Eating disorders involve extreme weight control practices (food restriction, binge eating, purging) as well as difficulties in how a person experiences and perceives herself and her body. An individual in the early stages of anorexia nervosa often reports feeling well and denies having an eating problem. If she derives a sense of accomplishment from losing weight or receives compliments about her appearance from peers or others, she is likely to continue to pursue thinness. While patients with bulimia nervosa tend to acknowledge being bothered by their abnormal eating habits, some are unready to return to health and others want immediate recovery but feel afraid to make the necessary behavioral changes. For family members who are trying to encourage their loved one to enter treatment, the health professional can be an invaluable resource.

The individual with severe weight loss due to an eating disorder is unlikely to recognize that she has a serious illness or that she is at risk of medical problems associated with malnutrition. Tailored to the patient’s age and degree of readiness for change, education efforts can focus on the basic connections between nutrition and health. Often included is the point that when a body does not receive enough food, it tries to adapt by slowing its production of energy; such changes impose increasing strain on the organ systems and may lead to medical compromise.

Of primary concern is the heart, which the professional can introduce to the patient as the hollow, muscular organ that pumps blood to the various tissues of the body, delivering oxygen and nutrients and taking away waste products such as carbon dioxide. The pumping action results from cardiac muscle fibers relaxing and contracting (tightening, squeezing) in precise rhythmic sequences. A healthy “pump” adjusts its output of blood to meet the fluctuating needs of the various tissues. In order to serve the rest of the body, however, the heart itself requires a steady supply of fuel. If this remarkable organ is undernourished, it gradually weakens and slows down, becoming increasingly vulnerable to life-threatening rhythms.

Many patients and families have heard about the dangers of high blood pressure but are not aware that abnormally low blood pressure carries its own set of risks (such as weakness, lightheadedness, and fainting) and can eventually be harmful to the heart, kidneys and other vital organs. Low blood pressure associated with malnutrition is a common characteristic of anorexia nervosa. In addressing this topic with the patient, it will be helpful to highlight the good news by reassuring her that soon after she begins to feed her body, her blood pressure and resting pulse are likely to return to normal.

To help discourage purging (self-induced vomiting, laxative misuse, diuretic misuse), the provider can explain that in order to function properly, nerves and muscles (including the heart) require electrolytes--salts and minerals such as sodium, potassium, and calcium that are part of a healthy meal plan. Purging can interfere with the balance of electrolytes and cause medical problems. For example, a potassium level that falls too low may open the door to dangerous heart rhythms.

Patients with anorexia nervosa are particularly sensitive to the cold and often need help appreciating that a lack of fat tissue renders a body less efficient at holding in the heat. In addition, the professional can discuss how a semi-starved body “prioritizes” its energy needs, redirecting blood that formerly warmed the skin to the heart and other vital organs.

Eating disorder sufferers tend to exercise to an extreme, often in the interest of controlling their weight. Many individuals with these illnesses feel guilty if physical activity is missed. To the athlete who believes “the thinner I get, the better I’ll perform,” the provider will emphasize that this is not how it works. In fact, an undernourished body may draw upon muscles for fuel, gradually leading to weakness—hardly what the competitive athlete has in mind. In addition, malnutrition and overexercise are disruptive to the body’s hormones, often causing menstrual periods to stop or become irregular. And absent periods increase the risk of bone loss (osteoporosis) and potential fracture. The first step to an athletic future, the professional advises, is to eat three balanced meals plus snacks each day.

Many patients need reminders that severe weight loss affects the brain. Some individuals with anorexia nervosa experience difficulties with concentration, attention and memory. These problems will often subside as nutritional status improves.

The clinician focuses education content on health, not weight, and advises family members to do the same when addressing body image with their loved one at home. Suppose, for example, that an individual severely restricts all cereal products for fear that these foods will pile on the pounds; the idea would be to highlight the key roles carbohydrates play in maintaining health. The provider approaches educational and motivational interventions from a positive perspective, praising the patient for steps she is taking toward recovery and encouraging her to “keep up the good work.”