorder?

Researchers believe ED stems from a combination of biological, psychological, and sociocultural factors. The road to recovery begins with identification of the underlying cause and risk factors.

The National Eating Disorders Association and the National Alliance of Mental Illness identify risk factors for developing ED. Biological influences include dieting, a family member with an ED or mental condition, and Type 1 diabetes. Teens/young adults and women tend to be more at risk.

Psychological factors include distorted body image, perfectionism, obsessive-compulsiveness, anxiety, or social phobia. Social effects involve diet fads, our culture's "ideal" body type, overprotective parents, being bullied, and certain activities like gymnastics or dancing.

Although there are identifiable risk factors, an ED can present itself regardless of age, race, socioeconomic class, body type, or gender. For example, eating disorders are not always visible. Clearing any misconceptions or preconceived ideas can prevent misdiagnosis.

Types of Eating Disorders

EDs are not unhealthy choices in dietary habits. They are a detrimental attempt to manage emotional issues. Just as there are many risk factors for why someone may develop an eating disorder, there are also different types of eating disorders.

Some of the most common EDs include anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED), avoidant-restrictive food intake disorder (ARFID), other specified feeding or eating disorder (OSFED), and unspecified feeding or eating disorder.

  • Collapse All

Anorexia Nervosa

According to the National Institute of Mental Health (NIMH), AN is "characterized by a significant and persistent reduction in food intake, leading to extremely low body weight in the context of age, sex, and physical health; a relentless pursuit of thinness; a distortion of body image and intense fear of gaining weight; and extremely disturbed eating behavior."

AN has a high incidence of morbidity and mortality because of medical complications associated with self-starvation or suicide.

AN can present at any age, but it is more common in adolescent females with the median age of onset at 18 years old. Other risk factors include a transition or major life event, trauma or abuse, dieting, genetics, or culture. An extreme drive for perfectionism or obsessive-compulsive disorder can accompany AN.

Symptoms of AN can present as physical signs of starvation or behavioral changes. Some more common symptoms include severe restricted eating, emaciation, extreme fear of weight gain, wearing baggy clothes, and distorted body image.

Bulimia Nervosa

The NIMH characterizes BN as "binge eating (eating large amounts of food in a short time, along with the sense of a loss of control), followed by a type of behavior that compensates for the binge, such as purging (e.g., vomiting, excessive use of laxatives, or diuretics), fasting, and/or excessive exercise."

BN typically starts in the late teens or early adulthood and is more common in women. The median age of onset is 18 years old. Other risk factors can be genetic or familial predisposition, a previous traumatic event, dieting, distorted body image, or psychological issues, such as depression and anger.

BN symptoms may include callused/bruised knuckles, weight fluctuations, irregular periods and dental problems. Isolation, fainting, dry skin, hoarding food, or excessive exercise are also signs to look for.

Binge-Eating Disorder

The NIMH says that BED is the leading eating disorder in the U.S. It is "characterized by recurrent binge-eating episodes, during which a person feels a loss of control and marked distress over his or her eating. Unlike bulimia nervosa, binge-eating episodes are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorder often are overweight or obese."

BED is more prevalent in females, with the highest incidences occurring for those ages 45-59 years, followed by 19-29. The median age of onset is 21.

Other risk factors can be genetic or familial predisposition, psychological issues like depression or anger, substance misuse, distorted body image, and a previous traumatic event. Dieting and boredom are also factors. Symptoms of BED may include eating even when full, concealed eating, eating large amounts of food, frequent dieting, and feelings of shame, depression, disgust, and guilt.

Other Eating Disorders

With avoidant-restrictive food intake disorder, a person limits their intake of food but does not have a distorted body image or fear of weight gain as seen with AN. Other eating disorders include unspecified feeding or eating disorders or specified feeding or eating disorders.

OSFEDs include purging disorders that entail purging but not binging. Night-eating syndrome involves waking up at night and consuming a large amount of food. A patient with pica disorder eats things that are not food. Rumination disorder involves regular regurgitation of food that is rechewed, reswallowed, or spit out.

Best Practices for Nurses When Caring for Patients With Eating Disorders

The role of the nurse is cyclical, from detection to recovery and ongoing monitoring. Godzik states, "Nurses collaborating with patients with ED should be cognizant that patients can certainly enter recovery from an ED. However, it is something that nurses should be monitoring on an ongoing basis."

Best practices for nurses include the following.

1. Conscious Language

Nurses must be conscientious when communicating with patients with ED. Refrain from commenting about their weight, appearance, and food/intake.

"Asking the patient about whether they want to be made aware of their weight is important," Godzik says.

"Also, healthcare providers like nurses should not make comments about weight changes of their patients ('Oh, wow, you lost so much weight. You look great!' … or 'I see you gained weight. What's going on in your life?')," Godzik continues. "Comments about appearance can be difficult for patients to hear if they've experienced ED behaviors in the past."

Options to promote constructive self-talk could be to compliment them on other positive qualities unrelated to appearance or highlight features they like about themselves.

2. Identifying Potential Triggers

A patient may face setbacks on their road to recovery. Identifying stressors can help minimize the chance of relapse. Patients can overcome obstacles with a relapse prevention plan that lists their triggers. They can also throw away their scale and create a healthy meal plan.

Godzik says that nurses should check in at each appointment about the patient's appetite and pay close attention to changes in vital signs, height, and weight. "Stressors in a patient's life can bring up feelings and emotions that might cause relapse for them."

However, Godzik notes that "it is important to keep in mind that patients recovering from ED can be sensitive to hearing or visualizing weight on the scale. Nurses … should be mindful that not all patients want to hear about their weight. It can be triggering for them and cause them to ruminate about their eating behaviors."

3. Collaborative Plan of Care

The nurse case/care manager promotes autonomy and accountability by offering guidance to allow the patient to play an active part in managing their ED. Guiding patients to recovery, nurses can help them develop a plan of care to include meals (for instance, small frequent meals with snacks), physical and social activity, and managing all aspects of healthier living.

4. Support and Resources

Nurses provide a safe environment with active listening, open communication, and empathy. As an advocate, nurses ensure a multidisciplinary and holistic team approach. They can provide referral options to patients and loved ones, such as information on support groups and other eating disorder resources.

What Are Common Treatments and Therapies for Eating Disorders?

Patients diagnosed with ED suffer deep emotional turmoil because of traumatic thoughts or events. As the patient confronts their trauma, the risk of ED behavior can increase. They are also at an increased risk for suicide, mental disorders, physical illnesses, or substance misuse. An integrated approach to treating eating disorder symptoms is best.

Common treatments for EDs include nutritional counseling or psychotherapies. Psychotherapy may entail group therapy, family therapy, and individual psychotherapy, such as cognitive behavioral therapy (CBT). Another method of treatment includes medications like antidepressants, antipsychotics, or mood stabilizers.

"The goals of treatment for a patient with an eating disorder need to be patient-centered or patient-driven, meaning that the patient and the nurse work to formulate shared goals for recovery." –Cassandra Godzik

Godzik says, "The goals of treatment for a patient with an eating disorder need to be patient-centered or patient-driven, meaning that the patient and the nurse work to formulate shared goals for recovery. Goals and outcomes are determined alongside the patient, versus telling the patient what to do."

Godzik states that treatment can involve family members or a patient's friends to support the patient. "It is a team effort."

"Some goals that might be generated during ED treatment," Godzik says, "can be (1) not engaging in ED behaviors (restricting calories, not binging, and purging) during the next week; (2) restoring weight to healthy body mass index limits; and (3) participating in group or individual therapy twice weekly."

More Than Just Food

Risk factors vary, making ED detection a challenge. The role as a nurse is crucial in identifying the risks and clinical presentation of EDs and managing the patient through recovery.

Continuing education helps nurses stay up to date on EDs. By applying knowledge and nursing tips in caring for patients with ED, nurses can play a significant role in a positive patient outcome.

Helpful Eating Disorder Resources for Nurses

MedlinePlus.gov offers information on the types of eating disorders and identifies the causes, risk factors, symptoms, and clinical presentation of the disorder. It also lists diagnostic testing and treatment options.

ANAD is the nation's leading nonprofit, providing free peer support services to anyone struggling with disordered eating and body image. Volunteers understand the journey through their own experience and recovery from EDs.

Eating disorder treatments at Cleveland Clinic include psychotherapy, such as CBT, the Maudsley approach or family-based treatment, medication, and nutritional counseling. An ideal plan would include a collaborative method of collective treatments.

A team of healthcare professionals developed these questions as a screening tool when assessing patients with ED:

  • Do you make yourself S ick because you feel uncomfortably full?
  • Do you worry that you have lost C ontrol over how much you eat?
  • Have you recently lost more than O ne stone (14 lbs.) in a three-month period?
  • Do you believe yourself to be F at when others say you are too thin?
  • 5. Would you say that F ood dominates your life?

Meet Our Contributor

Portrait of Cassandra Godzik, Ph.D., APRN, PMHNP-BC, CNE

Cassandra Godzik, Ph.D., APRN, PMHNP-BC, CNE

Dr. Cassandra Godzik is the associate dean at Regis College School of Nursing . During her time at Regis, she has worked as an RN in the adolescent personality disorder and adult female eating disorder units at McLean Hospital. She is also a psychiatric nurse practitioner working as a nurse manager/clinical educator at McLean. In this role, she assists people with psychiatric diagnoses in inpatient and residential settings.

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13.4: Applying the Nursing Process to Eating Disorders

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People with eating disorders may appear healthy even when they are very ill. Additionally, individuals with anorexia nervosa often do not view their behavior as a problem. They are typically only seen in health care settings due to concerned family or friends who encourage them to seek treatment. Conversely, individuals with bulimia nervosa or binge eating disorder may feel shame and sensitivity to the perceptions of others regarding their illness. Therefore, it is vital for the nurse to build a therapeutic nurse-patient relationship with clients with eating disorders and empathize with possible feelings of low self-esteem and lack of control over eating. [1]

This section will apply the nursing process to anorexia and bulimia nervosa.

When assessing an individual with a potential or diagnosed eating disorder, it is vital to obtain their perception of the problem while assessing for signs and symptoms. Care planning that does not address their perspective will not be effective. As previously mentioned, clients with anorexia nervosa often do not perceive their behaviors as a problem, so specialized therapeutic techniques may be required. Review signs and symptoms associated with various eating disorders in the “ Basic Concepts ” section.

Subjective Assessment

A complete nursing assessment includes health history, psychosocial assessment, and screening for risk of suicide or self-harm. Nutritional patterns, fluid intake, and daily exercise should also be assessed. If the client has a binging or purging pattern, the amount of food eaten and/or the frequency of these behaviors should be assessed.

Objective Assessment

Objective assessments include routine weight monitoring and orthostatic vital signs. Common objective assessment findings for individuals with anorexia nervosa and bulimia nervosa are compared in Table 13.4a. Clients with binge eating disorder may have obesity and gastrointestinal symptoms but do not typically have other associated abnormal assessment findings.

Table 13.4a Comparison of Assessment Findings in Anorexia Nervosa and Bulimia Nervosa [2]

Diagnostic and Lab Work

Laboratory and diagnostic testing are typically performed to rule out thyroid imbalances and to evaluate for potential physiological complications resulting from starvation, dehydration, and electrolyte imbalances. Laboratory testing may include the following [3] :

  • Complete blood count
  • Electrolyte levels
  • Glucose level
  • Thyroid function tests
  • Erythrocyte sedimentation rate (ESR)
  • Creatine phosphokinase (CPK)

Diagnostic testing may include these tests:

  • Electrocardiogram (ECG)
  • Dual energy X-ray absorptiometry (DEXA) to measure bone density

Common nursing diagnoses for individuals diagnosed with anorexia nervosa or bulimia nervosa include these diagnoses [4] :

  • Imbalanced Nutrition: Less Than Body Requirements
  • Risk for Electrolyte Imbalance
  • Risk for Imbalanced Fluid Volume
  • Impaired Body Image
  • Ineffective Coping
  • Interrupted Family Processes
  • Chronic Low Self-Esteem
  • Powerlessness
  • Risk for Spiritual Distress

Outcome Identification

These are the typical overall treatment goals for individuals with eating disorders [5] :

  • Restoring adequate nutrition
  • Bringing weight to a healthy level
  • Reducing excessive exercise
  • Stopping binge-purge and binge eating behaviors

SMART expected outcomes are individualized for each client based on their established nursing diagnoses and current status. (SMART is an acronym for Specific, Measurable, Attainable/Actionable, Relevant, and Timely.) An example of a SMART expected outcome for an individual hospitalized with anorexia nervosa who is experiencing electrolyte imbalances is:

  • The client will maintain a normal sinus heart rhythm with a regular rate during their hospitalization. [6]

Planning Interventions

Planning depends on the acuity of the client’s situation. As previously discussed, clients are hospitalized for stabilization. Common criteria for hospitalization include extreme electrolyte imbalance, weight below 75% of healthy body weight, arrhythmias, hypotension, temperature less than 98 degrees Fahrenheit, or risk for suicide. [7] After a client is medically stable, the treatment plan includes a combination of psychotherapy, medications, and nutritional counseling. Review the “ Treatment for Eating Disorders ” section for more details.

Implementation

Nurses individualize interventions based on the client’s current clinical status and their phase of treatment. Interventions can be categorized based on the American Psychiatric Nursing Association (APNA) standard for Implementation that includes the Coordination of Care; Health Teaching and Health Promotion; Pharmacological, Biological, and Integrative Therapies; Milieu Therapy ; and Therapeutic Relationship and Counseling . (Review information about these subcategories in the “ Application of the Nursing Process in Mental Health Care ” chapter.) Read nursing interventions for clients with eating disorders categorized by APNA categories in Table 13.4b.

Table 13.4b Examples of Nursing Interventions by APNA Subcategories [8] , [9]

Inpatient Care

If the client is exhibiting risk for suicide, a safety plan should be immediately implemented. Review nursing care for clients with risk for suicide in the “ Application of the Nursing Process in Mental Health Care ” chapter.

Severely malnourished clients may require therapeutic enteral nutrition. Any client with negligible food intake for more than five days is at risk of developing a potentially fatal complication called refeeding syndrome. The hallmark feature of refeeding syndrome is hypophosphatemia but may also involve serious sodium and fluid imbalances; changes in glucose, protein, and fat metabolism; thiamine deficiency; hypokalemia; and hypomagnesaemia. To avoid this syndrome, a thorough nutritional assessment must be performed followed by the slow reintroduction of nutrients and fluids according to evidence-based guidelines. [13]

After resolving acute symptoms, clients with anorexia begin a weight restoration program for incremental weight gain with a treatment goal set for 90% of ideal body weight. Specially trained dieticians assist in developing daily meal plans and caloric intake, and clients are generally weighed two or three times a week to gauge progress. [14]

Nurses should be aware that clients with bulimia nervosa typically establish a therapeutic nurse-client relationship more quickly than clients with anorexia nervosa. As previously discussed in this chapter, clients with anorexia nervosa often do not view their condition as a disorder and value their obsessive-compulsive behaviors with eating as a way to feel safe and secure and avoid negative feelings. Conversely, clients with bulimia nervosa view their behaviors as problematic and desire help. [15]

Outpatient Care

Outpatient partial hospitalization is an option for clients who have been medically stabilized. In this setting, clients are in a clinical setting during the day and then go home to practice skills in the afternoon. Outpatient treatment continues if the client maintains a contracted weight, vital signs are within a normal range, and there is an absence of disordered eating behaviors. [16]

A significant part of the recovery process includes rebuilding relationships with family. Family members or significant others often feel frustrated, powerless, and hopeless because the strategies they previously attempted, such as forcing the client to eat or begging the client to eat, were not successful. The nurse helps with this recovery process by providing education to the client and their loved ones about the illness, treatment, and meal planning. Adaptive coping skills to address disordered thoughts should be reinforced. [17]

Review information about coping strategies in the “ Stress, Coping, and Crisis Intervention ” chapter.

Nurses refer clients and their loved ones to resources as part of discharge planning. Review examples of community resources in the following box.

Resources for Individuals With Eating Disorders

  • National Eating Disorders Association (NEDA) : Support, resources, and treatment options
  • Eating Disorders Resource Group : Resources including treatment apps
  • ANAD : Eating disorder peer support groups

Evaluation is a continuous process of reviewing a client’s progress towards their individualized goals and SMART outcomes. Interventions are continually evaluated and modified based on their success in meeting these short-term goals.

  • Halter, M. (2022). Varcarolis’ foundations of psychiatric-mental health nursing (9th ed.). Saunders. ↵
  • National Institute of Mental Health. (2021, December). Eating disorders . U.S. Department of Health and Human Services. https://www.nimh.nih.gov/health/topics/eating-disorders ↵
  • Ackley, B., Ladwig, G., Makic, M. B., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing diagnosis handbook: An evidence-based guide to planning care (12th ed.). Elsevier. ↵
  • American Nurses Association, American Psychiatric Nurses Association, and International Society of Psychiatric-Mental Health Nurses. (2014). Psychiatric-Mental Health Nursing: Scope and Standards of Practice (2nd ed.). ↵
  • Miller, W. R., & Rollnick, S. (2013) Motivational Interviewing: Helping people to change (3rd ed.). Guilford Press. ↵
  • Froreich, F. V., Ratcliffe, S. E., & Vartanian, L. R. (2020). Blind versus open weighing from an eating disorder patient perspective. Journal of Eating Disorders 8 , 39. https://doi.org/10.1186/s40337-020-00316-1 ↵
  • Mehanna, H. M., Moledina, J., & Travis, J. (2008). Refeeding syndrome: What it is, and how to prevent and treat it. BMJ, 336 , 1495–1498. https://doi.org/10.1136/bmj.a301 ↵

Nursing Care Plan for Eating Disorders (Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder)

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Pathophysiology

Eating disorders are a serious, sometimes fatal illness that cause a significant change in a client’s eating behaviors that most commonly occurs in young women (teens – 20s), but can occur in clients of any gender or age. Early detection and treatment improves the likelihood of recovery. Types of eating disorders include anorexia nervosa (voluntary starvation), bulimia nervosa (binge-eating followed by purging) and binge-eating disorder (binge-eating without purging). Inadequate nutrition can lead to serious medical complications and even death. These conditions frequently coexist with other mood or personality disorders and substance abuse.

Diagnostic Criteria:

Anorexia Nervosa

  • Restriction of nutritional intake that leads to significant low body weight
  • Intense fear of gaining weight or becoming fat
  • Altered perception of body weight or shape

Bulimia Nervosa

  • Eating a larger amount of food in a short period of time than normal
  • Lack of control over eating
  • Recurrent purging: self-induced vomiting, misuse of laxatives, diuretics, fasting or excessive exercise
  • Binge-eating and purging both occur at least once a week for 3 months
  • Self perception is unreasonably influenced by body shape and weight

Binge-Eating Disorder

  • Eating quickly, until uncomfortably full, or alone due to embarassment
  • Eating large amounts of food when not physically hungry
  • Feeling disgusted with oneself or guilty afterward
  • Marked distress regarding binge-eating
  • Binge-eating occurs at least once/wk for 3 months
  • Binge-eating is not associated with purging

Desired Outcome

Client will verbalize understanding of nutritional needs. Client will improve weight toward normal range. Client will establish more realistic body image.  Client will demonstrate compliance with therapy and treatment.

Eating Disorders (Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder) Nursing Care Plan

Subjective data:.

  • Obsession with calories or fat content of foods
  • Fear of gaining weight
  • Denial of low body weight
  • Constipation
  • Feeling cold most of the time
  • Feeling tired
  • Muscle weakness
  • Chronic sore throat
  • Abdominal pain
  • Eating alone or in secret
  • Frequent dieting

*Note – the presence of these symptoms individually do not indicate an eating disorder, assess the full clinical picture.

Objective Data:

  • Restricted eating
  • Low blood pressure
  • Infertility
  • Brittle hair and nails
  • Dry, yellowing skin
  • Muscle wasting
  • Thinning bones
  • Eating very fast
  • Growth of hair all over the body (lanugo)

Nursing Interventions and Rationales

  • Perform complete nursing assessment noting skin, muscle tone and neurological status; include weight (BMI) and vital sign assessment

Get a baseline for effectiveness of interventions. Note any deficits or other issues that may need to be prioritized.

Determine severity of condition.

  • Assess nutritional status and set a weight goal

Determine if client is under or over weight and nutritional needs

  • Assess client for depression and suicide potential

Clients with eating disorders often have accompanying depression with suicidal thoughts. Monitor for safety.

  • Supervise client during meals and for at least one hour after eating (in inclient treatment)

Determine client’s eating habits and prevent purging after meals.

  • Encourage liquid intake over solid foods

Eliminates the need to choose foods, provides hydration and is more easily digested.

  • Provide small meals and snacks appropriately

Prevents bloating and discomfort in clients following starvation and encourages eating more appropriate portions.

  • Monitor for signs of food hoarding or disposing of food.

Clients may try to hoard food for secretive eating or dispose of food to avoid calories.

  • Monitor exercise program and set limits and goals accordingly

Moderate exercise helps maintain muscle strength and tone, but excessive exercise burns too many calories and contributes to clients’ disorder.

Alternatively, lack of exercise can lead to depression, muscle wasting and increased weight and a negative self image.

  • Administer TPN supplemental nutrition as appropriate

In cases of severe malnourishment and life-threatening situations, TPN may be used to maintain gastric function and provide nourishment.

  • Monitor fluid balance and administer oral and IV fluids as appropriate

Failure to eat or drink and repeated purging through vomiting or excessive use of laxatives can cause a fluid imbalance and lead to dehydration. Prevent electrolyte imbalances and cardiac involvement by maintaining adequate hydration.

  • Record routine weights per facility protocol

Monitor progress of interventions and incorporate routine accountability checks for clients.

  • Monitor skin for wounds, dryness, excoriation or deep tissue injuries

Lack of hydration and proper nutrition lead to decreased perfusion and poor circulation. Dryness and itching is common. Wounds may develop over bony prominences.

  • SSRI antidepressants
  • Anti-anxiety medications
  • Psychostimulants

Medications may help relieve the underlying conditions that increase symptoms by improving mood and thinking.

Psychostimulants have proven helpful in studies to help treat binge-eating disorder and maintain weight.

Some medications may be given to curb appetite so that cognitive behavior therapy may be more effective.

  • Provide education for clients and family members regarding disease, treatment and support resources

Help client and family members make informed decisions and reduce stress and anxiety about treatments. Provide opportunity for continued support and therapy for optimal recovery.

  • https://www.opalfoodandbody.com/wp-content/uploads/2016/01/summary-of-dsm-5.pdf
  • https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml
  • https://npwomenshealthcare.com/continuing-education-practical-strategies-for-the-diagnosis-and-management-of-binge-eating-disorder/

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Nursing care plan for anorexia nervosa

Nursing care plan for anorexia nervosa

Table of Contents

Introduction to Anorexia Nervosa

Anorexia Nervosa is an eating disorder characterized by a fear of gaining weight, abnormal levels of body fat, and a strong desire to be thin. It can affect both men and women of all ages. People with anorexia nervosa may also experience changes in their thinking patterns, moods, and behavior. This disorder can have serious health impacts, such as malnutrition and organ failure.

Assessment of Anorexia Nervosa

  • Weight Changes . An individual may be significantly underweight, losing large amounts of weight over short periods, or experiencing a prolonged period of weight loss.
  • Body Image Distortion . A person can have an unrealistic perception of their body size and shape which can result in an aversion to being seen in public. They may also try to hide their body.
  • Restrictive Eating Habits . People may have excessive rigid rules about what and how much they eat, such as avoiding certain foods because of their calorie or fat content.
  • Fatigue . Feeling tired and weak, particularly after meals.
  • Poor Concentration . An individual may struggle to focus on tasks, retain information, and feel overwhelmed.

Nursing Diagnosis for Anorexia Nervosa

  • Nutrition : Imbalanced, less than body requirements related to decreased intake of food.
  • Activity Intolerance : Related to physical and psychological effects of malnutrition.
  • Emotional Disturbance : Experienced in response to body image and self-evaluation.
  • Disturbed Personal Identity : Dysfunctional components of self-concept creation influenced by body image.
  • Social Interaction : Ineffective related to difficulty in creating authentic relationships.

Outcomes for Anorexia Nervosa

  • The patient will gain weight to normal body mass index.
  • The patient will display improved physical and psychological well-being.
  • The patient will demonstrate increased self-esteem.
  • The patient will display improved social interactions.
  • The patient will display improved body image.

Interventions for Anorexia Nervosa

  • Increase patient understanding of healthy nutrition.
  • Assess and monitor food and beverage intake.
  • Provide nutritious snacks between meals.
  • Encourage structured exercise program.
  • Assist patient in setting realistic goals.
  • Refer patient to mental health professional.
  • Instruct patient on relaxation techniques.
  • Encourage positive self-talk.

Rationales for Anorexia Nervosa

  • Increasing patient’s understanding of nutrition will foster awareness and education on the importance of balanced nutrition for health optimization.
  • Assessment and monitoring of food and fluids will provide baseline data used to compare future intake.
  • Nutritious snacks will help provide adequate calories and nutrition throughout the day.
  • Structured exercise will help increase mobility and improve overall physical health.
  • Realistic goal setting will assist the patient to focus on positive accomplishments and reduce potential for negative thoughts and behaviors.
  • Mental health referral will provide the patient with additional support from a professional in managing Anorexia Nervosa.
  • Relaxation techniques will teach the patient methods to reduce stress levels.
  • Positive self talk will reinforce a positive self image, reduce fear and depression, and increase overall well-being.

Evaluation of Anorexia Nervosa

At the end of the nursing care plan, the patient should have achieved the desired outcomes of: improved physical and psychological well-being; increased self-esteem; improved social interactions; and improved body image.

Conclusion to Nursing Care Plan for Anorexia Nervosa

A nursing care plan for individuals with Anorexia Nervosa should encompass interventions aimed at promoting nutrition, physical activity, emotional health, and positive self-image. By providing holistic care, the patient can safely and effectively transition toward recovery.

FAQs about Anorexia Nervosa

  • What is Anorexia Nervosa? Anorexia Nervosa is an eating disorder characterized by a fear of gaining weight, abnormal levels of body fat, and a strong desire to be thin.
  • What are the symptoms of Anorexia Nervosa? Common symptoms include weight changes, changes in body image, restrictive eating habits, fatigue, poor concentration, and emotional distress.
  • What are the nursing interventions for Anorexia Nervosa? Interventions may include increasing patient’s understanding of healthy nutrition, assessing and monitoring food and drink intake, providing nutritious snacks, encouraging structured exercise program, assisting patient in setting realistic goals, referring patient to mental health professional, instructing patient on relaxation techniques, and encouraging positive self-talk.
  • How can Anorexia Nervosa be effectively managed? Anorexia Nervosa can be managed effectively through a comprehensive, holistic approach that incorporates interventions discussed above.
  • What is the expected outcome of an effective care plan for Anorexia Nervosa? The patient should achieve improved physical and psychological well-being; increased self-esteem; improved social interactions; and improved body image.

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Imbalanced Nutrition Nursing Care Plan and Management

anorexia nervosa nursing care plan

In this nursing care plan and management guide, learn how to provide care for patients with with nutritional imbalance or nutritional deficits. Gain knowledge on nursing assessment , interventions, goals, and nursing diagnosis specific to imbalanced nutrition by referring to this comprehensive guide.

Table of Contents

What is nutritional imbalance, nursing assessment and rationales, nursing interventions and rationales, 5 diseases-classified diets nurses could teach patients, recommended resources, references and sources.

Like a machine, the body needs to be supplied with the right kind and the right amount of fuel. Nutrients we ingest through food should be in adequate amounts to essentially meet our body’s metabolic demands. An imbalance in the nutritional needs of a person occurs when the individual’s metabolic and nutritional demands are not sufficiently supplied.

Evidence shows that poor nutritional status leads to prolonged hospital stays, decreased quality of life, and increased morbidity and mortality (Stratton et al., 2006; Wakahara et al., 2007; Sorensen et al., 2008). In addition, the economic impact of disease-related malnutrition has a significant bearing: the estimated cost of treatment for a patient with nutritional risk was 20% higher than the average cost of treating the same disease in a patient without nutritional risk (Amaral et al., 2007). 

Several diseases can greatly affect the nutritional status of an individual, this includes but not limited to gastrointestinal malabsorption, burns , cancer ; physical factors (e.g., activity intolerance , pain , substance abuse ); social factors (e.g., economic status, financial constraint); psychological factors (e.g., dementia , depression , grieving ). In certain conditions such as trauma, sepsis , surgery , and burns , adequate nutrition is vital to healing and recovery. Also, religious and cultural factors can influence the food habits of clients. 

Routine assessment is needed to identify potential problems that may have led to nutritional imbalance and identify any circumstances affecting nutrition that may transpire during nursing care.

1. Determine real, exact body weight for age and height. Do not estimate. The first and vital step in an anthropometric assessment is to measure an individual’s weight accurately using a scale. Weight is used as a basis for caloric and nutritional requirements. When a person loses weight unintentionally, it can be an indicator of poor health and an inability of the body to fight off infection . Also, when a person gains weight, it can indicate poor nutritional practices or a side effect of a medication they might be taking (Padilla et al., 2021). 

  • In pregnant women , having low pre-pregnancy weight and inadequate weight gain can indicate growth problems and potential low birth weight for babies.
  • For newborns , they are weighed with the use of balance scales or digital scales. Infants born weighing less than 5 pounds, 8 ounces (2,500 grams) are thought to have a low birth weight. An average newborn typically weighs about 8 pounds. Low-birth-weight infants may be healthy even though they are small. But low-birth-weight infants can also have various serious health problems. Newborns are weighed so frequently after birth because weight is an excellent indicator of nutritional health in infants.

2. Determine the patient’s height. An individual’s height is not commonly indicative of their health on its own. Nevertheless, when combined with their weight, it can reveal a lot about their health in terms of how much they weigh, likened to how tall they are. Thus, taller individuals will typically weigh more than shorter ones, so the proportions of the measurements have to be considered (Padilla et al., 2021). A person’s height is measured using a measuring tape. 

3. Determine the patient’s body mass index (BMI). BMI is determined by combining two anthropometric variables: weight in kilograms (kg) and height in square meters (m 2 ). A high BMI can indicate too much fat on the body, while a low BMI can indicate too little fat on the body. The higher an individual’s BMI, the greater their chances of developing certain serious conditions, such as heart disease, high blood pressure, and diabetes . A very low BMI can signify various health problems, including anemia , decreased immune function, and bone loss  (Padilla et al., 2021).

Calculating for the BMI: 

BMI is calculated the same way for people of all ages. However, BMI is interpreted differently for adults and children. The formula is BMI = kg/m2, where kg is a person’s weight in kilograms and m2 is their height in meters squared.

Body Mass Index for Adults

Adults aged 20 and older can interpret their BMI based on standard weight status categories. These are the same for men and women of all ages and body types (CDC, 2000).

Body Mass Index for Children

BMI is interpreted differently for people under age 20. BMI is age- and sex-specific for children and teens and is often considered BMI-for-age. A high amount of body fat in children can lead to weight-related diseases and other health issues. Being underweight can also put one at risk for health issues (CDC, 2000).

Body mass index-for-age percentiles for boys 2 to 20 years Body mass index-for-age percentiles for girls 2 to 20 years

Children’s anthropometric data reflect growth and development, general health status, and dietary adequacy over time. In adults, body measurement data are used to assess and evaluate disease risk, body composition changes, and health and dietary status over the adult lifespan (McDowell et al., 2008).

Other anthropometric measurements are head circumference, somatotype, and body circumferences to assess adiposity (waist, hip, and limbs) and skinfold thickness. Typical equipment list required to obtain anthropometric measurements includes weight scale, calibration weights, stadiometer, knee caliper, skinfold calipers, non stretchable tape measure, and infantometer to measure the recumbent length (Casadei & Kiel, 2020).

4. Assess the patient’s nutritional risk using nutritional risk screening tools. Nutritional risk screening tools are very useful in the everyday routine to detect potential or manifest malnutrition in a timely method. At least 33 different nutritional risk screening tools exist. Still, the three most common are the Nutritional Risk Screening 2002 (NRS-2002) for the inpatient setting, the Malnutrition Universal Screening Tool (MUST) for the ambulatory setting, and the Mini Nutritional Assessment (MNA) for institutionalized geriatric patients (Reber et al., 2019).

  • 4.1. The Nutritional Risk Screening 2002 (NRS-2002). This is the most common nutritional risk screening tool used in hospitals. It incorporates pre-screening with four questions. In case of a positive outcome in one of the questions, a screening pursues, which has surrogate measures of nutritional status, with static and dynamic parameters and data on the severity of the disease (stress metabolism).
  • 4.2. The Malnutrition Universal Screening Tool (MUST). This nutritional risk screening tool was designed to determine malnourished individuals in all care settings (hospitals, nursing homes, home care, etc.). It was the basis for the NRS-2002.
  • 4.3. The Mini Nutritional Assessment Short-Form (MNA). This nutritional risk screening tool is most often used in standardized geriatric patients by incorporating screening and assessment features. Unlike the NRS-2002, the MNA comprises different components (altered sense of taste and smell, loss of appetite, loss of thirst, frailty, depression) usually suitable for the nutritional status of older people.

You can learn more about these tools via the Nutritional Risk Screening and Assessment page . 

5. Assess the patient’s nutritional status. Assessment of the nutritional status should be conducted in patients identified as at nutritional risk following the screening for risk of malnutrition. Assessment allows the nurses and health care providers to collect more information and perform a nutrition-focused physical examination to distinguish if there is a nutrition issue, identify the problem, and determine the severity (Reber et al., 2019).

  • 5.1. The Subjective Global Assessment (SGA). This is the most common tool used in assessing the nutritional status. It contains data on medical history (dietary intake change, weight loss, gastrointestinal and functional impairment) and physical examination ( muscle wasting, loss of subcutaneous fat, ascites, ankle edema , and sacral edema). Each patient is classified as: well-nourished (SGA-A), moderately or suspected of being malnourished (SGA-B), or severely malnourished (SGA-C).

6. Assess the patient’s eating pattern. A thorough understanding of the patient’s eating pattern will provide the health care team baseline data, understand what interventions might be helpful, and aid in determining nutritional risk and worsening nutritional status. A study revealed that girls and women with type 1 diabetes have increased rates of disturbed eating behaviors and clinically significant eating disorders than their nondiabetic counterparts (Goebel-Fabbri, 2009).

7. Assess the patient’s food choices by taking a nutritional history with the participation of significant others. Aside from physical assessment, a comprehensive understanding of the patient’s nutritional history is necessary to determine the degree of malnutrition accurately, if present, and metabolic energy needs. It is necessary to assess their usual daily food intake before improving patients’ dietary habits or offering them nutritional guidance. Also, taking a nutrition history will heighten patients’ awareness of nutritional health (Hark & Deen, 1999). The nurse can ask questions like: 

  • How many meals and snacks do you eat in 24 hours ? A good way to begin is to ask patients what they consume during the day and night to assess their overall intake. This information will also reveal irregular eating habits.
  • How often do you eat high-fiber foods such as cereals, fruits, and vegetables? According to the American Cancer Society, at least five servings of fruits and vegetables and at least one serving of a fiber-rich cereal every day.  Unfortunately, the National Health and Nutrition Examination Survey (NHANES) revealed only 23 percent of Americans eat five or more servings of fruits and vegetables every day.
  • How often do you usually consume dairy products, and what type? Because of calcium ‘s pivotal role in the normal development of healthy bones , NHANES III data revealed that most Americans do not consume adequate calcium and that older adults and teenagers have the greatest risk for a low calcium intake.
  • What types of food and beverages do you usually consume in a day? Does the patient eat poultry products, fish, desserts, sweets, or consumes enough water in a day? Aside from food, a lack of fluid intake plays a fundamental role in a patient’s nutritional status.

The nurse plays an integral role in collecting these data. Although there is no single test to determine malnutrition, the utilization of a complete nutritional assessment is the most useful tool to identify and treat malnutrition properly. Family members may provide more accurate details on the patient’s eating habits, especially if the patient has altered perception .

8. Compare usual food intake to USDA Food Pyramid, noting slighted or omitted food groups. The United States Department of Agriculture (USDA) created the food pyramid in 1992. It was called the “Food Guide Pyramid” or “Eating Right Pyramid.” It was updated in 2005 to “MyPyramid.” The new food pyramid was eventually replaced in 2011 by the USDA’s “MyPlate.” This colorful plate is divided into four sections — one for fruit, veggies, protein, and grains, and has a circle for dairy in the corner. In a study, MyPlate guidelines have been available to the public since it was updated, and findings of this study show that the guidelines influenced the food choices of at least 40% of the participants. It could be inferred that public awareness and use of MyPlate guidelines will grow over time (Uruakpa et al., 2013).

9. Ascertain etiological factors for decreased nutritional intake. Several factors may affect the patient’s nutritional intake, so it is vital to assess properly. Ambulatory patients with nutritional problems such as weight loss may be experiencing difficulties unrelated to disease. Patients with dentition problems need a referral to a dentist. It may also be related to mastication or swallowing food, or there may be underlying depression or a lack of social interaction. At the same time, patients with memory losses may need services like Meals on Wheels. Other medications also affect the appetite of the patient. All these factors can reduce voluntary intake, are remediable, and should be considered in patients suspected of having nutritional problems. Based on a study, patients with heart failure most often rated as affecting food intake were anxiety , fatigue , sadness, shortness of breath , nausea , decreased hunger sensations, and diet restrictions. Healthy elders rated factors most often as affecting food intake were eating alone, reduced hunger sensations, early satiety, and decreased senses of taste and smell. Among patients with heart failure, many factors distinctive from those present due to age were reported to affect food intake (Lennie et al., 2006). 

10. Look for physical signs of poor nutritional intake. The patient encountering nutritional deficiencies may resemble to be sluggish and fatigued. Other manifestations include decreased attention span, confused, pale and dry skin, subcutaneous tissue loss, dull and brittle hair , and red, swollen tongue and mucous membranes. Vital signs may show tachycardia and elevated BP. Paresthesias may also be present. Other signs that may indicate poor nutrition include: 

  • Iron Deficiency . If patients’ iron levels are low, they may frequently experience headaches, dizziness, and chills. If they have a thyroid disorder, it can make their muscles weak. Painful joints and paleness, and dryness of skin may also be present. Too little iron can also cause hair to fall out or stop growing.
  • Vitamin A Deficiency. If a person doesn’t take in enough vitamin A, night vision and the sharpness of sight could deteriorate over time.
  • Vitamin B1, B2, & B6 Deficiency. Dandruff, seborrheic dermatitis , mouth ulcers such as canker sores, and angular cheilitis may indicate deficiencies in thiamine (vitamin B1), riboflavin (vitamin B2), and pyridoxine (vitamin B6).
  • Vitamin B3 Deficiency. Niacin (vitamin B3) is necessary for keeping hair healthy. Alopecia, a condition in which hair falls out in small patches, is one possible symptom of niacin deficiency.
  • Vitamin B7 Deficiency. Biotin (vitamin B7) is another B vitamin that, when deficient, may be related to hair loss.
  • Folate Deficiency. Folate is the natural form of folic acid (vitamin B9) specifically necessary for women of childbearing age. Symptoms of a folate deficiency include irritability, diarrhea , fatigue, poor growth, and a smooth, tender-feeling tongue.
  • Vitamin B12 Deficiency. Vitamin B12 deficiency can create burning sensations in the feet or tongue, mild cognitive impairment , and changes in memory, thinking, or behavior. Over time, B12 deficiency can permanently damage the nervous system , traveling up the spine and into the brain.
  • Calcium Deficiency. Calcium deficiency could cause arrhythmia or irregular heartbeat and even lead to chest pains. A person who might not be getting enough calcium is muscle cramps, tingling fingers, muscle twitching, and fractures.
  • Magnesium Deficiency. The primary symptoms of severe magnesium deficiency include migraines, abnormal heart rhythm, restless leg syndrome , fatigue, and muscle cramps.
  • Potassium Deficiency. Symptoms of a deficiency include abnormal heart rhythm or palpitations, tingling and numbness, muscle weakness, muscle twitching, muscle cramps, constipation , and an a.
  • Vitamin C Deficiency. When brushing and flossing, individuals with vitamin C deficiency experience redness, swelling , and bleeding gums. Another sign might be that they bruise easily.
  • Vitamin D Deficiency. If a patient feels weak and has pain in the bones, the individual might be deficient in vitamin D.
  • Zinc Deficiency. Zinc is necessary for protein synthesis and cell division, two processes needed for hair growth. As such, zinc deficiency may cause hair loss.

Awareness of these history and physical examination elements can help physicians, dietitians, nurses, and pharmacists to provide optimal care for these patients (Jensen & Binkley, 2002).

11. Note the patient’s perspective and feeling toward eating and food. Various psychological, psychosocial, religious, and cultural factors determine the type, amount, and appropriateness of food utilized. A study concerning anorexia nervosa, bulimia nervosa, binge eating disorder , and obesity without eating disorders in female patients revealed that anorexia and bulimia nervosa patients presented more dysfunctional eating attitudes, whereas obese and binge eating disorder patients presented interesting differences. Similarities and differences support an individualized therapeutic approach for eating disorders and obese patients (Alvarenga et al., 2014). For example, individuals with anorexia nervosa demonstrate a severe engagement in behaviors to reduce their weight, which leads to severe underweight status (Keating et al., 2012).

12. Evaluate the environment in which eating happens. Most adults find themselves “eating on the run” or relying massively on fast foods with lower nutritional components. A study indicated that a high activity level causes people to prefer something instant. Fast food is extremely easy to get and does not demand a long time to be served. Most fast foods are high in calories, cholesterol , fat, and salt but low in fiber (Widyantara et al., 2014). Older people living independently may not have the drive to prepare meals for themselves. Availability of services that can be supplemented by family or community, or subscribing to a meal plan, might greatly influence their food intake. The need for a different environment would be highlighted if the services were unavailable.

13. Assess the patient’s ability to obtain and use essential nutrients. Several factors may affect the patient’s nutritional intake, so it is necessary to assess accurately. Cases of vitamin D deficiency rickets have been reported among dark-skinned infants and toddlers who were exclusively breastfed and were not given supplemental vitamin D (Ziegler et al., 2006).

14. Review laboratory values that indicate well-being or deterioration. Laboratory tests play a significant part in determining the patient’s nutritional status. An abnormal value in a single diagnostic study may have many possible causes.

  • 14.1. Serum albumin. This determines the degree of protein reduction (2.5 g/dl signifies severe diminution; 3.8 to 4.5 g/dl is normal).
  • 14.2. Transferrin. This is vital for iron transfer and typically decreases as serum protein decreases.
  • 14.3. RBC and WBC. These values frequently drop during malnutrition, indicating anemia , and reduced resistance to infection. Having anemia lacks enough healthy red blood cells to carry adequate oxygen to the body’s tissues which can make a person feel tired and weak. And when the WBC count is very low, the health care team may need to take steps to avoid an infection.
  • 14.4. Serum electrolyte values. Potassium is typically elevated, and sodium is typically lowered in malnutrition.

This care plan addresses general concerns related to nutritional deficits in the hospital or home setting.

1. Ascertain healthy body weight for age and height. Refer to a dietitian for a complete nutrition assessment and methods for nutritional support. Experts like a dietician can determine nitrogen balance as a measure of the patient’s nutritional status. A negative nitrogen balance may mean protein malnutrition. The dietician can also determine the patient’s daily requirements of specific nutrients to promote sufficient nutritional intake.

2. Set appropriate short-term and long-term goals. Patients may lose concern in addressing this dilemma without realistic short-term goals.

3. Provide a pleasant and quiet environment. A pleasing atmosphere helps in decreasing stress and is more favorable for eating. A quiet and nondistracting environment can help the patient focus on eating. 

4. Promote proper positioning . Elevating the head of the bed 30 degrees aids in swallowing and reduces the risk for aspiration with eating.

5. Provide good oral hygiene and dentition. Oral hygiene has a positive effect on appetite and the taste of food. Dentures need to be clean, fit comfortably, and be in the patient’s mouth to encourage eating.

6. If the patient lacks strength, schedule rest periods before meals and open packages and cut up food for the patient. Nursing assistance with activities of daily living (ADLs) will conserve the patient’s energy for activities the patient values. Patients who take longer than one hour to complete a meal may require assistance.

7. Provide companionship during mealtime. Attention to the social perspectives of eating is important in hospital and home settings.

8. Consider seasoning for patients with changes in their sense of taste, if not contraindicated. Seasoning may improve the flavor of the foods and attract eating.

9. Consider six small nutrient-dense meals instead of three larger meals daily to lessen the feeling of fullness. Eating small, frequent meals lessens the feeling of fullness and decreases the stimulus to vomit.

10. Link usual food intake to USDA Food Pyramid, noting slighted or omitted food groups. The Food Guide Pyramid emphasizes the importance of balanced eating. The omission of entire food groups increases the risk of deficiencies.

11. For patients with physical impairments, refer to an occupational therapist for adaptive devices. An expert may provide special devices that can help patients feed themselves.

12. For patients with impaired swallowing , coordinate with a speech therapist for evaluation and instruction. A speech therapist may provide adjustments to the thickness and consistency of foods to improve nutritional intake.

13. If the patient is a vegetarian, evaluate if obtaining sufficient amounts of vitamin B12 and iron. Strict vegetarians may be at particular risk for vitamin B12 and iron deficiencies. Proper care should be taken when implementing vegetarian diets for pregnant women, infants, children, and the elderly .

14. Determine the time of day when the patient’s appetite is at its peak. Offer the highest calorie meal at that time. Patients with liver disease often have their largest appetite at breakfast time.

15. Encourage family members to bring food from home to the hospital. Patients with specific ethnic or religious preferences or restrictions may not consider foods from the hospital.

16. Offer high protein supplements based on individual needs and capabilities. Such supplements can increase calories and protein without conflict with voluntary food intake.

17. Offer liquid energy supplements. Energy supplementation has been shown to produce weight gain and reduce falls in frail elderly living in the community.

18. Discourage caffeinated or carbonated beverages. These beverages can spoil the patient’s appetite by decreasing hunger and can lead to early satiety. 

19. Keep a high index of suspicion of malnutrition as a causative factor in infections. Impaired immunity is a critical adjunct factor in malnutrition-associated infections in all age groups.

20. Encourage exercise. Metabolism and utilization of nutrients are improved by activity. See Activity Intolerance nursing diagnosis.

21. Consider the possible need for enteral or parenteral nutritional support with the patient, family, and caregiver , as appropriate. Nutritional support may be recommended for patients who cannot maintain nutritional intake by the oral route. If the gastrointestinal tract is functioning well, enteral tube feedings are indicated. For those who cannot tolerate enteral feedings, parenteral nutrition is recommended.

22. Validate the patient’s feelings regarding the impact of current lifestyle, finances, and transportation on the ability to obtain nutritious food. Validation lets the patient know that the nurse has heard and understands what was said, promoting the nurse-patient relationship .

23. Once discharged, help the patient and family identify areas to change that will make the greatest contribution to improved nutrition. Change is difficult. Multiple changes may be overwhelming.

24. Adapt modification to their current practices. Accepting the patient’s or family’s preferences shows respect for their culture.

As nurses, we are responsible for the well-being of our patients. That means that we should mind what they feel, how they look, what they eat, and how they are doing. Holistic care is a forte of nurses that no other care provider could imitate. We are used to focusing on disease prevention practices and treatments at hospitals, but what can we do for patients who are about to be discharged? Other than the common hospital diets you could teach , here are five disease-classified meals that would surely keep the patient out of the grasp of certain lifestyle diseases that affect the humanity today.

Inflammatory bowel disease is a condition wherein inflammatory and ulcerative lesions line the small intestine or colon . This disease of the gastrointestinal system is chronic and has two types: Crohn’s disease and ulcerative colitis. Inflammatory bowel diseases cause nutrient deficiencies and fluid imbalances, giving the patient a hard time in determining what kind of food he or she could eat to make up for the loss of nutrients that severe diarrhea , a common manifestation in both of the types, can cause.

Nutrition Matters

The most common concern for patients with IBD is malnutrition. The abdominal pain, nausea, and diarrhea discourage the patient from eating. Teach your patient to:

  • Consume a diet high in protein and calories to aid healing and promote weight gain.
  • Serve a low residue diet to restrict more fiber and residue. They reduce the frequency and volume of the stool .
  • For breakfast, you could teach your patient to consume a glass of apple juice, cream of rice, scrambled eggs, toast with butter and jelly, and ½ cup of milk.
  • For lunch, the patient could have tomato juice, turkey sandwich on white bread, canned peach halves, gelatin, and ½ cup of milk.
  • For dinner, a diet of roasted chicken, mashed potatoes, cooked carrots, French bread with butter, rice pudding, cranberry juice and ½ cup of milk would be sufficient to aid in weight gain but minimize diarrhea associated with this disease.
  • For snacks, the patient could opt for Melba toast and ½ cup of milk.
  • The patient could include meat, poultry, fish, eggs, and milk, fruit and vegetables juices without the pulp, bread, cereals, and ice cream.

Particulars of the Disease

Most often called the silent killer; hypertension is a consistent blood pressure that never goes below 140/90 mmHg, only higher. Inability to control or maintain a normal blood pressure risks the patient to increase chances of heart failure and MI.

One of the factors that increase the risk of developing hypertension is a high sodium diet. For people who had already existing hypertension , here are tips to reduce the sodium  you consume:

  • Read the labels on your food containers.
  • Only use products with reduced sodium or no salt added.
  • To enhance the flavors when cooking, use spices, herbs, oils, and lemon to add food flavor.
  • Rinse canned foods to remove more sodium.
  • Eat fresh foods because processed foods contain a high amount of sodium.
  • 7 to 8 servings of grains and grain products
  • 4 to 5 servings of vegetables
  • 4 to 5 servings of fruit
  • 2 to 3 servings of low-fat or fat-free dairy food
  • 2 or fewer servings of meat, fish, and poultry
  • 4 to 5 servings per week of nuts and seeds
  • 5 servings of sweets per week
  • 2 to 3 servings of fat and oils

Chronic renal failure is an irreversible and progressive condition which is the result of the loss of kidney function. This is a sudden onset of the destruction of the nephrons that leads to irreversible kidney damage.

The daily protein requirements are 0.8-1g/kg. These should be foods like beef, fish milk, poultry, pork and egg whites. This is to prevent weight loss and protein catabolism. Here are some considerations for the diet of the patient:

  • Limit sodium intake to 3 to 4g/day.
  • Consume potassium according to the level of serum potassium in the body.
  • To add flavor to the patients food, use spices instead of salt.
  • Avoid processed foods. It is much better to bake, broil and grill the patient’s food.
  • When dining out, avoid meats with gravies and sauces.
  • Avoid salads with dressings; opt for a serving of cooked vegetables without sauce.
  • Ensure appropriate calcium intake of 800 to 1, 500 mg daily.

Diabetes mellitus is a chronic disease that affects the insulin status of the body. It could be either insulin deficiency or resistance which disturbs protein, carbohydrate, and fat metabolism, leading to hyperglycemia . Almost 16 million people and counting are affected by this disease.

The diet plan must meet the needs of the patient’s nutrition by controlling the blood glucose level and maintaining an appropriate weight. Proper diet is the cornerstone of treatment. Here are guidelines to follow for type 1 and 2 diabetes patients:

  • Sugar can be used, but use it cautiously.
  • Eat lean protein foods. A patient needs 85g of protein daily or one meat serving that’s about the size of a deck of playing cards.
  • Eat 20 to 35g of fiber daily.
  • Limit cholesterol intake to 300mg/day.
  • Eat a lot of fresh fruits and vegetables.
  • For breakfast, the patient can have 2 slices of whole wheat toast,  a tsp of olive oil, ¼ cup egg white omelet, ½ cup cooked oatmeal, and ½ cup apple juice.
  • For lunch, serve turkey sandwich (whole wheat bread and low-fat cheese), 1 apple, 28g bag of baked chips, I glass of water
  • For an afternoon snack, a bunch of carrot sticks would do, and for a bedtime snack, ¼ cup low-fat cottage cheese and ½ cup canned fruits in its juice.
  • For dinner, 2 cups cooked spaghetti, 1 cup spaghetti sauce, 57g lean ground beef, 1 cup salad with 1 tomato, 1 slice garlic bread, and 8oz of water.
  • Small, frequent, and nutritious meals are a must for diabetic patients.

Epilepsy or most commonly known as seizure disorder is a brain condition characterized by recurrent seizures . These are associated with abnormal electrical charges of neurons that trigger convulsive movements.

Some patients with seizure disorders could not attain control with the use of medications. They are prescribed with a ketogenic diet together with their medications. This intervention is most effective among children. A study conducted revealed that increased blood ketone levels reduce the incident of seizure activity. Here is an example of a ketogenic diet for the patient.

  • For breakfast, scrambled eggs with butter diluted cream, and orange juice.
  • For lunch, spaghetti squash with butter and parmesan cheese, lettuce leaf with mayonnaise, and orange diet soda mixed with whipped cream.
  • For dinner, hotdog slices with sugar-free ketchup, asparagus with butter, and chopped lettuce with mayonnaise.
  • For snacks, the patient can have sugar free vanilla ice cream
  • Servings for the food could be calculated by a dietitian, so it would be best for the family to work out the diet with a dietitian.
  • The diet should be supplemented with calcium, a sugar-free and lactose-free multivitamin, and fluoride.
  • The key to success would be the family’s understanding of the dietary teachings.

Recommended nursing diagnosis and nursing care plan books and resources.

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy .

Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.

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Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition) Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.

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Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

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Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care  Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

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All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health   Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.

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Other recommended site resources for this nursing care plan:

  • Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ! Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
  • Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.

You can use these journals and books for your background reading about imbalances in nutrition .

  • Amaral, T. F., Matos, L. C., Tavares, M. M., Subtil, A., Martins, R., Nazare, M., & Pereira, N. S. (2007). The economic impact of disease-related malnutrition at hospital admission. Clinical nutrition, 26(6), 778-784. https://doi.org/10.1016/j.clnu.2007.08.002
  • Ann E. Goebel-Fabbri (2009). Disturbed eating behaviors and eating disorders in type 1 diabetes: Clinical significance and treatment recommendations., 9(2), 133–139. https://doi.org/10.1007/s11892-009-0023-8  
  • Casadei, K., & Kiel, J. (2020). Anthropometric measurement. StatPearls [Internet].
  • Centers for Disease Control and Prevention (2000).  https://www.cdc.gov/growthcharts/cdc_charts.htm  
  • Charlotte Keating; Alan J. Tilbrook; Susan L. Rossell; Peter G. Enticott; Paul B. Fitzgerald (2012). Reward processing in anorexia nervosa. , 50(5), 567–575. https://doi.org/10.1016/j.neuropsychologia.2012.01.036  
  • Cooten, M. H., Bilal, S. M., Gebremedhin, S., & Spigt, M. (2018). The association between acute malnutrition and water, sanitation, and hygiene among children aged 6–59 months in rural Ethiopia. Maternal & Child Nutrition, 15(1). https://doi.org/10.1111/mcn.12631  
  • Hark, L., & Deen, D. (1999). Taking a nutrition history: a practical approach for family physicians. American Family Physician, 59(6), 1521. https://www.aafp.org/afp/1999/0315/p1521.html  
  • Jensen, G. L.; Binkley, J.  (2002). Clinical Manifestations of Nutrient Deficiency. Journal of Parenteral and Enteral Nutrition, 26(5 Suppl), S29–S33. https://doi.org/10.1177/014860710202600509      
  • Kyle, U. G., & Coss-Bu, J. A. (2010). Nutritional assessment and length of hospital stay. Canadian Medical Association Journal, 182(17), 1831–1832. https://doi.org/10.1503/cmaj.101256  
  • Lennie, T. A., Moser, D. K., Heo, S., Chung, M. L., & Zambroski, C. H. (2006). Factors influencing food intake in patients with heart failure: a comparison with healthy elders. Journal of Cardiovascular Nursing, 21(2), 123-129. https://doi.org/10.1097/00005082-200603000-00008  
  • McDowell, M. A., Fryar, C. D., Ogden, C. L., & Flegal, K. M. (2008). Anthropometric reference data for children and adults: United States, 2003–2006. National health statistics reports, 10(1-45), 5. http://ghk.h-cdn.co/assets/cm/15/11/550017f045e74_-_nhsr010.pdf  
  • Padilla, C. J., Ferreyro, F. A., & Arnold, W. D. (2021). Anthropometry as a readily accessible health assessment of older adults. Experimental Gerontology, 153, 111464. https://doi.org/10.1016/j.exger.2021.111464  
  • Reber E, Gomes F, Vasiloglou MF, Schuetz P, Stanga Z. Nutritional Risk Screening and Assessment. J Clin Med. 2019;8(7):1065. Published 2019 Jul 20. https://doi.org/10.3390/jcm8071065  
  • Sorensen, J., Kondrup, J., Prokopowicz, J., Schiesser, M., Krähenbühl, L., Meier, R., … & EuroOOPS Study Group. (2008). EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome. Clinical nutrition, 27(3), 340-349.
  • Stratton, R. J., King, C. L., Stroud, M. A., Jackson, A. A., & Elia, M. (2006). ‘Malnutrition Universal Screening Tool’predicts mortality and length of hospital stay in acutely ill elderly. British journal of nutrition, 95(2), 325-330. https://doi.org/10.1079/BJN20051622
  • Uruakpa, F. ., Moeckly, B. G., Fulford, L. D., Hollister, M. N., & Kim, S. (2013). Awareness and use of MyPlate Guidelines in Making Food Choices. Procedia Food Science, 2, 180–186. https://doi.org/10.1016/j.profoo.2013.04.026  
  • Wakahara, T., Shiraki, M., Murase, K., Fukushima, H., Matsuura, K., Fukao, A., … & Moriwaki, H. (2007). Nutritional screening with Subjective Global Assessment predicts hospital stay in patients with digestive diseases. Nutrition, 23(9), 634-639. https://doi.org/10.1016/j.nut.2007.06.0053
  • ​​Widyantara, K. I. S., Zuraida, R., & Wahyuni, A. (2014). The relation of fast-food eating habits, physical activity , and nutrition knowledge with the nutritional status of first-year medical student of University of Lampung 2013. Medical Journal of Lampung University, 3(3), 77-85. http://repository.lppm.unila.ac.id/20407/  
  • Ziegler, E. E., Hollis, B. W., Nelson, S. E., & Jeter, J. M. (2006). Vitamin D deficiency in breastfed infants in Iowa. Pediatrics, 118(2), 603-610. https://doi.org/10.1542/peds.2006-0108  

5 thoughts on “Imbalanced Nutrition Nursing Care Plan and Management”

Thank you so much for this useful information I was able to be helped as I needed

Thank you for the information!

This is really hard if it’s for a newborn but still quite helpful.

Hi, will try to update this care plan with interventions for newborns. :)

Excellent! This site has been really helpful. Thank you.

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13.4 Applying the Nursing Process to Eating Disorders

People with eating disorders may appear healthy even when they are very ill. Additionally, individuals with anorexia nervosa often do not view their behavior as a problem. They are typically only seen in health care settings due to concerned family or friends who encourage them to seek treatment. Conversely, individuals with bulimia nervosa or binge eating disorder may feel shame and sensitivity to the perceptions of others regarding their illness. Therefore, it is vital for the nurse to build a therapeutic nurse-patient relationship with clients with eating disorders and empathize with possible feelings of low self-esteem and lack of control over eating. [1]  

This section will apply the nursing process to anorexia and bulimia nervosa.

When assessing an individual with a potential or diagnosed eating disorder, it is vital to obtain their perception of the problem while assessing for signs and symptoms. Care planning that does not address their perspective will not be effective. As previously mentioned, clients with anorexia nervosa often do not perceive their behaviors as a problem, so specialized therapeutic techniques may be required. Review signs and symptoms associated with various eating disorders in the “ Basic Concepts ” section.

Subjective Assessment

A complete nursing assessment includes health history, psychosocial assessment, and screening for risk of suicide or self-harm. Nutritional patterns, fluid intake, and daily exercise should also be assessed. If the client has a binging or purging pattern, the amount of food eaten and/or the frequency of these behaviors should be assessed.

Objective Assessment

Objective assessments include routine weight monitoring and orthostatic vital signs. Common objective assessment findings for individuals with anorexia nervosa and bulimia nervosa are compared in Table 13.4a. Clients with binge eating disorder may have obesity and gastrointestinal symptoms but do not typically have other associated abnormal assessment findings.

Table 13.4a Comparison of Assessment Findings in Anorexia Nervosa and Bulimia Nervosa [2]  

Diagnostic and Lab Work

Laboratory and diagnostic testing are typically performed to rule out thyroid imbalances and to evaluate for potential physiological complications resulting from starvation, dehydration, and electrolyte imbalances. Laboratory testing may include the following [3] :

  • Complete blood count
  • Electrolyte levels
  • Glucose level
  • Thyroid function tests
  • Erythrocyte sedimentation rate (ESR)
  • Creatine phosphokinase (CPK)

Diagnostic testing may include these tests:

  • Electrocardiogram (ECG)
  • Dual energy X-ray absorptiometry (DEXA) to measure bone density

Common nursing diagnoses for individuals diagnosed with anorexia nervosa or bulimia nervosa include these diagnoses [4] :

  • Imbalanced Nutrition: Less Than Body Requirements
  • Risk for Electrolyte Imbalance
  • Risk for Imbalanced Fluid Volume
  • Impaired Body Image
  • Ineffective Coping
  • Interrupted Family Processes
  • Chronic Low Self-Esteem
  • Powerlessness
  • Risk for Spiritual Distress

Outcomes Identification

These are the typical overall treatment goals for individuals with eating disorders [5] :

  • Restoring adequate nutrition
  • Bringing weight to a healthy level
  • Reducing excessive exercise
  • Stopping binge-purge and binge eating behaviors

SMART expected outcomes are individualized for each client based on their established nursing diagnoses and current status. (SMART is an acronym for Specific, Measurable, Attainable/Actionable, Relevant, and Timely.) An example of a SMART expected outcome for an individual hospitalized with anorexia nervosa who is experiencing electrolyte imbalances is:

  • The client will maintain a normal sinus heart rhythm with a regular rate during their hospitalization. [6]

Planning Interventions

Planning depends on the acuity of the client’s situation. As previously discussed, clients are hospitalized for stabilization. Common criteria for hospitalization include extreme electrolyte imbalance, weight below 75% of healthy body weight, arrhythmias, hypotension, temperature less than 98 degrees Fahrenheit, or risk for suicide. [7] After a client is medically stable, the treatment plan includes a combination of psychotherapy, medications, and nutritional counseling. Review the “ Treatment for Eating Disorders ” section for more details.

Implementation

Nurses individualize interventions based on the client’s current clinical status and their phase of treatment. Interventions can be categorized based on the American Psychiatric Nursing Association (APNA) standard for Implementation that includes the Coordination of Care; Health Teaching and Health Promotion; Pharmacological, Biological, and Integrative Therapies; Milieu Therapy ; and Therapeutic Relationship and Counseling . (Review information about these subcategories in the “ Application of the Nursing Process in Mental Health Care ” chapter.) Read nursing interventions for clients with eating disorders categorized by APNA categories in Table 13.4b.

Table 13.4b Examples of Nursing Interventions by APNA Subcategories [8] , [9]

Inpatient Care

If the client is exhibiting risk for suicide, a safety plan should be immediately implemented. Review nursing care for clients with risk for suicide in the “ Application of the Nursing Process in Mental Health Care ” chapter.

Severely malnourished clients may require therapeutic enteral nutrition. Any client with negligible food intake for more than five days is at risk of developing a potentially fatal complication called refeeding syndrome. The hallmark feature of refeeding syndrome is hypophosphatemia but may also involve serious sodium and fluid imbalances; changes in glucose, protein, and fat metabolism; thiamine deficiency; hypokalemia; and hypomagnesaemia. To avoid this syndrome, a thorough nutritional assessment must be performed followed by the slow reintroduction of nutrients and fluids according to evidence-based guidelines. [13]

After resolving acute symptoms, clients with anorexia begin a weight restoration program for incremental weight gain with a treatment goal set for 90% of ideal body weight. Specially trained dieticians assist in developing daily meal plans and caloric intake, and clients are generally weighed two or three times a week to gauge progress. [14]  

Nurses should be aware that clients with bulimia nervosa typically establish a therapeutic nurse-client relationship more quickly than clients with anorexia nervosa. As previously discussed in this chapter, clients with anorexia nervosa often do not view their condition as a disorder and value their obsessive-compulsive behaviors with eating as a way to feel safe and secure and avoid negative feelings. Conversely, clients with bulimia nervosa view their behaviors as problematic and desire help. [15]  

Outpatient Care

Outpatient partial hospitalization is an option for clients who have been medically stabilized. In this setting, clients are in a clinical setting during the day and then go home to practice skills in the afternoon. Outpatient treatment continues if the client maintains a contracted weight, vital signs are within a normal range, and there is an absence of disordered eating behaviors. [16]  

A significant part of the recovery process includes rebuilding relationships with family. Family members or significant others often feel frustrated, powerless, and hopeless because the strategies they previously attempted, such as forcing the client to eat or begging the client to eat, were not successful. The nurse helps with this recovery process by providing education to the client and their loved ones about the illness, treatment, and meal planning. Adaptive coping skills to address disordered thoughts should be reinforced. [17]  

Nurses refer clients and their loved ones to resources as part of discharge planning. Review examples of community resources in the following box.

Resources for Individuals With Eating Disorders

  • National Eating Disorders Association (NEDA) : Support, resources, and treatment options
  • Eating Disorders Resource Group : Resources including treatment apps
  • ANAD : Eating disorder peer support groups

Evaluation is a continuous process of reviewing a client’s progress towards their individualized goals and SMART outcomes. Interventions are continually evaluated and modified based on their success in meeting these short-term goals.

  • Halter, M. (2022). Varcarolis’ foundations of psychiatric-mental health nursing (9th ed.). Saunders. ↵
  • National Institute of Mental Health. (2021, December). Eating disorders . U.S. Department of Health and Human Services. https://www.nimh.nih.gov/health/topics/eating-disorders ↵
  • Ackley, B., Ladwig, G., Makic, M. B., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing diagnosis handbook: An evidence-based guide to planning care (12th ed.). Elsevier. ↵
  • American Nurses Association, American Psychiatric Nurses Association, and International Society of Psychiatric-Mental Health Nurses. (2014). Psychiatric-Mental Health Nursing: Scope and Standards of Practice (2nd ed.). ↵
  • Miller, W. R., & Rollnick, S. (2013) Motivational Interviewing: Helping people to change (3rd ed.). Guilford Press. ↵
  • Froreich, F. V., Ratcliffe, S. E., & Vartanian, L. R. (2020). Blind versus open weighing from an eating disorder patient perspective. Journal of Eating Disorders 8 , 39. https://doi.org/10.1186/s40337-020-00316-1 ↵
  • Mehanna, H. M., Moledina, J., & Travis, J. (2008). Refeeding syndrome: What it is, and how to prevent and treat it. BMJ, 336 , 1495–1498. https://doi.org/10.1136/bmj.a301 ↵

A syndrome in which individuals exhibit hypophosphatemia, sodium and fluid imbalances; changes in glucose, protein, and fat metabolism; thiamine deficiency; hypokalemia; and hypomagnesaemia.

Nursing: Mental Health and Community Concepts Copyright © 2022 by Chippewa Valley Technical College is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

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Treatment of Anorexia Nervosa—New Evidence-Based Guidelines

Gaby resmark.

1 Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Osianderstr. 5, 72076 Tuebingen, Baden-Wuerttemberg, Germany

Stephan Herpertz

2 Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-University Bochum, Alexandrinenstr. 1-3, 55791 Bochum, Nordrhein-Westfalen, Germany; [email protected]

Beate Herpertz-Dahlmann

3 Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of the RWTH Aachen, Neuenhofer Weg 21, 52074 Aachen, Nordrhein-Westfalen, Germany; ed.nehcaaku@ztreprehb

Almut Zeeck

4 Department of Psychosomatic Medicine and Psychotherapy, University Hospital Freiburg, Hauptstr. 8, 79104 Freiburg, Baden-Wuerttemberg, Germany; [email protected]

Anorexia nervosa is the most severe eating disorder; it has a protracted course of illness and the highest mortality rate among all psychiatric illnesses. It is characterised by a restriction of energy intake followed by substantial weight loss, which can culminate in cachexia and related medical consequences. Anorexia nervosa is associated with high personal and economic costs for sufferers, their relatives and society. Evidence-based practice guidelines aim to support all groups involved in the care of patients with anorexia nervosa by providing them with scientifically sound recommendations regarding diagnosis and treatment. The German S3-guideline for eating disorders has been recently revised. In this paper, the new guideline is presented and changes, in comparison with the original guideline published in 2011, are discussed. Further, the German guideline is compared to current international evidence-based guidelines for eating disorders. Many of the treatment recommendations made in the revised German guideline are consistent with existing international treatment guidelines. Although the available evidence has significantly improved in quality and amount since the original German guideline publication in 2011, further research investigating eating disorders in general, and specifically anorexia nervosa, is still needed.

1. Introduction

1.1. anorexia nervosa.

Anorexia nervosa (AN) is a serious illness leading to high morbidity and mortality [ 1 , 2 , 3 , 4 ]. It is characterised by a restriction of energy intake, weight loss, fear of weight gain and distorted body image. According to the diagnostic criteria of the International Classification of Diseases, 11th Revision (ICD-11) [ 5 ] and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) [ 6 ], the resulting malnutrition and low body weight may result in massive impairment to health. Often it takes years for patients with AN to achieve a first remission or to recover permanently. A quarter of adult patients go on to develop an enduring form of the disorder, and one-third of patients continue to suffer from residual symptoms in the long-term. The long-term outcome of adolescent-onset AN is more favourable [ 7 ]. Because of its severe and protracted course, AN represents a high emotional and economic burden for sufferers, carers and the society in general [ 8 , 9 ]. Age of onset peaks in middle to late adolescence, which affects educational and professional development. The consequences of starvation can have a negative impact on bone density, growth, and brain maturation, especially in children and adolescents. Many patients are affected by comorbid psychological diseases, such as depression, anxiety or obsessive–compulsive disorder. Additionally, the ego-syntonic nature of AN leads to a strong ambivalence regarding weight gain and recovery, which complicates and often slows down the recovery process. In light of these factors, treatment of AN remains challenging. To improve patients’ chances of recovery, all individuals dealing with this illness should be well informed about the nature and challenges of treating AN.

1.2. Evidence-Based Treatment Guidelines for Eating Disorders

Evidence-based guidelines have been developed in several countries around the world to guide the treatment of different eating disorders, such as AN. These guidelines have the following aims [ 10 ]:

  • To support all professionals involved in the diagnosis and treatment of eating disorders, as well as sufferers and their relatives, in deciding on adequate measures of care (prevention, diagnosis, therapy and aftercare);
  • To improve health care outcomes;
  • To minimise risks;
  • To increase treatment safety and efficiency;
  • To avoid non-indicated diagnostic and treatment methods.

Further, guidelines can reveal gaps in the health care system [ 11 ] and inspire new paths of research.

Treatment guidelines provide recommendations based on current scientific evidence. In cases where a lack of scientific evidence is available, recommendations are often provided based on expert opinion, influenced by years of clinical experience.

2. The German S3Guideline for the Diagnosis and Treatment of Eating Disorders

2.1. historical development of the s3-guideline.

In 2000, the German Society for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) published a guideline for the diagnosis and treatment of eating disorders in Germany for the first time [ 12 ]. In the same year, a guideline of the German Society of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (DGKJP) was also published [ 13 ]. Both guidelines were developed by expert groups using informal consensus (a representative group of experts from the relevant medical society prepares a recommendation which is adopted by the board of the society, development stage one) with the aim of developing recommendations for the diagnosis and treatment of eating disorders. In the autumn of 2003, a conference of members of the German Society for Psychosomatic Medicine and Medical Psychotherapy (DGPM) and the German College of Psychosomatic Medicine (DKPM) decided to develop an evidence-based guideline for eating disorders in Germany according to development stage three (S3, based on all elements of systematic development—logic, decision and outcome analysis, evaluation of the clinical relevance of scientific studies and periodic review).

One year later, in the spring of 2004, a group composed of psychiatrists, child and adolescent psychiatrists, medical specialists in psychosomatic medicine and psychologists with expertise in eating disorders, was formed. The group included representatives of the five professional societies (DGKJP, the German Psychological Society (DGPs), DGPM, DGPPN and DKPM) that are responsible for the care of patients with eating disorders within the German health care system. In 2010, the evidence-based guideline for the diagnosis and treatment of eating disorders was published online by the Association of the Scientific Medical Societies in Germany (AWMF) [ 14 ]. The AWMF advises on matters and tasks of fundamental and interdisciplinary interest in medicine and provides, among other things, a wide range of clinical practice guidelines on its website. The AWMF is the national member for Germany in the Council for International Organisations of Medical Sciences (CIOMS) at the World Health Organisation, Geneva. In 2011, the guideline was made available in book format [ 15 ]. Based on the scientific guideline, a patient guideline was published in 2015 [ 16 ]; this guideline, supported by the German Society for Eating Disorders (DGESS), was designed to communicate the content of the scientific guideline to patients and relatives. The patient guideline, available both online [ 16 ] and in book format [ 17 ], addresses care structures and supports communication with professional health care providers, such as the family doctor, medical or psychological psychotherapists for adults or child and adolescent psychiatrists and psychotherapists.

Over the last two years, the scientific guideline has been revised, and a second edition will be available in German at the beginning of 2019, both online [ 14 ] and in book format. An English version of the guideline is currently in preparation and will be released at a later date. The scientific guideline addresses all age groups and is available in both a short and an extended version. The thematic structure of the recent guideline largely corresponds to the first edition and includes chapters covering epidemiology, diagnostics, the therapeutic relationship, AN, Bulimia nervosa (BN), Binge eating disorder (BED), physical sequelae and methodology. The chapter ‘Diagnostics’ is subdivided into sections on the diagnostics of psychological and somatic symptoms. In line with DSM-5 [ 6 ], two new categories of eating disorders have been added to the revised guideline: the ‘Other Specified Feeding or Eating Disorders’ (OSFED), which also include the ‘Night Eating Syndrome’, and the ‘Avoidant Restrictive Food Intake Disorder’ (ARFID), which replaces the old category of ‘Eating Disorders Not Otherwise Specified’ (EDNOS). With regard to the therapeutic studies on AN [ 18 ], BN [ 19 ] and BED [ 20 ], meta-analyses were performed based on a systematic literature search and assignment of pre-determined quality indicators (evidence level I).

2.2. Recommendation for AN—Differences between the First Version and the Revision

Changes in treatment recommendations were based on a systematic literature search (2008–2017), in which 26 new randomised controlled trials (RCTs) on psychotherapeutic treatments, 13 new RCTs on pharmacotherapy and 2 new RCTs on nutritional management were identified [ 14 , 18 ]. The evidence base has considerably improved since the first version, although studies still show a large heterogeneity in terms of samples (adolescents, adults, severe and enduring AN), setting (outpatient, day hospital, inpatient), treatment phase (acute, maintenance) and outcome measures used. It should be emphasised that an improvement in study quality can be seen. In recent years, for example, studies have been published with sample sizes that allow sufficient statistical power [ 21 , 22 , 23 , 24 , 25 , 26 ].

Treatment recommendations were based on a network-meta-analysis (see Section 2.3 ), newly published RCTs, systematic reviews, or lower levels of evidence (if RCTs or systematic reviews were not available). The guideline group discussed each recommendation in light of the available evidence, clinical relevance and suitability. The most relevant changes in the revised version concerning evidence levels and recommendations are summarised in Table 1 . Evidence levels were assigned using the Oxford Centre of Evidence Based Medicine criteria [ 27 ]: An evidence level of I is given if there is evidence for a specific treatment based on a systematic review (or meta-analysis) of randomised controlled trials (Ia), or one randomised controlled trial with narrow confidence interval (Ib). An evidence level of II is based on cohort-studies (IIa: systematic review, or IIb: individual cohort study). Evidence level III refers to case-control studies and evidence level IV to case-control series.

German guideline—changes in treatment recommendations for AN.

FBT, Family-Based Treatment; FPT, Focal Psychodynamic Therapy; CBT-E, Enhanced Cognitive Behaviour Therapy; MANTRA, Maudsley Model of Anorexia Nervosa Treatment for Adults; SSCM, Specialist Supportive Clinical Management.

Treatment recommendations in the German treatment guideline were graded according to levels ‘A’, ‘B’, ‘0’ and ‘KKP’ [ 28 ]. ‘A’ is the strongest recommendation, which is usually based on evidence level I (something ‘is to be done’). ‘B’ recommendations are less strong (something ‘should be done’; evidence level II) and ‘0’ recommendations are even less explicit (something ‘may be done’). ‘KKP’ (‘clinical consensus point’) stands for recommendations, which are not based on empirical research and were derived from the experience of experts (good clinical practice). Grading of recommendations was based largely on the evidence level, but also took the following criteria into account: clinical relevance of effect sizes and end points, the balance of benefits and risks, ethical considerations, patient preferences and applicability. Grading of recommendations was discussed in several consensus meetings.

Several key treatment recommendations did not change. They will be referred to in the comparison of evidence-based guidelines from other countries (see Section 3.2 ).

Up and down-grading of recommendations: Only one recommendation was downgraded. It is the recommendation for the use of low-dose neuroleptics in some cases of AN. The decision was based on the consideration that this recommendation should be followed only with caution and not as an overall clinical standard. In contrast, the recommendation not to use neuroleptics for the treatment of AN was upgraded due to an increase in evidence (systematic reviews). The same is true for the recommendation to continuously address motivation to change throughout treatment. Several studies show that motivation to change is a relevant predictor of treatment outcome. Recent high-quality trials made it possible to make specific recommendations regarding the use of specialised psychotherapeutic treatments. However, due to ethical reasons, no study compared an active treatment with untreated control groups. Therefore, it was decided that the recommendation should be classified as ‘B’ and not ‘A’. A further recommendation was upgraded based on clinical relevance; Inpatient treatment should take place in facilities which are able to offer a specialised multimodal treatment programme. In Germany, some adult and child and adolescent psychiatric and psychosomatic hospitals are not specialised and have no experience with the treatment of patients with AN. Treatment in such facilities is, therefore, not recommended, due to high associated risks, not to mention high costs. The new guideline also includes the explicit recommendation to consider co-morbidity in patients with AN. Co-morbid conditions like borderline-personality disorder or post-traumatic stress disorder, for example, might require changes in treatment planning and prioritisation of therapy goals. Although empirical evidence is scarce, a recommendation for a stabilisation phase as a final phase in inpatient treatment was included, as relapse after discharge is common [ 29 , 30 , 31 ], and the transition from one service level to another service level (especially to a level with less supervision and support) is a major challenge for patients with AN. Finally, there was new empirical evidence suggesting that a short inpatient stay for weight stabilisation followed by day hospital treatment is as effective as long-term inpatient treatment for children and adolescents with AN, providing there is continuity in the therapists that are responsible and if there is sufficient support by family members [ 23 ].

2.3. Network-Meta-Analysis

Based on the systematic literature search (see Section 2.2 ), a network-meta-analysis was conducted to answer the following question: What is the comparable effectiveness of different psychotherapeutic treatments for AN? Additionally, two further questions were addressed using standardised mean change statistics: What is the amount of weight gain that can be expected in different treatment settings? And: What is the amount of weight gain that can be expected in adolescents vs. adults?

Predefined inclusion and exclusion criteria were used to select the studies. Each study was rated by two independent researchers and additionally assessed for quality [ 18 ]. For more details on data analysis see [ 18 ].

Network-meta-analysis: 18 randomised controlled studies met inclusion criteria for the data-analysis. Ten studies were on adolescents (625 patients), and 8 studies were on adults (622 patients). No treatment approach was found to be superior. However, there were several limitations to the analysis and interpretation of results. All studies compared active treatments with each other, with no study including an untreated control group. Only a few comparisons were replicated. Furthermore, the majority of studies on adolescents evaluated family-based treatment approaches mostly by the same group of researchers, while interventions in adults were almost exclusively on an individual basis. The manualised treatment approaches that were evaluated in high quality trials comprise the Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) [ 25 ], Focal Psychodynamic Therapy (FPT) [ 26 , 32 , 33 ], Enhanced Cognitive Behaviour Therapy (CBT-E) [ 26 , 34 , 35 ], Specialist Supportive Clinical Management (SSCM) for adults [ 25 , 35 , 36 ], and family-based treatment (FBT) for adolescents [ 21 , 22 , 24 ].

Standardised mean change statistics (SCM): Analyses were conducted with 38 studies (1164 patients). Seventeen of these studies were naturalistic studies, and four studies were on adolescents (350 patients). For a course of up to 27 weeks, significantly higher weight gains can be expected in inpatient treatment compared to outpatient treatment (for adults: mean weight gain of 537 g/week in inpatient treatment vs. 105 g/week in outpatient treatment; for adolescents: mean weight gain of 615 g/week in inpatient treatment vs. 192 g/week in outpatient treatment). The estimated effect sizes for weight gain in adolescents were significantly higher compared to adults (in RCTs: SMC = 1.97 vs. 1.02, in naturalistic studies SMC = 1.84 vs. 1.42, respectively).

In sum, there are several existing manualised psychotherapeutic treatments for AN, which can be considered evidence-based and effective. However, there is a need for replication studies. There are differences regarding treatment response and most suitable treatment approach in adult versus adolescent patients.

3. Comparison of the German S3-Guideline with International Evidence-Based Clinical Treatment Guidelines

3.1. international evidenced-based eating disorders guidelines.

There are currently several additional evidence-based guidelines available, which provide recommendations regarding the diagnosis and treatment of eating disorders. Most of the guidelines were written by multidisciplinary groups (comprising health care professionals and researchers), and most were designed solely for use by health specialists involved in the treatment of eating disorders. The most recent of these guidelines are the Dutch [ 37 ] and the revised British guidelines [ 38 ], both published in 2017. The British guideline [ 38 ], published by the National Institute for Health and Care Excellence (NICE), addresses all age groups (children, adolescents and adults), and all eating disorder categories (AN, BN, BED and Other Specified Feeding or Eating Disorders (OSFED)). Several lay members of the community were involved in the development of this guideline. The Dutch guideline addresses AN, BN and BED [ 39 ]. This guideline, designed to be used by both specialists and population members, is only available in Dutch [ 39 ]. Healthcare professionals collaborated with patients and relatives, as well as health insurance representatives, during the developmental stages of the guideline [ 39 ].

The next most recent guideline, published in 2016, is the Danish guideline [ 40 ]. This ‘quick guide’, provides a brief overview, designed solely for the treatment of AN. The guideline is available in English, and it addresses all age groups. The full-length version of this guideline is only available in Danish. The Australian and New Zealand guideline [ 41 ] was published in 2014 by the Royal Australian and New Zealand College of Psychiatrists. Community members and stakeholders collaborated with healthcare professionals and academics in the development of the guideline. This guideline contains two sections separately addressing AN in children and adolescents, and in adults. BN and BED, as well as avoidant/restrictive food intake disorder, are also addressed.

In 2012, the American Psychiatric Association (APA) released a guideline watch [ 42 ], reviewing new evidence published since the last APA guideline in 2006, but gives no explicit recommendations [ 43 ]. This guideline addresses AN, BN and BED, and also makes reference to EDNOS. The guideline is designed primarily for the treatment of adults, but also briefly addresses the treatment of children and adolescents. The French guideline [ 44 ], published in 2010, is written specifically for AN. It addresses all age groups and is available in English. In 2009, the Spanish guideline [ 45 ] for eating disorders was published. This guideline, which concerns eating disorder patients over 8 years of age, is written not only for healthcare specialists, but also for the population and educational professionals. It addresses AN, BN, BED and EDNOS.

In addition to these national guidelines, several more specific evidence-based guidelines also exist. A guideline, developed specifically for the Canadian province of British Columbia, was released in 2010 [ 46 ]. This guideline addresses AN, BN and EDNOS (except BED), and advisesthe on treatment of all age groups. In 2011, the World Federation of Societies of Biological Psychiatry (WFSBP) released a guideline specifically addressing the pharmacological treatment of eating disorders [ 47 ]. This guideline, written in English, addresses the pharmacological treatment of AN, BN and BED. In 2014, the Management of Really Sick Patients with Anorexia Nervosa (MARSIPAN and Junior MARSIPAN) guideline [ 48 ] was published, a guideline which specifically addresses the treatment of children, adolescents and adult patients with ‘severe’ AN.

In line with an evidence-based approach, most of the guidelines explicitly state that the development of the guideline involved a systematic literature review, a rating of the identified literature, and a complex consensus process, involving collaboration and review by numerous experts [ 14 , 38 , 41 , 43 , 44 , 45 , 46 , 47 , 48 ]. Only the MARSIPAN [ 48 ] and WFSBP guidelines [ 47 ] do not explicitly refer to a complex consensus process, and the British Columbia guideline [ 46 ] does not mention a rating system. The Danish ‘quick guide’ [ 40 ] has a complete absence of information on the methodological process. However, the inclusion of evidence levels in the guide implies that the developmental process was rigorous. A detailed review of the evidence upon which the recommendations are based is only available in the British guideline and the Danish full-length guideline. A more detailed comparison of the methods employed in developing the guidelines goes beyond the scope of this review article. All of the guidelines are available online. The Australian and New Zealand, MARSIPAN, WFSBP and APA guidelines are published in online scientific journals and partly in print versions, and the remainder of the guidelines are available on the relevant publishing society’s website.

3.2. Commonalities and Differences

3.2.1. treatment setting.

For adults: Similar to the German guideline [ 14 ], all remaining guidelines (excluding the Danish [ 40 ] and WFSBP guidelines [ 47 ]) recommend outpatient treatment as a first treatment option, suggesting day patient or inpatient treatment as a more intensive treatment option if outpatient treatment proves ineffective [ 38 , 39 , 41 , 43 , 44 , 46 , 48 ]. The German guideline states, however, that in some cases this ‘stepped-care’ approach may not be appropriate.

Inpatient treatment is recommended in cases with a BMI <15 kg/m², rapid or continuing weight loss (>20% over 6 months), high physical risk, severe co-morbid conditions or denial of illness. If these criteria are met, an inpatient setting may be necessary for initial treatment. Likewise, all remaining guidelines (excluding the Danish and WFSBP guidelines) also suggest more intense treatment settings from the outset in cases of severe medical instability. All of these guidelines provide information regarding hospital admission criteria with varying degrees of detail, but agree on the necessity to judge the need for hospitalisation on an individual and multifactorial basis. Further, they state that compulsory treatment is possible in the case of extreme medical complications. The Danish and WFSBP guidelines do not make reference to treatment setting. For an overview of indicators of high medical risk and the handling of medical complications see the review of Zipfel and colleagues [ 4 ].

For children and adolescents: Corresponding to the treatment recommendations for adults, outpatient treatment is proposed as the first line treatment for children and young people by the German [ 14 ] and most other guidelines [ 38 , 41 , 43 , 44 ] if the patient is in a stable medical state. If more intensive care is needed, several guidelines suggest a graduated procedure from inpatient to partial and finally to outpatient treatment programs [ 40 , 44 , 45 ]. Only the German guideline [ 14 ] gives a special recommendation for a referral to day patient treatment. Interestingly, the British and accordingly the Spanish guidelines advise admitting children and young people to a setting with age-appropriate facilities, which are near to their home and have the capacity to provide appropriate educational activities [ 38 , 45 ].

Regarding medical risk and necessity for inpatient treatment, the Australian and New Zealand, British Columbia, British, APA and French guidelines [ 38 , 41 , 44 , 46 , 49 ] provide exact criteria, such as a BMI below the 3 rd percentile or an expected body weight (EBW) below 75%, an abnormally low heart rate or blood pressure, electrolyte disturbances, etc. However, the exact values vary between countries. As for adults, these guidelines also indicate psychiatric risk factors, such as suicidality or severe self-injurious behaviour. The German and Spanish guidelines [ 14 , 45 ] are more unspecific to indicate hospitalisation (see above). The German and French guidelines [ 14 , 44 ] also refer to psychosocial risks, such as social isolation and family crisis, to consider inpatient treatment.

3.2.2. Psychotherapy

For adults: All guidelines except for the Danish [ 40 ] and WFSBP [ 47 ] address the efficacy of specific psychological interventions. No guideline recommends one single superior treatment option. The German [ 14 ], British [ 38 ] and Dutch guidelines [ 39 ] conclude that cognitive-behavioural therapy (CBT or CBT-E respectively), MANTRA, and SSCM are equally effective treatment options, and so, all treatments are recommended as first-line options. Additionally, the German guideline recommends FPT as another first-line treatment option. The remaining guidelines all review evidence for CBT, as well as a variety of other treatments including SSCM [ 41 ], psychodynamic therapy [ 43 , 44 , 45 , 46 ], interpersonal therapy [ 43 , 45 , 46 ], behaviour therapy [ 45 ] and ‘systematic and strategic therapies’ [ 44 ]. These guidelines all conclude that psychological interventions are effective, however, state that there is insufficient evidence to identify which is the most efficacious. The French [ 44 ], Dutch [ 39 ] and APA guidelines [ 43 ] also suggest that psychological interventions may not be as effective in severely malnourished patients.

The Danish guideline [ 40 ] also recommends the use of psychotherapeutic treatments, however, does not make any recommendations regarding specific interventions. This guideline provides a ‘weak recommendation’ that both group and individual psychotherapeutic treatment be considered as first-line treatment options, based on ‘very low evidence’ which suggests the approaches are equally effective. Recommendations for the inclusion of alternative elements, such as meal support and supervised physical activity, during the treatment phase are mentioned. Other guidelines make specific recommendations against alternative treatments; for example, the German [ 14 ] and the Australian and New Zealand guidelines [ 41 ] state that nutritional counselling alone should not be used as the sole treatment, and the British guideline [ 38 ] recommends against the use of alternative physical therapies, such as yoga, warming therapy, transcranial magnetic stimulation and acupuncture. The Spanish guideline [ 45 ] also advises against the use of excessively rigid behavioural programs for inpatients.

Some guidelines make recommendations regarding the required duration of treatment. The Australian and New Zealand guideline [ 41 ] states that a longer-term follow-up is necessary as relapse is common, and the Spanish guideline [ 45 ] states that duration of treatment should span at least six months for outpatients and twelve months for inpatients. The APA guideline [ 43 ] states that due to the enduring nature of the illness, psychotherapeutic treatment is usually required for at least one year, and the British guideline [ 38 ] makes specific recommendations regarding the time span of treatments, for example suggesting that CBT treatment for eating disorders should consist of 40 sessions over 40 weeks. The French guideline [ 44 ] recommends that treatment should last at least one year after significant clinical improvement, and the German guideline [ 14 ] states that after outpatient treatment, patients should regularly meet with their general practitioner (GP), or other care coordinator, for at least one year. The German guideline also recommends that the last phase of inpatient treatment before transfer to an outpatient setting should include a stabilisation period where patients demonstrate that they can maintain the achieved weight gain for a specified amount of time.

Some treatment guidelines make additional specific recommendations. The German [ 14 ], French [ 44 ], MARSIPAN [ 48 ] and Australian and New Zealand guidelines [ 41 ] all emphasise the importance of adopting a multi-disciplinary, collaborative approach to treatment. In a similar vein, the German [ 14 ], British Columbia [ 46 ] and APA guidelines [ 43 ] highlight the importance of effective communication between all involved health workers, and recommend identifying someone to act as the primary care coordinator, such as the patient’s GP.

The MARSIPAN guideline [ 48 ] is specifically written regarding the treatment of patients who have a severe or enduring form of AN. The Australian and New Zealand [ 41 ] and British Columbia guidelines [ 46 ] also include comprehensive sections which address the treatment of such patients and suggest taking an alternative approach, focused on enhancing quality of life. The French [ 44 ], German [ 14 ] and APA guidelines [ 43 ] also briefly mention the treatment of patients with enduring AN. Other guidelines provide information regarding other additional elements related to AN. For example, both the Spanish [ 45 ] and French guidelines provide information regarding the care required for pregnant patients. Additionally, the APA and British Columbia guidelines include recommendations for therapists and specialists regarding communicating with patients (for example addressing the therapeutic relationship, boundaries). The German guideline does not entail any recommendations, but devotes a separate chapter to this topic.

For children and adolescents: All guidelines strongly recommend the involvement of parents or near caregivers in all treatment settings. The Australian and New Zealand, Spanish, APA and German guidelines explicitly mention family-based treatment or therapy (FBT) [ 14 , 41 , 43 , 45 ]. However, the Australian and British guidelines also propose alternatives if FBT is not appropriate, such as other forms of family therapy [ 41 ], as well as individual treatment, such as adolescent-focused therapy (AFT) or CBT, in older adolescents [ 38 , 41 ]. No guideline gives an explicit advice whether conjoint or separate FBT should be conducted. The French guideline does not refer to FBT, but to family therapy in general [ 44 ]. The British guideline also does not specifically use the term FBT, but has its own terminology instead (anorexia nervosa-focused family therapy, FT-AN) [ 38 ]. Although many key features of this treatment resemble FBT, FT-AN also includes other approaches, such as multi-family therapy, conjoint or separate family therapy and exclusion or inclusion of a family meal, which is a core feature of FBT. The British guideline also requests therapists and staff to be aware of or address carers’ needs [ 38 ].

A summary of guidelines’ essential key recommendations regarding psychotherapy for AN is shown in Table 2 .

International guidelines’ key recommendations regarding psychotherapy for AN.

✓ recommendation given; + explicit recommendation in favour; N.R., no recommendation reported; AUS, Australia and New Zealand; BC, British Columbia; DEN, Denmark; FR, France; GER, Germany; NETH, The Netherlands; SP, Spain; UK, United Kingdom; US, United States; CBT(-E), (Enhanced) Cognitive Behaviour Therapy; FPT, Focal Psychodynamic Therapy; MANTRA, Maudsley Model of Anorexia Nervosa Treatment for Adults; SSCM, Specialist Supportive Clinical Management; IPT, Interpersonal Therapy; FBT, Family-Based Treatment/Therapy; FT-AN, AN-focused Family Therapy; 1 and siblings; ?, ambiguous evidence.

3.2.3. Nutritional Management

For adults: The WFSBP guideline [ 47 ] suggests that nasogastric feeding is effective for malnourished patients, however, does not address risks associated with refeeding, or provide any specific nutritional or weight gain recommendations. All remaining guidelines, (excluding the Danish guideline [ 40 ]), recommend nasogastric feeding for severely malnourished patients, when oral feeding is not an option [ 14 , 38 , 39 , 41 , 43 , 44 , 46 , 48 ]. These guidelines address the risk of refeeding syndrome, recommending that treatment is administered by experienced staff. The APA guideline [ 43 ] recommends nasogastric feeding over parenteral feeding, and the British guideline [ 38 ] explicitly recommends against parenteral nutrition. The German guideline also discusses the use of percutaneous endoscopic gastronomy feeding as a potential alternative, when patients will not tolerate nasogastric feeding [ 14 ]. The Danish guideline does not provide any recommendations regarding refeeding, nutritional intake or weight restoration.

In the original German guideline [ 15 ], an initial food intake of approximately 30 to 40 kcal/kg per day was recommended for highly underweight patients (see Table 1 ), which, upon revision, was considered too strict. The revised German guideline [ 14 ], as well as the Danish [ 40 ], French [ 44 ] and WFSBP guidelines [ 47 ], do not give specific recommendations regarding energy intake during refeeding. Both the British [ 38 ] and MARSIPAN guidelines [ 48 ] recommend commencing refeeding at 5 to 10 kcal/kg/day for severely underweight patients, and gradually increasing to 20 kcal/kg/day within 2 days. The British Columbia guideline [ 46 ] also recommends beginning refeeding at 5 to 10 kcal/kg/day if severity factors (e.g., nasogastric feeding) are involved. In the absence of severity factors, intake of 20 to 25 kcal/kg/day is recommended, and intake should not exceed 70 to 80 kcal/kg/day. The Spanish guideline [ 45 ] recommends a slightly higher caloric intake of 25 to 30 kcal/kg/day for severely malnourished patients, and they also provide a recommended upper limit of 1000 kcal/day. The APA guideline [ 43 ] recommends initiating refeeding at 30 to 40 kcal/kg/day, and also suggests that males may require a significantly higher energy intake to gain weight. The Dutch guideline has an even higher recommended refeeding starting point of 40 to 60 kcal/kg/day for severely underweight patients [ 39 ]. The Australian and New Zealand guideline [ 41 ] does not provide a recommended nutritional intake based on weight, but instead recommends a specific starting intake of 1433 kcal/day, with increases of 478kcal every 2 to 3 days.

Several guidelines also provide recommendations regarding appropriate weekly weight gain goals in inpatient and outpatient settings. Five guidelines recommend a minimum weight gain of 0.5 kg/week in an inpatient setting; the German [ 14 ], French [ 44 ] and Spanish guidelines [ 45 ] recommend weight gain ranging between 0.5 and 1 kg/week, the Australian and New Zealand guideline [ 41 ] recommends weight gain between 0.5 and 1.4 kg/week, and the Dutch guideline suggests weight gain ranging between 0.5 and 1.5 kg/week [ 39 ]. In contrast, the British Columbia guideline [ 46 ] suggests a higher minimum weight gain ranging from 0.8 to 1.4 kg/week, and the APA guideline [ 43 ] suggests a minimum weight gain ranging from 0.9 to 1.4 kg/week. The remaining guidelines [ 38 , 40 , 47 , 48 ] do not provide specific weight gain recommendations. Only four of the guidelines provide recommendations regarding weight gain per week in an outpatient setting. The French guideline recommends a weight gain of 0.25 kg/week, while the German, APA guidelines and Dutch recommend a weekly gain of between 0.2 to 0.5 kg [ 39 ].

For children and adolescents: The British guideline for the management of severely ill young people with AN (Junior MARSIPAN) [ 48 , 50 ] advocates to commence refeeding at about 40 kcal/kg/day and increase the meal plan by 200 kcal/day, while the others do not explicitly give calorie specifications for children and adolescents. Almost all guidelines recommend nasogastric tube feeding, if a meal plan and supplement drink tops are not managed [ 14 , 41 , 43 , 45 , 50 ].

The French, Danish and German guidelines emphasise the necessity of achieving a target weight at which menstruation can reoccur [ 14 , 40 , 44 ]. While the French guideline does not give any threshold criteria, the German guideline defines the 25 th age-adapted BMI-percentile (with the 10th percentile as a minimum) in contrast to the Danish guideline with the 50 th weight-for height percentile as target weight.

Supplementary nutritional counselling is advised by the British, Spanish and German guidelines for children and adolescents and their carers to help young people meet their dietary needs for pubertal development and growth [ 14 , 38 , 45 ]. According to these guidelines, growth and pubertal development should be regularly monitored in this age group.

3.2.4. Psychopharmacology

For adults: Use of pharmacotherapy is addressed in all treatment guidelines excluding the Danish guideline [ 40 ]. All of these guidelines emphasise the lack of evidence surrounding medication use for AN, and most guidelines emphasise that caution must be taken when administering medication, due to the physical complications associated with AN (e.g., cardiac problems). The Spanish [ 45 ], APA [ 43 ] and British guidelines [ 38 ] explicitly state that medication should not be used as the sole treatment. The British guideline also states that there is no proven benefit of combined treatment over psychotherapy alone in treating patients without comorbidities. All guidelines excluding the MARSIPAN [ 48 ], Danish and British guidelines give cautious recommendations for the use of antipsychotic medications. The French guideline [ 44 ] provides a cautionary recommendation, without addressing specific medications or effects. The remaining guidelines all make specific reference to the antipsychotic olanzapine; the German [ 14 ], WFSBP [ 47 ], Dutch [ 39 ], Australian and New Zealand [ 41 ], and APA guidelines recommended it to assist with anxious and obsessional thoughts, the WFSBP and Spanish guidelines suggest that it may be useful for improving general psychological symptoms, and the British Columbian [ 46 ], Spanish and APA guideline cautiously recommended it for improvements in weight gain. In contrast, the German guideline recommends against the use of antipsychotics for weight gain. The German guideline states there is no conclusive evidence to recommend the use of antidepressants for the core symptoms of AN, and the Dutch guideline also explicitly recommends against the use of selective serotonin reuptake inhibitors (SSRIs) [ 39 ]. In contrast, antidepressants are cautiously recommended by the French, WFSBP and APA guidelines, to assist with co-occurring symptoms of depression, obsessive–compulsive or anxiety disorder. Specifically, the APA guideline discusses the advantages of using selective serotonin reuptake inhibitors in combination with psychotherapy to address persistent depressive or anxiety symptoms, but recommends against the use of monoamine oxidase inhibitors and bupropion, due to adverse reactions and health risks. The APA guideline cautiously recommends the use of pro-motility agents for use against bloating, and use of antianxiety agents before eating for some patients. Similarly, the MARSIPAN guideline [ 48 ] discusses the use of benzodiazepines for particularly anxious patients. The WFSBP and APA guidelines discuss potential weight gain benefits of taking zinc supplements, while the German guideline suggests restricting zinc supplementation to cases with proven zinc deficiency.

For children and adolescents: With the exception of hormone replacement therapy the German and most other international guidelines do not give any specific recommendations for this age group. The Junior MARSIPAN guideline concludes that it ‘may be necessary to prescribe regular sedative antipsychotic medication, such as olanzapine’, if the patients are extremely agitated and resist refeeding [ 48 ]. It also gives clear recommendations for ECG monitoring if antipsychotics are applied. Hormone replacement therapy: In several guidelines including the German guideline the prescription of an oral contraceptive is not recommended [ 38 , 41 , 43 ]. The British guideline suggests considering a bone mineral density scan after one year of underweight in children and adolescents. Moreover—in correspondence to the German guideline—the British guideline suggests to consider transdermal estrogen replacement in combination with cyclic progesterone application in girls with a bone age over 15 years and long-term underweight as well as incremental physiological doses of estrogen in those below 15 years [ 14 , 38 ]. Similar indications are mentioned in the APA and the Australian and New Zealand guidelines [ 41 , 43 ].

4. Discussion

This review provides an overview of the newly revised and published German S3-guideline for eating disorders [ 14 ]. In particular, it highlights the changes in recommendations regarding the treatment of AN since the publication of the original guideline in 2011 [ 15 ]. In summary, family-based therapy approaches are recommended for adolescents, whereas individual approaches are suggested for adults. There is no evidence indicating the superiority of one specialised approach over another. In more intensive settings, as well as in adolescents, higher weight gains can be expected. To date, there is no convincing evidence for the positive effect of pharmacotherapy regarding the core symptoms of AN.

The revised German guideline is currently the most recent eating disorder treatment guideline internationally. Recommendations are, therefore, based on the most up to date research findings and evidence available. The development of this guideline involved a rigorous process, including a comprehensive literature review and analysis, and consultation and contribution by many experts in the eating disorder field. The findings of the literature review and network analysis are also available in English [ 18 ].

The German guideline also includes an easily comprehensible guide for sufferers with eating disorders and their relatives [ 17 ], which has been developed with the help of patient representatives. The German guideline, hereby, stresses the necessity of providing information and support to significant others, who often bear a high emotional burden, but also play an important role in helping patients to overcome the eating disorder. The guideline has been published in two different formats—as a scientific book (only the original version so far) and on the website of the Association of the Scientific Medical Societies in Germany (AWMF, awmf.org [ 14 ]), where it is freely available.

Similar to the Dutch guideline, the original version of the German guideline has been published in German only, which limits its distribution and implementation to Germany, Austria and Switzerland. An English translation of the revised version, which is currently in preparation, is, therefore, an invaluable step towards increasing the utility of this guideline.

The review also explores the similarities and differences between the German guideline and other existing international guidelines. There is significant homogeneity among the international guidelines in the recommendations derived from the existing evidence. All agree that there is no superior treatment for AN, if specialised approaches are compared. There are, however, some inconsistencies regarding aspects, such as medication and nutritional management. Most guidelines implemented a thorough methodology. We think there is a need for European research initiatives which aim to enhance the evidence base and clinical guidance regarding AN across the different participating countries. Recommendations must, however, take into account the specificities of the national health care systems.

Overall, evidence for treatment of AN has increased, yet even in the latest German guideline, many of the recommendations are still based on expert opinion. Guidelines do not only mirror the current state of research but also point out gaps that need to be bridged. There is still a need for more research in the field of eating disorders, particularly in AN. In view of the so-called ‘research-practice gap’, it needs to be mentioned that guidelines are not designed to propagate conformist standard therapy, or to restrict clinicians’ individual willingness to learn and innovate. They should not be seen as directives, but as advice.

5. Conclusions

The German S3-guideline is, at present, the most recently revised evidence-based treatment guideline for AN. Based on newly available evidence, several amendments have been made regarding treatment recommendations, since the original guideline publication in 2011. Overall, the recommendations provided in the German guideline are fairly consistent with those provided in other international evidence-based eating disorder guidelines. Adult and adolescent patients should be distinguished in terms of treatment response and the most suitable treatment approach. Although the existing guidelines provide a sound base of information, which can be used by healthcare professionals to guide diagnosis and treatment decisions, further research regarding the treatment of AN is still urgently needed.

Acknowledgments

The support of the publication fund of the University Hospital Tuebingen was greatly appreciated. We would also like to thank all contributors to the German S3-guideline and the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). The authors would like to thank Brigid Kennedy for her help in preparing this manuscript.

Author Contributions

Conceptualisation, G.R. and A.Z.; methodology, A.Z.; investigation, G.R.; writing—original draft preparation, G.R., S.H., B.H.-D. and A.Z.; writing–review and editing, G.R.

The S3-guideline was funded by the Christina Barz-Stiftung in the Association of German Academic Foundations.

Conflicts of Interest

The authors declare no conflict of interest.

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Read the latest issue online A manifesto for general practice nursing in 2024

Supporting patients with eating disorders

Supporting patients with eating disorders

  • Key indicators of an eating disorder include weight changes, avoiding eating with others, and wearing baggy clothes
  • Be aware of the language you use in patients with eating disorders – telling someone they ‘look well’ can be interpreted as looking fat
  • A patient does not have to be really thin to be suffering from an eating disorder. Weight loss is not the only symptom in anorexia
  • Presenting with another physical health problem eg missed periods or dizziness.
  • Digestive problems.
  • Withdrawn, isolative behaviours.
  • Weight changes.
  • Wearing of baggy clothes.
  • Avoiding meal times or eating with people.
  • Becoming rigid in relation to what and how they eat – eg new rules about times, cutlery or food groups.
  • Increased interest in what others are eating – it is very common for a person to take great delight in watching others eat plenty when they deny themselves.
  • Acknowledge her courage in coming forward for help.
  • Support her to access the right help, encouraging her to see her GP.
  • Advise her that vomiting is dangerous and can affect sodium and potassium levels, which can affect cardiac functioning and cause oedema. Vomiting also affects tooth enamel and the oesophagus and can cause bleeding. 
  • Useful guidelines for medical monitoring can be downloaded from Kings Medical Guidelines for Eating Disorders and Junior MARSIPAN. 5,6
  • Try to identify why she is being sick. Is she anxious? Is she trying to lose or control weight? Does she have any physical health issues such as phobias?
  • Suggest that she speaks to her parents, keeping her engaged to build trust. 
  • Set up a weekly review to assess risk and monitor her condition. Agree who is responsible for monitoring weight – the school nurse or GP – and how this will be communicated between agencies.
  • Be aware of consent, capacity and confidentiality issues.
  • Refer to the local CAMHS.
  • Ask what she would find helpful – perhaps support from a special educational needs co-ordinator or pastoral officer. 
  • Ask if she is struggling with school work. Is eating in front of peers overwhelming and how could a plan of care be made to support nutritional intake and reduce anxieties?
  • Be aware of the language you use. For example, avoid commenting on weight or telling her she is ‘looking well’ as people with eating disorders often interpret this as looking fat.
  • Highlight his bravery in being open and coming forward for help as this can be particularly difficult for males.
  • Review baseline bloods, ECG, weight, blood pressure and pulse. Monitor these regularly.
  • Refer to the local adult eating disorder NHS team.
  • Encourage self-help support in the interim – such as the national eating disorders charity BEAT, the mental health charity MIND and the Men Get Eating Disorders Too website (see resources online).
  • Emphasise that he has previously worked hard to manage his symptoms for two years and kept stable. Try to identify what has helped him get back on track in the past.
  • Monitor and treat his depression.
  • Encourage her to visit her GP if she is not being monitored regularly. 
  • Offer her and her family support. Joint sessions may be helpful in identifying short-term goals and aims.
  • Emphasize that the expectation is not to suddenly make a full recovery and gain weight. Indeed, this may be scary and cause the patient to disengage. Agree goals – for example to prevent further deterioration.
  • Refer her to the local NHS adult eating disorder team.
  • Suggest helpful books for the family, such as Skills-Based Caring for A Loved One With An Eating Disorder. 7  
  • Suggest sources of online support, and local groups.
  • Highlight the importance of hope and emphasise the lady’s positive step in seeking help.
  • People with eating disorders are attention seekers  – Completely the opposite is true. In most cases, people with eating disorders want to hide from the world and be left alone.
  • People with anorexia just don’t like food  – Most people with anorexia love food, but have become fearful of normal eating. They often restrict themselves to the point where they struggle to identify hunger.
  • Eating disorders are just about wanting to be thin  – For many sufferers, it is not about their weight. It is a symptom of their unhappiness and a desire to feel in control of something.
  • You have to be really thin to be suffering from an eating disorder – While weight loss is one of the indicators in anorexia, it is not the only symptom. Very often the sufferer may be told they are a healthy weight. This is unhelpful and dangerous if someone has started as overweight and lost a large amount in a short period, resulting in a healthy BMI even though they are very unwell. Many people with bulimia are of a healthy weight on paper but their thought patterns and behaviours put them at risk physically and mentally.
  • Eating after 7pm is bad for your health – While eating just before going to sleep might make you feel uncomfortable, it does not make you gain weight. The time you eat your evening meal doesn’t matter. What matters is the calories consumed over a 24-hour period.
  • Over-exercisers should be told to stop – While it may seem appropriate to advise someone with an eating disorder and exercise issues to stop, most people find this approach unhelpful and will continue their behaviours in secret. It is often more helpful to agree a controlled plan with an open and honest approach with appropriate medical monitoring. The LEAP programme 8 has been identified as a model for working with people who cannot stop exercising and is an example of putting the patient at the centre of their care.
  • More provision of child eating disorder services. 11  
  • Better GP and junior medic training and more eating disorder specialists trained. 
  • More collaboration in the new NICE quality standard for eating disorders.

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DAVID A. KLEIN, MD, MPH, JILLIAN E. SYLVESTER, MD, AND NATASHA A. SCHVEY, PhD

Editor's Note: This article has been updated to incorporate the January 2021 guidelines from the American Academy of Pediatrics.

This is a corrected version of the article that appeared in print.

Am Fam Physician. 2021;103(1):22-32

Related letter: The Role of Weight Stigma in the Development of Eating Disorders

Patient information: See related handout on eating disorders .

Author disclosure: No relevant financial affiliations.

Eating disorders are potentially life-threatening conditions characterized by disordered eating and weight-control behaviors that impair physical health and psychosocial functioning. Early intervention may decrease the risk of long-term pathology and disability. Clinicians should interpret disordered eating and body image concerns and carefully monitor patients' height, weight, and body mass index trends for subtle changes. After diagnosis, visits should include the sensitive review of psychosocial and clinical factors, physical examination, orthostatic vital signs, and testing (e.g., a metabolic panel with magnesium and phosphate levels, electrocardiography) when indicated. Additional care team members (i.e., dietitian, therapist, and caregivers) should provide a unified, evidence-based therapeutic approach. The escalation of care should be based on health status (e.g., acute food refusal, uncontrollable binge eating or purging, co-occurring conditions, suicidality, test abnormalities), weight patterns, outpatient options, and social support. A healthy weight range is determined by the degree of malnutrition and pre-illness trajectories. Weight gain of 2.2 to 4.4 lb per week stabilizes cardiovascular health. Treatment options may include cognitive behavior interventions that address body image and dietary and physical activity behaviors; family-based therapy, which is a first-line treatment for youths; and pharmacotherapy, which may treat co-occurring conditions, but should not be pursued alone. Evidence supports select antidepressants or topiramate for bulimia nervosa and lisdexamfetamine for binge-eating disorder. Remission is suggested by healthy biopsychosocial functioning, cognitive flexibility with eating, resolution of disordered behaviors and decision-making, and if applicable, restoration of weight and menses. Prevention should emphasize a positive focus on body image instead of a focus on weight or dieting. .

Eating disorders are potentially life-threatening conditions characterized by disordered eating and weight-control behaviors that impair physical health and psychosocial functioning. 1 – 3 Adolescence and early adulthood are vulnerable periods for the development of eating disorders; however, up to 8% of females and 2% of males are affected during their lifetimes, including persons of all ages, sizes, sexual and gender minority groups, races, ethnicities, socioeconomic strata, and geographic locations. 1 , 4 – 6 Diagnostic characteristics of specific eating disorders are presented in Table 1 . 2

Persons with anorexia or bulimia nervosa have a two- to sixfold increase in age-adjusted mortality attributed to medical complications and have suicide completion rates up to 18 times the completion rates of peers. 7 – 10 At least one-third of persons with disordered eating develop persistent symptoms that remain 20 years postdiagnosis. 11 , 12 Co-occurring mood, anxiety, substance use, personality, or somatic disorders are identified in more than two-thirds of persons with eating disorders. 1 , 13 Early intervention with symptom improvement decreases the risk of a protracted course and long-term pathology. 1 , 3 , 14 , 15

Early Identification

Clinicians, especially those caring for adolescents and young adults, should routinely conduct confidential psychosocial assessments that include questions about eating behaviors, body image, and mood. 5 , 16 – 18 , 60 The U.S. Preventive Services Task Force is planning to review the health outcomes of screening for eating disorders and the performance of primary care–relevant screening tools. 19 Clinicians should monitor patients' height, weight, and body mass index (BMI) trends, including percentile changes and growth curves for youth to avoid missing critical windows for intervention before pathology becomes entrenched 20 , 21 , 60 ( eFigure A ) . Subtle changes in the amount and speed of weight loss can be as harmful as low weight. 20 – 22

anorexia nervosa nursing care plan

Persons with restrictive eating disorders may perceive benefits from the disorder, minimize pathology, and resist treatment. 17 , 20 , 23 Clinicians should acknowledge that a person's motivation to change may be compromised by malnutrition or co-occurring conditions, lack of self-awareness, or fear. 23 – 25 Disordered thoughts and behaviors may provide perceived structure, self-worth, and safety in coping with difficult emotions and stressors. 23 – 25 Initial praise of the patient's weight loss by family members, peers, or clinicians may lead to fear of regaining weight and body image distortion. 5 In males, body dissatisfaction may center on muscularity and leanness, leading to rigid routines and use of appearance- or performance-enhancing substances. 26 “Bulk and cut” routines, which involve cycles of excessive energy intake for muscle building followed by caloric deficit to achieve visible muscularity, may mimic binge-purge pathology. 27

The use of empathetic, nonjudgmental motivational inter viewing techniques (e.g., “I'm curious about your meal preparation routine. Is it stressful for you?” or “Given your experiences, your skepticism is appreciated.”) may help overcome barriers and patient resistance 16 , 17 , 25 , 28 ( Table 2 24 , 29 ) . The patient's history should be corroborated by family members and other contacts, ideally. Clinicians should note objective findings and interpret screening tools such as the SCOFF questionnaire in context because critical information may be withheld 17 , 20 , 23 , 30 ( eTable A ) .

Clinical Approach

The initial medical evaluation should establish the diagnosis while excluding alternative or co-occurring diagnoses (e.g., thyroid or gastrointestinal disease) based on clarity of the clinical picture. At all related medical visits, pertinent psychosocial and clinical factors should be reviewed. A physical examination, monitoring of orthostatic vital signs, laboratory testing (e.g., a metabolic panel with magnesium and phosphate levels), and electrocardiography should also be considered ( Table 3 and Table 4 ) . 1 , 20 , 25 , 31 Goals should include the identification of trends in nutrition, menstruation, height, weight, and BMI; the establishment of motivation for change; determination of medical and mental health sequelae; and the provision of unified, evidence-based care by team members and caregivers. 3 , 60 Therapeutic relationships between the patient, treatment team, and caregivers should be based on rapport and trust. 17 , 25

WEIGHT ASSESSMENT

The weigh-in process at the office may be viewed by patients as stressful and requires sensitivity. Weight measurements are ideally recorded with the patient facing away from the scale in a hospital gown. The extent to which the clinician reveals weight is individualized. Because BMI percentiles do not indicate how far extreme weights deviate from the norm among youths, clinicians should use reference data to determine the degree of malnutrition ( Table 5 ) . 3 Next they should determine an appropriate healthy weight range in collaboration with treatment team members, based on pre-illness height, weight, and BMI trajectories; age at pubertal onset; and current pubertal stage (affecting expected body composition). 3 Describing weight in terms of percent median BMI, Z-score, and the amount and rate of weight change is more precise and preferred over ideal, expected, or median body weight terminology. 3 In adults, normative BMI data and pre-illness trends can guide clinical recommendations, acknowledging that some persons are healthiest at higher weights. Home weight measurement should generally be discouraged.

Traditional percentages of daily nutritional recommendations may be misleading. 5 , 20 Moderately active adolescent females require approximately 2,200 kcal per day (adolescent males need 2,800 kcal per day) [ corrected ]; athletes and persons who are hypermetabolic post-recovery at any age require more. 5 , 20 Daily caloric averages for adults can be found at https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines . Discussions around energy intake will differ based on patient factors and choice of treatment. Some clinicians frame nutrition in terms of portions, snacks, and meals, and avoid recommending calorie counts, which may entrench disordered thinking. The multidisciplinary team should guide portion size modifications or reintroduction of foods that cause distress with caregiver endorsement. Weight gain of 2.2 to 4.4 lb (1 to 2 kg) per week stabilizes cardiovascular health. 3 , 32

Treatment Options

Establishing a treatment plan.

Most patients receive optimal care in the outpatient setting. 3 , 33 , 34 The ideal outpatient treatment team should include an experienced therapist, dietitian, and a clinician who is knowledgeable about eating disorder–specific medical evaluations, potentially in a community-based specialized center. 3 , 33 , 60 Medical hospitalization (e.g., surveillance for refeeding syndrome) or psychiatric hospitalization (e.g., suicidality) may be necessary depending on health status, weight trajectory, outpatient options, and social support factors 3 , 20 , 35 ( Table 6 3 ) .

Patients who need professional supervision and structure to eat, gain weight, or avoid disordered behaviors, or for whom outpatient treatment has not been successful, may require residential care (i.e., constant care), partial hospitalization (e.g., day program), or intensive outpatient care (e.g., partial day, nondaily; Figure 1 ) . 3 , 20 , 33 , 60 Requiring feeding without a patient's consent should be guided by legal standards and by experts in specialty centers.

anorexia nervosa nursing care plan

BEHAVIORAL INTERVENTIONS

Cognitive behavior therapy (CBT), which can be applied in person or by self-help or guided self-help, is an evidence-based treatment for adults that has also demonstrated effectiveness for youth. 25 CBT targets the overvaluation of body shape and weight and subsequent cycles of dietary restraint, disinhibited eating, and compensatory behaviors 1 , 17 ( Table 7 3 , 5 , 17 , 24 , 34 , 36 – 38 ) . Direct engagement with a patient's social support system may be critical because eating is considered a social activity. 1 Treatment of less common eating disorders is not discussed because of limited data.

Anorexia Nervosa . Family-based therapy is recommended as a first-line treatment for youth and some young adults. 3 , 34 , 39 Studies of family-based therapy demonstrate higher remission rates and increased weight gain compared with individual therapy. 34 , 36 , 39 Family-based therapy empowers parents to play a vital role in facilitating patients' weight gain before progressively returning control to the patient. 3 Short hospitalizations for medical stabilization followed by family-based therapy or outpatient programs have similar outcomes as prolonged hospitalization 32 , 40 ; therefore, the safest, least intensive treatment environment is recommended. 41 In adults, CBT, family-based therapy, focal psychodynamic psychotherapy, interpersonal psychotherapy, and specialist supportive clinical management have demonstrated effectiveness and can be implemented based on patient preferences. 17 , 34 , 42 , 43

Bulimia Nervosa . Among adolescents, guidelines recommend family-based therapy and, alternatively, CBT as appropriate treatments. 1 , 17 , 34 Adults benefit from therapist-guided and self-guided forms of CBT or interpersonal psychotherapy. 17 , 34 , 37

Binge-Eating Disorder . Meta-analytic data support treatment with CBT and self-guided therapy. 38 In-person CBT more effectively decreases binge eating and therapy dropout than self-guided CBT at six months and confers markedly better outcomes than weight-loss therapies. 38 Patients who exhibit a rapid decrease in binge-eating behaviors (e.g., by two-thirds) in the first month of treatment are more likely to have sustained remission, regardless of treatment modality, than patients who do not. 44

PHARMACOTHERAPY

Pharmacotherapy should not be pursued as a monotherapy for eating disorders , 17 , 34 but it may be a worthwhile adjunctive therapy, specifically in the presence of co-occurring mental health conditions. 45 , 46 Patient sensitivities or fear of weight gain limits tolerability. 20 , 46 , 47 Medications that affect electrolytes or heart rate, or that prolong the corrected QT interval, should be prescribed with caution. 20 , 45 , 46

Anorexia Nervosa . There are no medications approved by the U.S. Food and Drug Administration (FDA) to treat anorexia nervosa. A recent multicenter, randomized controlled trial of 10 mg of olanzapine (Zyprexa) demonstrated modest benefit in inducing weight gain and appetite without metabolic syndrome components. 48 Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed despite a weak evidence base consisting of few randomized controlled trials. 46 , 47 Bupropion (Wellbutrin) is contraindicated in anorexia and bulimia nervosa because of the risk of seizure. 40 , 46 , 47

Bulimia Nervosa . Fluoxetine (Prozac) is an FDA-approved treatment in adolescents and adults; dosages titrated to 60 mg per day resulted in substantial decreases in bingeing and purging compared with placebo and lower dosages. 36 , 46 Studies of other SSRIs have found benefit at high dosages; however, high-dose citalopram (Celexa) and escitalopram (Lexapro) increase the risk of corrected QT interval prolongation. 46 Topiramate (Topamax) may decrease bingeing and purging behaviors, but it may also limit appetite cues, potentially complicating treatment. 46 , 49

Binge-Eating Disorder . Lisdexamfetamine (Vyvanse), approved by the FDA for binge-eating disorder , and topiramate decrease binge-eating episodes and may lead to weight stabilization or loss. 37 , 46 , 50 SSRIs, tricyclic antidepressants, anticonvulsants, and appetite suppressants may decrease binge eating, with a variable effect on weight. 46

BONE HEALTH

Among patients with weight loss, weight restoration is important for the recovery of bone mineral density. 3 , 20 , 47 , 51 However, weight restoration in females without resumption of menses indicates ongoing compromise. 51 Functional hypothalamic amenorrhea (i.e., anovulation linked to weight loss, excessive exercise, or stress) has been reviewed recently. 31 , 52

Hormonal contraceptives have not been associated with improved bone mineral density and may mask natural resumption of menses, an important recovery marker, but effective contraception should be offered to patients who want to prevent pregnancy. 31 , 52 Short-term transdermal 17-beta estradiol (e.g., 100-mcg patch, or incremental doses if bone age is less than 15) avoids first-pass liver metabolism and may be given with cyclic oral progestin (e.g., medroxyprogesterone [Provera], 2.5 mg per day, 10 days per month) to improve bone health after six to 12 months of nonpharmacologic therapy. 17 , 52 , 53 Resumption of menses, which may take longer than one year to achieve, is associated with return to pre-illness (or slightly higher) weight and a serum estradiol measurement greater than 30 pg per mL (110.13 pmol per L). 54

SPORTS PARTICIPATION

Participation in athletics may interfere with the healing process by allowing untreated disordered behaviors to continue. Therefore, participation requires considering a patient's clinical and psychosocial context and their ability to increase nutritional consumption to compensate for additional energy expenditure. Shared decision-making between the athlete, treatment team, and caregivers should prioritize recovery. One decision tool for patients with female athlete triad (i.e., menstrual dysfunction, low energy availability, and decreased bone mineral density) is shown in eTable B , which categorically restricts sports participation with disordered eating and a BMI of less than 16 kg per m 2 or purging more than four times per week. 55

OTHER TREATMENT CONSIDERATIONS

Weight restoration in patients with anorexia nervosa resolves most associated medical complications. 20 School-aged patients may benefit from a 504 plan allowing meal accommodations (e.g., with a trusted adult) and periodic snacking. Caregivers should be empowered to monitor social media use and restrict access to pro-anorexia (proana) and pro-bulimia (pro-mia) websites. Attention-deficit symptoms may emerge with poor nutrition and resolve with weight restoration; stimulant use may cause weight loss and decrease appetite cues, impeding treatment. Patients who purge should seek regular dental care. 17 , 24 Family members may benefit from individual or family-based counseling. 17

Markers of Recovery

Restoring the patient's healthy relationship with food involves fostering cognitive flexibility around eating, eliminating harmful behaviors, and reducing body dissatisfaction and overvaluation of shape and weight. 20 Among patients with weight loss, restoration of weight and menses (if applicable) is a critical first step in improving overall bio-psychosocial functioning. 3

For patients of all weight strata, caregivers and clinicians should support healthy, sustainable lifestyle choices such as optimizing family meals, physical activity, and consumption of fruits, vegetables, whole grains, legumes, and water, while limiting sweetened beverages, refined carbohydrates, and entertainment-based screen time. 5 Caregivers should be counseled to refrain from commenting on dieting or on weight or other appearance-related attributes. Body dissatisfaction should not serve as the impetus for weight-loss efforts; instead, health and specific health-related goals should be emphasized. 5 Acceptance of larger body size may be an important therapeutic target. 5 If necessary, neutral terms such as “weight” or “BMI” are less stigmatizing than “fat,” “large,” or “obese.” 56 Weight-based victimization should be assessed and confronted because it may contribute to eating pathology and weight gain. 5 , 16 , 57 Online resources are available for family members ( https://www.feast-ed.org ), clinicians ( https://www.aedweb.org ), and patients with disordered eating ( https://www.nationaleatingdisorders.org ).

This article updates previous articles on this topic by Harrington, et al. 58 ; Williams, et al. 24 ; and Pritts and Susman . 59

Data Sources: A PubMed search was completed using the MeSH function with the key phrases eating disorder, anorexia nervosa, bulimia nervosa, binge eating disorder, and one of the following: diagnosis, evaluation, management, or treatment. The reference lists of specific cited references were searched for additional studies of interest. The search included meta-analyses, randomized controlled trials, clinical trials, and reviews published after January 1, 2015. Other queries included Essential Evidence Plus and the Cochrane Database of Systematic Reviews. Search dates: April through June 2020.

The authors thank Arielle Pearlman for her editorial assistance in preparation of the manuscript.

The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the Uniformed Services University of the Health Sciences; the Departments of the Air Force, Army, Navy, or the U.S. military at large; the Department of Defense; or the U.S. government.

Treasure J, Duarte TA, Schmidt U. Eating disorders. Lancet. 2020;395(10227):899-911.

Diagnostic and Statistical Manual of Mental Disorders . 5th ed. American Psychiatric Association; 2014.

Golden NH, Katzman DK, Sawyer SM, et al.; Society for Adolescent Health and Medicine. Position paper: medical management of restrictive eating disorders in adolescents and young adults. J Adolesc Health. 2015;56(1):121-125.

Galmiche M, Déchelotte P, Lambert G, et al. Prevalence of eating disorders over the 2000–2018 period: a systematic literature review. Am J Clin Nutr. 2019;109(5):1402-1413.

Golden NH, Schneider M, Wood C Committee on Nutrition; Committee on Adolescence; Section on Obesity. Preventing obesity and eating disorders in adolescents. Pediatrics. 2016;138(3):e20161649.

Nagata JM, Ganson KT, Austin SB. Emerging trends in eating disorders among sexual and gender minorities. Curr Opin Psychiatry. 2020;33(6):562-567.

Smith AR, Zuromski KL, Dodd DR. Eating disorders and suicidality: what we know, what we don't know, and suggestions for future research. Curr Opin Psychol. 2018;22:63-67.

Arcelus J, Mitchell AJ, Wales J, et al. Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Arch Gen Psychiatry. 2011;68(7):724-731.

Chesney E, Goodwin GM, Fazel S. Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry. 2014;13(2):153-160.

Lipson SK, Sonneville KR. Understanding suicide risk and eating disorders in college student populations: results from a national study. Int J Eat Disord. 2020;53(2):229-238.

Dobrescu SR, Dinkler L, Gillberg C, et al. Anorexia nervosa: 30-year outcome. Br J Psychiatry. 2020;216(2):97-104.

Eddy KT, Tabri N, Thomas JJ, et al. Recovery from anorexia nervosa and bulimia nervosa at 22-year follow-up. J Clin Psychiatry. 2017;78(2):184-189.

Udo T, Grilo CM. Psychiatric and medical correlates of DSM-5 eating disorders in a nationally representative sample of adults in the United States. Int J Eat Disord. 2019;52(1):42-50.

Forman SF, Grodin LF, Graham DA, et al.; National Eating Disorder QI Collaborative. An eleven site national quality improvement evaluation of adolescent medicine-based eating disorder programs: predictors of weight outcomes at one year and risk adjustment analyses. J Adolesc Health. 2011;49(6):594-600.

Vall E, Wade TD. Predictors of treatment outcome in individuals with eating disorders: a systematic review and meta-analysis [published correction appears in Int J Eat Disord . 2016;49(4):432–433]. Int J Eat Disord. 2015;48(7):946-971.

Klein DA, Paradise SL, Landis CA. Screening and counseling adolescents and young adults: a framework for comprehensive care. Am Fam Physician. 2020;101(3):147-158. Accessed September 18, 2020. https://www.aafp.org/afp/2020/0201/p147.html

National Institute for Health and Care Excellence. Eating disorders: recognition and treatment. NICE guideline [NG69]. May 23, 2017. Accessed October 19, 2020. https://www.nice.org.uk/guidance/ng69

Sattler FA, Eickmeyer S, Eisenkolb J. Body image disturbance in children and adolescents with anorexia nervosa and bulimia nervosa: a systematic review. Eat Weight Disord. 2020;25(4):857-865.

U.S. Preventive Services Task Force. Screening for eating disorders in adolescents and adults. June 25, 2020. Accessed October 19, 2020. https://www.uspreventiveservicestaskforce.org/uspstf/draft-update-summary/screening-eating-disorders-adolescents-adults

Peebles R, Sieke EH. Medical complications of eating disorders in youth. Child Adolesc Psychiatr Clin N Am. 2019;28(4):593-615.

Yilmaz Z, Gottfredson NC, Zerwas SC, et al. Developmental premorbid body mass index trajectories of adolescents with eating disorders in a longitudinal population cohort. J Am Acad Child Adolesc Psychiatry. 2019;58(2):191-199.

Garber AK, Cheng J, Accurso EC, et al. Weight loss and illness severity in adolescents with atypical anorexia nervosa. Pediatrics. 2019;144(6):e20192339.

Gregertsen EC, Mandy W, Serpell L. The egosyntonic nature of anorexia: an impediment to recovery in anorexia nervosa treatment. Front Psychol. 2017;8:2273.

Williams PM, Goodie J, Motsinger CD. Treating eating disorders in primary care. Am Fam Physician. 2008;77(2):187-195. Accessed September 9, 2020. https://www.aafp.org/afp/2008/0115/p187.html

Mitchell JE, Peterson CB. Anorexia nervosa. N Engl J Med. 2020;382(14):1343-1351.

Gorrell S, Murray SB. Eating disorders in males. Child Adolesc Psychiatr Clin N Am. 2019;28(4):641-651.

Lavender JM, Brown TA, Murray SB. Men, muscles, and eating disorders: an overview of traditional and muscularity-oriented disordered eating. Curr Psychiatry Rep. 2017;19(6):32.

Macdonald P, Hibbs R, Corfield F, et al. The use of motivational interviewing in eating disorders: a systematic review. Psychiatry Res. 2012;200(1):1-11.

Rollnick S, Mason P, Butler C. Health Behavior Change: a Guide for Practitioners . Churchill Livingstone; 1999.

Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ. 1999;319(7223):1467-1468.

Klein DA, Paradise SL, Reeder RM. Amenorrhea: a systematic approach to diagnosis and management. Am Fam Physician. 2019;100(1):39-48. Accessed September 18, 2020. https://www.aafp.org/afp/2019/0701/p39.html

Madden S, Miskovic-Wheatley J, Wallis A, et al. A randomized controlled trial of in-patient treatment for anorexia nervosa in medically unstable adolescents. Psychol Med. 2015;45(2):415-427.

Lock J, La Via MC American Academy of Child and Adolescent Psychiatry Committee on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with eating disorders. J Am Acad Child Adolesc Psychiatry. 2015;54(5):412-425.

Hilbert A, Hoek HW, Schmidt R. Evidence-based clinical guidelines for eating disorders: international comparison. Curr Opin Psychiatry. 2017;30(6):423-437.

Garber AK, Cheng J, Accurso EC, et al. Short-term outcomes of the study of refeeding to optimize inpatient gains for patients with anorexia nervosa: a multicenter randomized clinical trial. JAMA Pediatr. ;2020:e203359.

Zeeck A, Herpertz-Dahlmann B, Friederich HC, et al. Psychotherapeutic treatment for anorexia nervosa: a systematic review and network meta-analysis. Front Psychiatry. 2018;9:158.

Slade E, Keeney E, Mavranezouli I, et al. Treatments for bulimia nervosa: a network meta-analysis. Psychol Med. 2018;48(16):2629-2636.

Hilbert A, Petroff D, Herpertz S, et al. Meta-analysis of the efficacy of psychological and medical treatments for binge-eating disorder. J Consult Clin Psychol. 2019;87(1):91-105.

Lock J, Le Grange D, Agras WS, et al. Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Arch Gen Psychiatry. 2010;67(10):1025-1032.

Herpertz-Dahlmann B, Schwarte R, Krei M, et al. Day-patient treatment after short inpatient care versus continued inpatient treatment in adolescents with anorexia nervosa (ANDI): a multicentre, randomised, open-label, non-inferiority trial. Lancet. 2014;383(9924):1222-1229.

Couturier J, Isserlin L, Norris M, et al. Canadian practice guidelines for the treatment of children and adolescents with eating disorders. J Eat Disord. 2020;8:4.

Byrne S, Wade T, Hay P, et al. A randomised controlled trial of three psychological treatments for anorexia nervosa. Psychol Med. 2017;47(16):2823-2833.

Schmidt U, Ryan EG, Bartholdy S, et al. Two-year follow-up of the MOSAIC trial: a multicenter randomized controlled trial comparing two psychological treatments in adult outpatients with broadly defined anorexia nervosa. Int J Eat Disord. 2016;49(8):793-800.

Grilo CM, Masheb RM, Wilson GT. Rapid response to treatment for binge eating disorder. J Consult Clin Psychol. 2006;74(3):602-613.

Marvanova M, Gramith K. Role of antidepressants in the treatment of adults with anorexia nervosa. Ment Health Clin. 2018;8(3):127-137.

Crow SJ. Pharmacologic treatment of eating disorders. Psychiatr Clin North Am. 2019;42(2):253-262.

Blanchet C, Guillaume S, Bat-Pitault F, et al. Medication in AN: a multidisciplinary overview of meta-analyses and systematic reviews. J Clin Med. 2019;8(2):278.

Attia E, Steinglass JE, Walsh BT, et al. Olanzapine versus placebo in adult outpatients with anorexia nervosa: a randomized clinical trial [published correction appears in Am J Psychiatry . 2019;176(6):489]. Am J Psychiatry. 2019;176(6):449-456.

Hoopes SP, Reimherr FW, Hedges DW, et al. Treatment of bulimia nervosa with topiramate in a randomized, double-blind, placebo-controlled trial, part 1: improvement in binge and purge measures. J Clin Psychiatry. 2003;64(11):1335-1341.

Fornaro M, Solmi M, Perna G, et al. Lisdexamfetamine in the treatment of moderate-to-severe binge eating disorder in adults: systematic review and exploratory meta-analysis of publicly available placebo-controlled, randomized clinical trials. Neuropsychiatr Dis Treat. 2016;12:1827-1836.

Misra M, Golden NH, Katzman DK. State of the art systematic review of bone disease in anorexia nervosa. Int J Eat Disord. 2016;49(3):276-292.

Gordon CM, Ackerman KE, Berga SL, et al. Functional hypothalamic amenorrhea: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2017;102(5):1413-1439.

Misra M, Katzman D, Miller KK, et al. Physiologic estrogen replacement increases bone density in adolescent girls with anorexia nervosa. J Bone Miner Res. 2011;26(10):2430-2438.

Golden NH, Jacobson MS, Schebendach J, et al. Resumption of menses in anorexia nervosa. Arch Pediatr Adolesc Med. 1997;151(1):16-21.

De Souza MJ, Nattiv A, Joy E, et al.; Expert Panel. 2014 Female Athlete Triad Coalition consensus statement on treatment and return to play of the female athlete triad: 1st international conference held in San Francisco, California, May 2012 and 2nd international conference held in Indianapolis, Indiana, May 2013. Br J Sports Med. 2014;48(4):289.

Puhl RM, Himmelstein MS. Adolescent preferences for weight terminology used by health care providers. Pediatr Obes. 2018;13(9):533-540.

Schvey NA, Marwitz SE, Mi SJ, et al. Weight-based teasing is associated with gain in BMI and fat mass among children and adolescents at-risk for obesity: a longitudinal study. Pediatr Obes. 2019;14(10):e12538

Harrington BC, Jimerson M, Haxton C, et al. Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa. Am Fam Physician. 2015;91(1):46-52. Accessed September 9, 2020. https://www.aafp.org/afp/2015/0101/p46.html

Pritts SD, Susman J. Diagnosis of eating disorders in primary care. Am Fam Physician. 2003;67(2):297-304. Accessed September 9, 2020. https://www.aafp.org/afp/2003/0115/p297.html

Hornberger LL, Lane MA Committee on Adolescence. Identification and management of eating disorders in children and adolescents. Pediatrics. 2021;147(1):e2020040279.

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  • Patient Care & Health Information
  • Diseases & Conditions
  • Anorexia nervosa

Anorexia (an-o-REK-see-uh) nervosa — often simply called anorexia — is an eating disorder characterized by an abnormally low body weight, an intense fear of gaining weight and a distorted perception of weight. People with anorexia place a high value on controlling their weight and shape, using extreme efforts that tend to significantly interfere with their lives.

To prevent weight gain or to continue losing weight, people with anorexia usually severely restrict the amount of food they eat. They may control calorie intake by vomiting after eating or by misusing laxatives, diet aids, diuretics or enemas. They may also try to lose weight by exercising excessively. No matter how much weight is lost, the person continues to fear weight gain.

Anorexia isn't really about food. It's an extremely unhealthy and sometimes life-threatening way to try to cope with emotional problems. When you have anorexia, you often equate thinness with self-worth.

Anorexia, like other eating disorders, can take over your life and can be very difficult to overcome. But with treatment, you can gain a better sense of who you are, return to healthier eating habits and reverse some of anorexia's serious complications.

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The physical signs and symptoms of anorexia nervosa are related to starvation. Anorexia also includes emotional and behavioral issues involving an unrealistic perception of body weight and an extremely strong fear of gaining weight or becoming fat.

It may be difficult to notice signs and symptoms because what is considered a low body weight is different for each person, and some individuals may not appear extremely thin. Also, people with anorexia often disguise their thinness, eating habits or physical problems.

Physical symptoms

Physical signs and symptoms of anorexia may include:

  • Extreme weight loss or not making expected developmental weight gains
  • Thin appearance
  • Abnormal blood counts
  • Dizziness or fainting
  • Bluish discoloration of the fingers
  • Hair that thins, breaks or falls out
  • Soft, downy hair covering the body
  • Absence of menstruation
  • Constipation and abdominal pain
  • Dry or yellowish skin
  • Intolerance of cold
  • Irregular heart rhythms
  • Low blood pressure
  • Dehydration
  • Swelling of arms or legs
  • Eroded teeth and calluses on the knuckles from induced vomiting

Some people who have anorexia binge and purge, similar to individuals who have bulimia. But people with anorexia generally struggle with an abnormally low body weight, while individuals with bulimia typically are normal to above normal weight.

Emotional and behavioral symptoms

Behavioral symptoms of anorexia may include attempts to lose weight by:

  • Severely restricting food intake through dieting or fasting
  • Exercising excessively
  • Bingeing and self-induced vomiting to get rid of food, which may include the use of laxatives, enemas, diet aids or herbal products

Emotional and behavioral signs and symptoms may include:

  • Preoccupation with food, which sometimes includes cooking elaborate meals for others but not eating them
  • Frequently skipping meals or refusing to eat
  • Denial of hunger or making excuses for not eating
  • Eating only a few certain "safe" foods, usually those low in fat and calories
  • Adopting rigid meal or eating rituals, such as spitting food out after chewing
  • Not wanting to eat in public
  • Lying about how much food has been eaten
  • Fear of gaining weight that may include repeated weighing or measuring the body
  • Frequent checking in the mirror for perceived flaws
  • Complaining about being fat or having parts of the body that are fat
  • Covering up in layers of clothing
  • Flat mood (lack of emotion)
  • Social withdrawal
  • Irritability
  • Reduced interest in sex

When to see a doctor

Unfortunately, many people with anorexia don't want treatment, at least initially. Their desire to remain thin overrides concerns about their health. If you have a loved one you're worried about, urge her or him to talk to a doctor.

If you're experiencing any of the problems listed above, or if you think you may have an eating disorder, get help. If you're hiding your anorexia from loved ones, try to find a person you trust to talk to about what's going on.

The exact cause of anorexia is unknown. As with many diseases, it's probably a combination of biological, psychological and environmental factors.

  • Biological. Although it's not yet clear which genes are involved, there may be genetic changes that make some people at higher risk of developing anorexia. Some people may have a genetic tendency toward perfectionism, sensitivity and perseverance — all traits associated with anorexia.
  • Psychological. Some people with anorexia may have obsessive-compulsive personality traits that make it easier to stick to strict diets and forgo food despite being hungry. They may have an extreme drive for perfectionism, which causes them to think they're never thin enough. And they may have high levels of anxiety and engage in restrictive eating to reduce it.
  • Environmental. Modern Western culture emphasizes thinness. Success and worth are often equated with being thin. Peer pressure may help fuel the desire to be thin, particularly among young girls.

Risk factors

Anorexia is more common in girls and women. However, boys and men have increasingly developed eating disorders, possibly related to growing social pressures.

Anorexia is also more common among teenagers. Still, people of any age can develop this eating disorder, though it's rare in those over 40. Teens may be more at risk because of all the changes their bodies go through during puberty. They may also face increased peer pressure and be more sensitive to criticism or even casual comments about weight or body shape.

Certain factors increase the risk of anorexia, including:

  • Genetics. Changes in specific genes may put certain people at higher risk of anorexia. Those with a first-degree relative — a parent, sibling or child — who had the disorder have a much higher risk of anorexia.
  • Dieting and starvation. Dieting is a risk factor for developing an eating disorder. There is strong evidence that many of the symptoms of anorexia are actually symptoms of starvation. Starvation affects the brain and influences mood changes, rigidity in thinking, anxiety and reduction in appetite. Starvation and weight loss may change the way the brain works in vulnerable individuals, which may perpetuate restrictive eating behaviors and make it difficult to return to normal eating habits.
  • Transitions. Whether it's a new school, home or job; a relationship breakup; or the death or illness of a loved one, change can bring emotional stress and increase the risk of anorexia.

Complications

Anorexia can have numerous complications. At its most severe, it can be fatal. Death may occur suddenly — even when someone is not severely underweight. This may result from abnormal heart rhythms (arrhythmias) or an imbalance of electrolytes — minerals such as sodium, potassium and calcium that maintain the balance of fluids in your body.

Other complications of anorexia include:

  • Heart problems, such as mitral valve prolapse, abnormal heart rhythms or heart failure
  • Bone loss (osteoporosis), increasing the risk of fractures
  • Loss of muscle
  • In females, absence of a period
  • In males, decreased testosterone
  • Gastrointestinal problems, such as constipation, bloating or nausea
  • Electrolyte abnormalities, such as low blood potassium, sodium and chloride
  • Kidney problems

If a person with anorexia becomes severely malnourished, every organ in the body can be damaged, including the brain, heart and kidneys. This damage may not be fully reversible, even when the anorexia is under control.

In addition to the host of physical complications, people with anorexia also commonly have other mental health disorders as well. They may include:

  • Depression, anxiety and other mood disorders
  • Personality disorders
  • Obsessive-compulsive disorders
  • Alcohol and substance misuse
  • Self-injury, suicidal thoughts or suicide attempts

There's no guaranteed way to prevent anorexia nervosa. Primary care physicians (pediatricians, family physicians and internists) may be in a good position to identify early indicators of anorexia and prevent the development of full-blown illness. For instance, they can ask questions about eating habits and satisfaction with appearance during routine medical appointments.

If you notice that a family member or friend has low self-esteem, severe dieting habits and dissatisfaction with appearance, consider talking to him or her about these issues. Although you may not be able to prevent an eating disorder from developing, you can talk about healthier behavior or treatment options.

  • Sim LA (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 31, 2018.
  • Anorexia nervosa. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://dsm.psychiatryonline.org. Accessed Nov. 13, 2017.
  • Hales RE, et al. Anorexia nervosa. In: The American Psychiatric Publishing Textbook of Psychiatry. 6th ed. Washington, D.C.: American Psychiatric Publishing; 2014. http://psychiatryonline.org. Accessed Nov. 13, 2017.
  • Klein D, et al. Anorexia nervosa in adults: Clinical features, course of illness, assessment, and diagnosis. https://www.uptodate.com/contents/search. Accessed Nov. 13, 2017.
  • Mehler P. Anorexia nervosa in adults and adolescents: Medical complications and their management. https://www.uptodate.com/contents/search. Accessed Nov. 13, 2017.
  • Mehler P. Anorexia nervosa in adults: Evaluation for medical complications and criteria for hospitalization to manage these complications. https://www.uptodate.com/contents/search. Accessed Nov. 13, 2017.
  • Pike K. Anorexia nervosa in adults: Cognitive behavioral therapy (CBT). https://www.uptodate.com/contents/search. Accessed Nov. 13, 2017.
  • Walsh BT. Anorexia nervosa in adults: Pharmacotherapy. https://www.uptodate.com/contents/search. Accessed Nov. 13, 2017.
  • Anorexia nervosa. Merck Manual Professional Version. http://www.merckmanuals.com/professional/psychiatric-disorders/eating-disorders/anorexia-nervosa. Accessed Nov. 13, 2017.
  • Harrington BC, et al. Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa. American Family Physician. 2015;91:46.
  • Brockmeyer T, et al. Advances in the treatment of anorexia nervosa: A review of established and emerging interventions. Psychological Medicine. In press. Accessed Nov. 13, 2017.
  • Davis H, et al. Pharmacotherapy of eating disorders. Current Opinion in Psychiatry. 2017;30:452.
  • Herpertz-Dahlmann B. Treatment of eating disorders in child and adolescent psychiatry. Current Opinion in Psychiatry. 2017;30:438.
  • Fogarty S, et al. The role of complementary and alternative medicine in the treatment of eating disorders: A systematic review. Eating Behaviors. 2016;21:179.
  • Eating disorders. National Alliance on Mental Illness. https://www.nami.org/Learn-More/Mental-Health-Conditions/Eating-Disorders/Overview. Accessed Nov. 13, 2017.
  • Lebow J, et al. Is there clinical consensus in defining weight restoration for adolescents with anorexia nervosa? Eating Disorders. In press. Accessed Dec. 4, 2017.
  • Lebow J, et al. The effect of atypical antipsychotic medications in individuals with anorexia nervosa: A systematic review and meta-analysis. International Journal of Eating Disorders. 2013;46:332.
  • Five things to know about safety of dietary supplements for children and teens. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/tips/child-supplements. Accessed Feb. 9, 2018.

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[Nursing intervention in the family treatment plan for anorexia nervosa]

Affiliation.

  • 1 Hospital de Día de Adolescentes, Centro de Salud Mental, Corporació Sanitària del Parc Taulí, Sabadell, Barcelona, España. [email protected]
  • PMID: 22104194
  • DOI: 10.1016/j.enfcli.2011.02.013

One of the main nursing interventions in the treatment of eating disorders is family psycho-education, an essential aspect of mental health treatment. This article describes and analyses the difficulties families expressed in the performance of a treatment plan for patients hospitalised for anorexia nervosa (AN) in the adolescent Day Hospital of Mental Health, of the Corporació Sanitària Parc Taulí, during 2009. Data was also collected data on professional interventions, performed by the nurse assigned to this unit, in order to group and categorise them, and as an aid to nursing intervention. A total of 10 families of the 10 patients admitted with a diagnosis of AN were included in the study period. In all cases, the patients were young women who had received treatment before in an Outpatient Unit, with partial or no response to the treatment. The difficulties expressed by the families were grouped into five categories from content analysis: problems in preparing a balanced diet, problems as they are unable to handle the behaviour and emotions of the patient, problems because as there are no previous family eating habits, problems because there is no family control or supervision, and problems with the established guidelines. Specific individualised interventions are proposed for developing and promoting a nursing care plan, and assessing the results.

Copyright © 2010 Elsevier España, S.L. All rights reserved.

Publication types

  • English Abstract
  • Anorexia Nervosa / nursing*
  • Family Nursing*
  • Patient Care Planning*

IMAGES

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    In Brief Anorexia nervosa (AN) is an eating disorder that is difficult to treat, and relapse is common. This article addresses management strategies and nursing interventions for adolescents diagnosed with AN. Figure DX, 16, WAS ADMITTED with anorexia nervosa (AN) after unsuccessful outpatient treatment.

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    1. Determine real, exact body weight for age and height. Do not estimate. The first and vital step in an anthropometric assessment is to measure an individual's weight accurately using a scale. Weight is used as a basis for caloric and nutritional requirements.

  15. 13.4 Applying the Nursing Process to Eating Disorders

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    Nursing Care Considerations for the Hospitalized Patient with an Eating Disorder Nurs Clin North Am. 2016 Jun;51(2) :213-35. doi ... focusing primarily on anorexia nervosa and bulimia nervosa, and the associated key areas for nursing assessment, diagnoses, and plan of care during hospitalization.

  18. Supporting patients with eating disorders

    Weight loss is not the only symptom in anorexia; Anorexia nervosa has the highest mortality rate of any psychiatric illness, either through the physical health complications or suicide. 1 While an eating disorder can become a very dangerous and life-threatening illness, early intervention can result in the best possible recovery outcome. 2

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  21. Effective nursing care of adolescents with anorexia nervosa: a ...

    Effective nursing care of adolescents with anorexia nervosa: a consumer perspective. 2013 Jul;22 (13-14):2020-9. doi: 10.1111/jocn.12182. This study indicates that the process of weight gain may be enhanced when accompanied by a process of therapeutic engagement. Therapeutic alliance may be an effective way for nurses to ensure weight gain and ...

  22. [Nursing intervention in the family treatment plan for anorexia nervosa]

    Anorexia Nervosa / nursing* One of the main nursing interventions in the treatment of eating disorders is family psycho-education, an essential aspect of mental health treatment. This article describes and analyses the difficulties families expressed in the performance of a treatment plan for patients hospitalised for anorexia …