Medical Management of Severe Eating Disorders

1. Medical Management of Severe Eating Disorders ByThe Doctor Weighs In

2. Introduction • Severe eating disorders are the only mental illnesses regularly accompanied by dangerous, life-threatening medical complications. Significant medical instability results from a number of abnormalities, such as progressive malnutrition, purging behaviors, and blood chemistry abnormalities. • In fact, the disorder can compromise virtually all of the body’s vital organs and systems. • There are a number of different eating disorders that lead to excessive weight loss and associated medical complications. • Related content:What You Need to Know About Eating DisordersEating Disorders: Risk Factors, Diagnosis, Treatment, and Outcomes

3. Medical Complications of Severe Eating Disorders

4. Medical Complications of Eating Disorders Can Be Treated Effectively • The good news is that nearly all medical complications of eating disorders can completely resolve with safe nutritional rehabilitation and weight restoration. This is true regardless of how extensive they are.

5. Many Patients with Severe Eating Disorders will Require a High Level of Care • More than one-third of individuals suffering from eating disorders will require treatment at a higher level of care. This can range from 24-hour inpatient psychiatric care to comprehensive daytime behavioral programming.  • Most treatment programs offer some degree of minimum internal medicine and/or nursing support to manage medical issues of eating disorders. However, some patients may be so medically compromised by their illness that they require specialized medical, hospital-based stabilization prior to entering a residential eating disorder treatment program.

6. Determining The Appropriate Level of Care Needed • It is not uncommon for patients, families, and providers to begin with the least intensive intervention. However, starting a treatment plan with the appropriate level of care can have a significant impact on the patient’s health. It is also a factor that influences success in recovery and satisfaction with treatment. • The American Psychiatric Association (APA) has outlined five levels of psychiatric care. They are divided between outpatient and inpatient treatments.

7. Weight Specific Recommendations to Levels of Care • It is important to remember that no guideline is absolute when it comes to these complex illnesses. The frequency of purging behaviors and other physical or psychiatric symptoms must be considered alongside patient weight to ascertain the appropriate level of care that may be needed.

8. What is Inpatient Medical Stabilization for Eating Disorders? • In general, initial medical stabilization in a hospital-based unit is recommended for eating disorder patients who are severely low weight, seriously medically compromised, or at risk for major complications from refeeding syndrome. The latter is a dangerous metabolic disturbance that can occur when nutritional rehabilitation is first initiated. • Patients with any/all of the following criteria may require medical treatment from experienced providers in a specialized medical hospital unit before entering a behavioral treatment program in a traditional eating disorder unit.

9. What is The Goal of Medical Stabilization of Patients with Severe Eating Disorders? • The goals of medical stabilization are to improve and normalize the patient’s vital signs, cardiovascular system, and bowel function as well as restore levels of key electrolytes including phosphorus, potassium, magnesium, and calcium in a timely manner. Medical stabilization also involves nutritional rehabilitation to support weight restoration. • Most experts agree that careful caloric initiation is vital to medical stability and improved cognitive function. It is hallmarked by the ability to tolerate and complete the most basic activities of daily living. Inpatient medical units have the expertise and resources to deliver any form of nutrition required, including oral, enteral, or intravenous calories.

10. Understanding The Difference Between Medical and Psychiatric Treatment • It is also important that providers, patients, and families understand the difference between inpatient psychiatric treatment and inpatient medical stabilization for the most severe eating disorders. • While an inpatient psychiatric facility offers round-the-clock behavioral treatment and likely some degree of medical support, an inpatient medical stabilization program requires a hospital-based telemetry unit. • Its full-time internal medicine physicians, nurses, dietitians, and skilled rehabilitation providers expertly treat any life-threatening medical complication of severe eating disorders. These medical teams collaborate with psychiatrists, psychologists, and behavioral health technicians to support behavioral recovery.

11. Avoiding Refeeding Syndrome • Increasing caloric intake quickly in individuals with severe anorexia nervosa or ARFID, without frequent monitoring of blood tests and electrolyte replenishment, can lead to refeeding syndrome. A dangerous shift in fluids and electrolytes within the body are characteristic of the disorder. • It occurs in a small subset of patients when calories are introduced quickly, lab tests are not checked frequently, and resultant abnormalities are not treated in a timely fashion. The lower the patient’s BMI, the greater the risk of refeeding complications.

12. Eating Disorder Patients with Normal or High BMI • Assuming that patients with a “normal” or “higher” BMI are always stable enough to access lower levels of care may inadvertently cause harm. Some of these patients may present with a falsely elevated weight. • They can also be at risk for dangerous complications due to excessive purging behaviors followed by abrupt cessation or significant and rapid “weight disruption” that is marked weight loss over a short period of time.

13. The Bottom Line on The Management of Severe Eating Disorders • Eating disorders at any stage are complex and can be life-threatening. Seeking treatment for a severe eating disorder can be overwhelming.

14. Get in Touch The Doctor Weighs In Author: Philip Mehler, MD, FACP, FAED, CEDS Click Here To Read The Full Article: https://thedoctorweighsin.com/medical-management-severe-eating-disorders/ Website:https://thedoctorweighsin.com/ Email:info@thedoctorweighsin.com