This post was originally published on November 30, 2010.
Reading through the latest comments on Laura's Soap Box, and those on Around the Dinner Table message board, I see many requests for educating medical professionals in the community about eating disorder treatment. "Colleen" says, for example:
"We still don't have any effective professional guidelines for treatment. My doc can't go to any definitive reference source and find a 'recipe' of what to do once he's made the diagnosis."
While I'm not sure that a recipe for the complexities of medical treatment of anorexia nervosa is even possible, there are some basic, rather simple, yet poorly understood things a generalist physician or nurse can do and should understand.
Let's start with how to take a weight. First though, please understand:
- Weighing is a source of extreme anxiety for children/youth with anorexia nervosa
- To the extent that it's seen as the only benchmark of progress, pressure to falsify it to please others will be strong
- Weight restoration is critical, critical, critical—even though it's not everything
- Any patient who can read has (web) access to recipes for multiple ways to falsify weight; YOU need to safeguard them against this overwhelming temptation by weighing them in a predictable, unvarying way (see below)
- I would encourage you not to share a patient's weight with them, but rather to carry the anxiety about the numbers FOR them (with their parents, of course). Don't make a big state secret out of it, just say something general like "You're doing a good job, we're pretty stable" or "we're headed in the safe direction". I also frequently say (because it is true) "I won't let you gain too much weight"
- Taking a weight is just like taking any other vital sign—which is what it is—do it professionally, privately and kindly
So, how to do it:
- Always weigh the patient on the same scale. If you have multiple scales in your office, mark one discretely (fingernail polish works, just a dot)
- ALWAYS weigh them in a gown with no underwear
- Please do not weigh them in the hall
- EDUCATE your nurse or medical assistant to say NOTHING while taking a weight or afterward and to write it down away from the patient; do not leave the chart in the room
- Weigh the patient after a void. Check the specific gravity of the urine in order to assess for any degree of water-loading; if the urine specific gravity is 1.005 or less, ask them to void again before weighing them. If it remains that dilute, abort the weighing and have a talk with them and their parent about over-drinking prior to a weight being taken. Let the parent help them prevent this
- We have seen weights worn everywhere, even taped to the body. Be alert but non-judgmental. Our medical assistant, Beth, has our patients do three jumping jacks before stepping on the scale since that has dislodged weights in the past (held under the arm or other places)
- If you have concerns about weights, ask them not to bring any bags, purses, etc into the exam room where they change into a gown. Once they leave, discretely check the wastebasket
- Teach your staff that this is not prison, you are not doing these things to "bust" them but to safeguard them