Often the first professionals to come into contact with a person who has an eating disorder are GPs, teachers and school nurses. For these professionals, eating disorders can seem challenging and bewildering. They see people with anorexia and bulimia more rarely than people with other physical or psychological problems, so feel they lack confidence and understanding in this specialty. Equally, eating disorders typically involve high levels of shame and secrecy. This means that a person with an eating disorder may not present to a healthcare professional or teacher with recognised symptoms.

GPs are more likely to see a patient who has anorexia or bulimia for other psychological or physical symptoms. Common physical concerns include anxiety or depression, self-harm and inappropriate concerns about weight or body shape.

Physical problems include digestion problems, unexplained weight loss, the loss or very irregular periods. In children, the presentation may be with vomiting or poor growth. Sometimes, the consultation is not initiated by the patient themselves but by another member of the family such as a parent.

The first encounter with a patient who has an eating disorder can be difficult for both doctor and patient. The patient, particularly if they have anorexia, is likely to be very fearful of seeing the doctor in case she is made to eat. They are going to be feeling frightened and confused at what is happening to them. Building an understanding relationship with the patient is very important and you should try to take a calm and non-judgemental approach. It is very helpful if you can show an understanding of how trapped and confused the patient feels.

Patients with bulimia nervosa and binge eating disorder may feel more certain about changing but are often profoundly ashamed of their eating habits. They may be embarrassed to talk about their eating problems and worried that their problem will be dismissed as trivial.

Anorexia nervosa can occur in pre-pubertal children but is more common in those over the age of 12 than in younger children. The clinical features are similar to those in adults, with the exception that amenorrhoea of course does not occur in premenarcheal children and the absence of periods is an unreliable sign in younger adolescents. It is more likely that the request for help will come from parents (or sometimes teachers) than from the child. Common presenting features in younger patients include:

o Concerns about weight or failure to gain weight

o Delayed menarche

o Irregular food intake, conflict at meal times and concern about eating with others

o Preoccupation with food

o Excessive exercise

o Abdominal pain, gastrointestinal disturbance, headache

o Mood swings, depression, anxiety, self-harm

o Low self esteem

o Social withdrawal

o School refusal

o Anxieties about psychosexual development

In children, significant nutritional compromise can occur without weight loss and a static weight can indicate significant under-nutrition at a time of growth. BMI norms differ according to age and BMI centile charts should therefore be used to assess weight in those under sixteen. Children may decompensate physically more rapidly than adults and become dehydrated more easily. Urgent action is required if the child’s physical health is significantly compromised. Longer term medical complications include growth retardation, pubertal arrest and reduction in peak bone mass. Physical causes of weight loss should always be excluded in children and referral to a paediatrician may be required.