Teens with eating disorder behaviors or symptoms may be referred to an eating disorder program by their pediatrician, family doctor, or nurse practitioner. While no two programs are exactly the same, outpatient programs usually perform a complete assessment to provide appropriate treatment for teens with eating disorders and support for family members. The approach is usually multidisciplinary, which means that more than one specially trained health care provider will be involved in the evaluation and treatment plan. All of these team members will likely involve the family as well, to plan the guidance and support needed at home. College students and young adults often see the team alone, but may still work with parents or other family members.
The first visit typically includes:
Medical Evaluation by a health care provider (HCP) who is specialized in caring for teens.
Your HCP will:
- Check your blood pressure, pulse, temperature, and weight
- Ask you and your family about your medical history
- Ask you questions about your eating habits and
- Order tests such as labs (blood tests), urinalysis (to see if you are drinking the right amount of fluids), EKG (a test which looks at the activity of your heart if your heart rate is low), and/or bone density test (DXA scan), if needed
Mental Health Evaluation by a psychologist or social worker experienced in eating disorder treatment.
You and the mental health provider may talk about:
- How you feel about the way your body looks
- Your food related behaviors
- Your family’s concerns about your health
- Your thoughts and feelings about being evaluated for an eating disorder
- Your treatment goals
- Anything else you feel is important for the counselor to know
Nutrition Evaluation by a registered dietitian experienced in eating disorder treatment.
You and your dietitian will:
- Talk about your food likes and dislikes
- Talk about any behaviors you have related to food
- Discuss common myths about food and eating disorders
- Talk about your health goals and concerns about changing your behaviors
- Work with you and your family on creating a healthy eating plan for you
After the evaluation: Your HCP will talk to you about a personal treatment plan that will likely include:
- Individual and family therapy
- Medical monitoring by your primary care provider
- Nutritional counseling and support from your dietitian
The Treatment Team: Eating disorders are both medical and psychological conditions. Therefore, treatment usually includes working with a team of specialists including: a doctor or nurse practitioner, therapist or counselor, a dietitian, and sometimes a psychiatrist or family therapist.
The Health Care Provider’s (HCP) role is to:
- Keep track of a person’s medical health by checking height, weight, blood pressure, pulse, and temperature.
- Draw blood or take urine samples, if necessary, to make sure the chemicals in the body called electrolytes are balanced.
- Order special tests such as an EKG to monitor heart rhythm, or a bone density test (DEXA) to see if osteoporosis (thinning of the bones) is present or developing.
- Offer suggestions on achieving weight goals, calcium and vitamin supplements, exercise, , and possibly medication for anxiety or depression.
- Determine the best treatment option for you. The HCP may suggest meeting with a therapist and nutritionist, going into residential treatment, having a family-based therapist, or being hospitalized until medically stable.
The Therapist/Counselor’s role is to:
- Help improve self-esteem, body image, and confidence.
- Involve parents and other family members in providing support, guidance, and supervision of meals.
- Teach healthy ways to manage emotions and stressful situations.
- Address other emotional problems that may be related to the eating disorder, such as depression, obsessive-compulsive disorder, or substance abuse.
- Create a place where someone can (privately) discuss her/his needs and goals.
- Provide a safe place to experience feelings of sadness, anxiety, anger, etc.
- Discuss disordered eating thinking and behaviors, and teach strategies to become mentally healthy.
The Family-based Therapist’s role is to:
- Provide parents guidance and support around refeeding their child.
- Teach parents how to manage mealtime conflict.
The Registered Dietitian’s role is to:
- Help create a safe and healthy eating plan that is balanced in all the food groups.
- Answer questions about food.
- Teach why our bodies need specific nutrients and which foods provide them.
- Offer suggestions on healthy eating, how to achieve weight goals, vitamin and mineral supplements, and exercise.
- Discuss the harmful myths and confusing messages about food and diets.
Treatment for an eating disorder is a very individualized process. Therefore, there are different types of treatments depending on how medically stable a person is and how much emotional support they need.
What to expect at each level of treatment:
Outpatient: for someone who is beginning to struggle with an eating disorder, or who is stepping down from residential or intensive outpatient (sometimes called IOP). There are two approaches to outpatient treatment: multi-disciplinary and family-based.
Multi-disciplinary: This type of treatment often involves regular meetings with ALL members of the treatment team. Medical providers usually schedule weight-checks for patients who are recovering from an eating disorder anywhere from 3 times a week to once a month. They may also want to check blood pressure, heart rate, and urine to make sure the patient is drinking enough fluids. Meetings with the therapist and dietitian may be scheduled weekly or bi-weekly.
Family-based treatment (FBT):This type of treatment puts parents and/or family members in charge of the recovery process. Family members control their child’s food and offer support at every meal and snack with guidance from a licensed therapist who specializes in family-based treatment. Family-based treatment is usually done at home, and may involve only the family-based therapist and a medical doctor, but other health professionals may also be involved. The focus of the treatment is on weight restoration and behavioral change. Once weight is restored the therapy will focus on normal adolescent developmental issues. This type of therapy is sometimes referred to as the “Maudsley” approach.
Intensive outpatient program (IOP): This type of treatment is for people either transitioning back into school, work, etc. from residential or partial hospital level of treatment, or for people who are not ready for or do not require a higher level of treatment. Intensive outpatient treatment usually involves evening group meetings 3-5 days per week. The amount of time spent at the program each day varies between programs. Usually 1 meal is supervised which may be provided by the program or brought by the patient.
Partial hospitalization program (PHP): This type of treatment occurs during the day and 2-3 meals are provided and supervised along with group and individual therapy, and nutrition education. Patients in partial programs often attend 5 days per week and go home at night.
Residential: This type of treatment is for medically stable patients who need a very structured level of treatment. Patients live and sleep in a center with other young people. Patients in residential programs have frequent meetings with their team (therapist, dietitian, nurse and/or health care provider, and psychiatrist) and have a lot of group meetings. After residential treatment, patients often meet with an outpatient team, or transfer to an intensive outpatient program.
In-patient: This type of treatment is for people with severe eating disorders who are medically unstable or people who were unsuccessful with treatment at a lower level. Patients receive 24-hour hospital supervision and care and have a very structured schedule. Once medically stable, patients may go home or go to residential treatment.
Treatment of eating disorders varies from person to person. Some people only do outpatient treatment, while others may need to transition through multiple levels of care as part of their eating disorder treatment. Transitioning into outpatient from inpatient or residential treatment may be very challenging in the beginning.
If you are transitioning from inpatient or residential to outpatient treatment, here are some important things to remember:
- Before you leave inpatient or residential treatment, set up an outpatient team that you can meet with regularly. Ask your treatment team to help you find providers that are the right fit for you and who accept your health insurance. Usually an outpatient team consists of a therapist, dietitian, HCP or nurse practitioner, and often a psychiatrist and/or a family therapist.
- Some days will be easier than others. It’s OK and normal for you to have some challenging days.
- It will be your responsibility to follow your meal plan when you are in an outpatient setting, not engage in unhealthy behaviors, and maintain a healthy weight.
- Don’t be afraid to seek support from family and friends when necessary, especially around meals. In some cases, your parents might be asked to be in charge of your meal plan.
- Think about one meal at a time, and try not to become discouraged if you have a hard time once in a while.
- Be completely honest with your treatment team and tell them if and when you have any thoughts about disordered eating or if you begin using unhealthy behaviors again.
- Realize that treatment and recovery are a process and that might mean stepping back up to a higher level of care at some point if your behaviors and/or weight are not improving at the outpatient level of care.
Group Support Meetings can also be helpful before treatment or during recovery. People with eating disorders often find it helpful to meet other people who are experiencing similar challenges. Group meetings are both encouraging and valuable because people can share concerns, accomplishments, and coping methods. Group meetings may be found at local health centers, agencies, or schools.