HAMR
Hamilton Addictions & Mental Health Resource
Eating Disorders
The eating disorders most commonly treated in adults are anorexia nervosa, bulimia nervosa and more recently, binge eating disorder. In addition to these disorders, there is a significant subgroup of patients falling into the “otherwise specified” category who also need detection and treatment. Eating disorders are considered complicated to treat because of the need to attend to medical, nutritional and psychiatric factors simultaneously. A multi-disciplinary approach to treatment is therefore felt to be essential and is typical of specialized treatment programs. The role of the primary healthcare physician and team is extremely important in the detection of individuals with an eating disorder, as well as in the medical monitoring and management of these patients. As the “quarterback” of their patients’ healthcare, physicians are in an important position to advocate for their patients’ care as they navigate the eating disorder treatment options. In many cases, physicians and other primary healthcare providers have to manage the care of patients while they wait for specialized treatment, and are responsible for following patients once they leave treatment. Because of the ambivalence many patients feel about recovery, the primary healthcare team can be responsible for following patients over long periods of time, some of whom are very medically compromised.
Managing Patients Medically
The primary care physician and team often must provide medical evaluation and monitoring of patients who are identified as having an eating disorder. The St. Joseph’s Eating Disorders Clinic has prepared a brief list of recommendations for medical monitoring of eating disorder patients, which is also available on their website.
Click here for the Medical Monitoring Form
For a more complete reference on medical monitoring of eating disorder patients, please see the Academy for Eating Disorders website: https://www.aedweb.org/images/2016MCSGV3.pdf
Levels of Care
Eating disorders vary in severity and medical risk which require different levels, or intensity, of treatment. Primary physicians can help direct patients to appropriate care:
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Types of Eating Disorders and Screening Tools
The types of eating disorders most often seen in adulthood are anorexia nervosa, bulimia nervosa, binge eating disorder, and the “other specified” category that includes milder versions of the disorders just mentioned as well as purging disorder and night eating syndrome. Another eating disorder most commonly found in children, but that also occurs in adults is avoidant/restrictive food intake disorder (ARFID). In assessing for anorexia, bulimia or binge eating disorder (or other specified disorders), if the patient presents with concerns that they have an eating disorder, it is typically not necessary or advisable to investigate other possible medical conditions. In the case of ARFID, the symptoms may be the direct result of another medical condition, but the severity of food avoidance or weight loss exceeds that expected.
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Anorexia Nervosa (AN): A person with anorexia nervosa will have deliberately set out to either lose weight or control their eating (for example, to eat “clean” or more healthily) and will have experienced a significant weight loss, falling below what is considered minimally normal (a Body Mass Index below 18.5 at minimum). Despite this low weight, the person with anorexia intensely fears the possibility of weight gain, or cannot seem to sustain behaviour that will lead to weight regain. Their self-evaluation is unduly influenced by their feelings about their weight or shape and they may have difficulty recognizing the seriousness of their low body weight. Some individuals are designated as “restricting type” if they only restrict their food intake and/or over-exercise. Others would be described as “binge-eating/purging type” if either binge eating or any type of purging of food (through self-induced vomiting, laxatives, etc.) is part of the clinical picture. The severity of anorexia is related to the extent of weight loss. Individuals whose BMI is above 16 are eligible for treatment in an outpatient setting and are considered to fall in the “mild to moderate” range. Individuals falling below this range (“moderate, severe and extreme”) would be considered appropriate for intensive treatment such as day hospital or inpatient care.
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Bulimia Nervosa (BN):
Persons with bulimia nervosa are typically trying to restrict their food, but are experiencing recurrent episodes of binge eating, where they experience a loss of control over their eating and eat what most people would consider to be a large amount of food compared to what people would typically eat in similar circumstances. The person with bulimia usually feels very distressed at this loss of control and tries to make up for it through various methods of compensating for the food they have eaten. The compensatory strategy that most people associate with bulimia is self-induced vomiting, but there are other strategies such as misuse of laxatives, diuretics or other medications; fasting; or excessive exercise that individuals with bulimia use to try to rid themselves of the food they have eaten. The binge eating and compensatory behaviours must both occur, on average, at least once a week over at least a three month period. It is understood that what drives the food restriction, and the attempts to make up for the binge eating, is that their self-worth is based on weight and shape. The severity of this disorder is related to the frequency of inappropriate compensatory behaviours, in part because this is also related to the medical risk associated with the disorder. Individuals in the mild to moderate range are using compensatory behaviours up to once per day. Individuals in the severe to extreme range are using compensatory behaviours more than once or twice per day. These patients are at the greatest medical risk, especially when using strategies such as vomiting or laxative abuse.
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Binge Eating Disorder (BED):
Persons with binge eating disorder are experiencing recurrent episodes of binge eating, where they experience a loss of control over their eating and eat what most people would consider to be a large amount of food compared to what people would typically eat in similar circumstances. They are not, however, engaging in any behaviours to compensate for the food that they have binge eaten. Because of this, persons with binge eating disorder are typically overweight or obese, and may first come to your attention because they are seeking weight loss of some kind. Binge eating is not simple overeating, as it is associated with at least three of the following: eating more rapidly; eating until uncomfortably full; eating large amounts even when not hungry; eating alone because of embarrassment about the eating; and feeling disgusted, depressed or guilty after eating. The binge eating must be occurring on average once a week for at least a three month period. Severity of the disorder is related to the frequency of binge eating. Individuals in the mild to moderate range are binge eating up to once per day. The severe to extreme range is when individuals are binge eating more than once or twice per day.
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Avoidant/Restrictive Food Intake Disorder (ARFID):
Persons with ARFID experience significant weight loss or nutritional deficiencies, require enteral feeding or oral nutritional supplements, or experience significant impact on their psychosocial functioning because of an inability to eat. The reason for these difficulties is because the person refuses to eat because they say they are not interested in eating or food; because they cannot tolerate the sensory qualities of food; or are worried about a negative consequence of eating (such as worrying they might choke, vomit or have symptoms of irritable bowel as examples).
Hospital (St. Joseph’s Healthcare Hamilton) Based Resources
St. Joseph’s Eating Disorders Clinic
The St. Joseph’s Eating Disorder Clinic provides psychiatric assessment and pharmacotherapy, as well as cognitive behaviour therapy for patients with the following conditions:
- Anorexia Nervosa (for individuals with a Body Mass Index [BMI] over 16)
- Bulimia Nervosa
- Binge Eating Disorder
- Avoidant/Restrictive Food Intake Disorder
- Other Specified Feeding and Eating Disorder, including Purging Disorder and Night Eating
Please note the following restrictions and recommendations:
- St. Joseph’s Eating Disorders Clinic is an outpatient program does not treat individuals whose eating disorders place them at high medical risk. Individuals whose BMI falls below 16 should be referred to more intensive eating disorder programs, such as Credit Valley Hospital, Toronto General Hospital, or London General Hospital. In these settings, individuals are more closely monitored medically and receive more support for making changes. Other individuals may be recommended to a higher level of care based on the assessment of medical risk due to other factors related to their eating disorder.
- The clinic may recommend alternative treatment for individuals with significant self-harm, substance abuse or psychotic disorders.
Please contact Ms. Seana Jackson-Brown if you have any questions about referring a patient to the eating disorders clinic.
Contact: Ms. Seana Jackson-Brown
Tel: (905) 522-1155, ext. 33561 Fax: (905) 905-540-6574
Website: http://www.stjoes.ca/hospital-services/mental-health-addiction-services/mental-health-services/eating-disorders-program
Community-based Resources for Eating Disorders in Hamilton
Hamilton Family Health Team For patients of family physicians who are part of the HFHT, please see resources listed on the HFHT website
General Online Patient Information on Eating Disorders
National Eating Disorders Information Centre (NEDIC): For information about eating disorders and treatment resources across the country: http://nedic.ca/
Advocacy: N IED is a not-for-profit coalition of health care professionals, counsellors and parents with children suffering from Eating Disorders. NIED aims to increase the awareness and education of Eating Disorders to sow the seeds for change in the understanding, treatment and funding of the disease in Canada: http://nied.ca/
Disorder Specific Online Patient Information
Mobile Apps:
- Recovery Record
- Rise Up
Online Resources for Physicians
Academy for Eating Disorders: https://www.aedweb.org/
The information contained in this website is for general information purposes only. The information is provided by Hamilton Academy of Medicine and while we endeavour to keep the information up to date and correct, we make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to the website or the information contained on the website for any purpose. Any reliance you place on such information is therefore strictly at your own risk.
