Nutrition Assessment: Eating Disorders

This information sheet can be used to help guide you in conducting a comprehensive nutrition assessment with an individual that has an eating disorder, or that you suspect may have an eating disorder.

NB: Ensure the individual has been assessed and is medically managed by a GP.

Confidentiality

• Permission to contact other members of treating team, family/carers

• Explain confidentiality boundaries

Social & Family History

• Living situation, family/carer support, school, work

• Family history of mental health

Past Medical & Psychiatric History

• General past medical history Previous eating disorder treatment

• Psychiatric history

Assessment of Nutrition Intake

• Diet History

• Current nutrition intake

• Premorbid nutrition intake

• Fluid Intake

• Time course of beliefs around food

• Food rules

• Feared foods

• Food & taste preferences

• Food allergies and intolerances

• Food rituals

• Weighing, measuring & calorie counting

• Hunger & fullness cues

Assessment of Eating Disorder Behaviours

Binge Eating

• Usual binge episodes (type of food, quantity, frequency, duration)

• Feelings before, during and after

• Binge environment (where, when)

• Perceived triggers

• Behavioural consequences following binge eating (restrict/fasting, self harm, isolation

Purging

• Self-induced vomiting (how often, one purge or multiple purges, method, precipitants)

• Blood vomited (how often, how much)

• Use of laxatives, enemas, suppositories, diuretics, diet pills, misuse of insulin, chewing and spitting, steroids, self phlebotomy, self lavage (what, how much, when)

Other Behaviours

Establish a baseline level of frequency and intensity of the following behaviours:

• Rumination (regurgitation of food, then re-chewed, re-swallowed or spat out)

• Night eating

• Medication and illicit drug taking

• Cigarette smoking

• Alcohol intake

• Chewing gum

Exercise

• Current pattern of exercise

• Types of exercise

• Incidental activity (walking, standing)

• Duration of exercise per 24 hours

• Calorie goals per session

• Changes to exercise patterns

• Motivation/intention to exercise

• Effects of missing a day of exercise

• Is weight and shape controlled with exercise?

• Exercise despite illness or injury?

Assessment of Weight

Weight History

• Weight history through adolescence/adult years

• Premorbid weight

• Highest and lowest weight

• Current weight, height and BMI

• Current trend

• Desired vs healthiest weight

• Healthy BMI range or BMI percentile for children and adolescents

• Body weight and shape within family

Attitudes Towards Weight & Shape

• Level of self-criticism (whole body and specific regions)

• Perception of shape

• Perceptions of others’ attitudes about their weight and shape

• Fear of weight gain

• Presence of body checking behaviours (weighing, mirror checking, feeling/touching specific areas, using a piece of clothing as a ‘ruler’, mirror checking pre/post intake)

• Family attitudes towards food, weight and shape (including family history of dieting)

Assessment of the Effects of Disordered Eating

Physical Symptoms

• Fainting, collapse, light headedness, dizziness

• Delayed gastric emptying (causing prolonged fullness)

• Diarrhoea, constipation

• Lack of concentration

• Feeling tired and not sleeping well

• Lethargy and low energy

Psychological Symptoms

• Changes in mood (irritably and rigid, low mood)

• Evidence of starvation syndrome (cognitive impairment, personality changes, preoccupation with food)

• Impaired concentration and alertness

• Agitation

• Increased/decreased need for sleep

• Impaired ability to make decisions, rigid and inflexible thinking

• Personality traits (perfectionism, obsessiveness, impulsivity)

Menstrual Disturbances

• Age of menarche or pubertal status (using Tanner Stages)

• Regularity, length

• Absence of menstrual periods

• Date of last menstrual period

• Use of contraception (pill, IUD

Effects on Quality of Life

• Effects of eating disorder (physically, emotionally, occupationally, socially, cognitively)

• Impact of eating disorder on family or significant other

• Amount of time spent thinking about eating, weight and shape (per hour or per day)

• Broken sleep, wake up thinking about the eating disorder

• Individual’s view on what maintains the eating difficulties

• Client’s beliefs about what needs to change in order for them to get better

• Denial or acknowledgment of illness severity

• Insight into illness

• Motivation to change

Risk Assessment

Managing an individual at risk of suicide and engaging in self-harm requires a skilled health professional to thoughtfully consider the level of risk and determine appropriate interventions to minimise the risk. Ensure the individual is engaged in a multi-disciplinary team, including a psychologist, psychiatrist, social worker or counsellor that is trained in assessing and managing risk.