Nurse’s Guide to Caring for Patients With Eating Disorders

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.

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:

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.

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.

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.

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.

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.

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.”

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.

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.

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.

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.”

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.

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