A specific dietary assessment is needed when a young person’s health is at risk due to food restriction and sustained weight loss. This happens in an appointment with questions such as what, when and how much is eaten. Weight history is helpful to assess the level of risk and includes:
- Weight change over a specified time period
- Calculation of % weight loss/gain
- Calculation of % weight for height or BMI
Physical activity and exercise routines provide useful information about energy expenditure, and how this balances with energy intake from food. Other behaviours eg. taking laxatives, water-loss pills or purging (vomiting) are also discussed. Purging can lead to damaging cycles of starving and bingeing. Starving, bingeing and purging cycles are almost always accompanied by distressing thoughts and feelings, and can escalate and become out-of-control quickly if not managed. Difficult as it may be, it’s really important to be honest about these matters, in order to get the right kind of help.
Whatever is going on with eating, restricting, bingeing or weight loss/gain, a meal plan can be a good starting point to help a young person start eating regularly again. Advice on regular weight checks at the same time and place together with information about how to self-monitor is part of the first appointment. Written information on these matters is also provided.
- Regular eating and regular weighing
- Self monitoring
- How families can help
The mindset of a young person experiencing these issues is really important to assess, as mental health is at risk as well as physical health. This can be with a registered psychologist, either family, systemic therapist or child psychologist. Onward referral to a specialist eating disorders service eg. CAMHS will be recommended immediately if a person is at serious risk of physical or mental harm. Young people with sustained weight loss who continue to restrict food intake in combination with either excessive exercise or purging are at high risk of physical and mental harm and unless they are able to engage with dietary treatment with meal planning, will be referred on to CAMHS through their GP.