Eating Disorders for Parents: Helping Your Child Prepare for an Evaluation

Young people with eating disorder behaviors or symptoms are generally referred to an eating disorder program by their pediatrician, family doctor, nurse practitioner, or physician assistant. As a parent, it’s normal to feel stressed, anxious and even guilty. It’s important to remember that no one is at fault. An eating disorder is an illness that requires treatment and support. For young people with restrictive intake, food is the medicine that will get your child back to a healthy weight. For young people with other types of eating disorders, normalizing food–related behaviors is essential to restoring physical and emotional health. While no two programs are exactly the same, outpatient programs usually do a complete evaluation and provide treatment for the patient with an eating disorder in addition to support for family members.

The approach is often multidisciplinary, which means that more than one health care provider trained in eating disorders will be involved in your child’s evaluation and treatment plan. Team members may also involve others in your family and will meet to discuss a plan for offering the guidance and support your child will need at home. College students and young adults often see the team alone, but even they frequently work with parents or other family members. Team members in many programs include a registered dietitian, mental health, and medical professionals. The roles may vary depending on if the program is family–based, if the treatment team is already in place, the age of the child, severity of the illness, and other factors.

The first visit typically includes the following:

1. Medical Evaluation by a health care provider who is specialized in caring for children, adolescents and young adults.The doctor or nurse practitioner will:
   • Check your child’s blood pressure, pulse, temperature, height and weight
   • Ask about your child’s medical history and growth, as well as his/her family’s medical history
   • Ask for notes and growth charts to be sent for review
   • Ask questions about your child’s eating habits, other behaviors, and physical symptoms
   • Perform a physical exam and order tests which may include blood tests, urinalysis (to see if your child is drinking the right amount of fluids), EKG (a test which looks at the activity of the heart), or bone density test, as needed
2. Mental Health Evaluation by a licensed therapist experienced in eating disorder treatment. The therapist may have your child fill out a special questionnaire to assess behaviors. Your child and the therapist may talk about:
   • Eating disorder related behaviors
   • Mental health history including depression and anxiety
   • Body image
   • The family’s concerns
   • Thoughts and feelings about being evaluated for an eating disorder
   • Treatment goals
   Having your child work with a therapist is an important part of his/her recovery. The therapist can help your child work on his/her body image, self–esteem, and discuss any other emotional issues that may affect their eating habits.
3. Nutrition Evaluation by a registered dietitian experienced in working with young people with eating disorders and their parents. The dietitian may talk mostly with your child or only with you (if the treatment is family–based) about:
   • Behaviors related to food
   • Health goals and concerns about changing behaviors
   • Food likes and dislikes
   • Common myths about food and eating disorders

In a culture obsessed with dieting and body image, it can be challenging to have a healthy relationship with food and exercise. A specially trained dietitian can help you and your child create a personal plan for healthy eating and exercise and discuss harmful myths and confusing messages about food and dieting.

After the evaluation:

Your child’s health care provider or team will talk to you and your child about a treatment plan that will likely include:

• Which level of care is most appropriate for your child right now
• Individual and family therapy
• Medical monitoring by your child’s primary care provider (PCP)
• Nutritional support for you and/or your child with a dietitian
• Other adjunct therapies such as yoga, mindfulness, or relaxation exercises