Medical Care and Monitoring

Will she get better? How? Those questions weighed heavily on Lucinda’s mind when she first came to talk to us about her daughter, who had developed anorexia nervosa and soon became our patient. She described Anita, then 16, as a very good student who worked as hard academically as she did on the swim team and had set her mind on becoming a marine biologist. Six years later, mother and daughter recall the turbulence that dominated their lives during Anita’s 10th- and 11th-grade years.

“When Anita first showed signs of anorexia, she’d insist she felt fine,” remembers Lucinda. “She’d say, ‘How could I have anorexia? I eat.’ Or ‘So-and-so is skinnier,’ or ‘I could eat more if I wanted to.’ As much as I wanted to believe that she was well, I didn’t.

Actually, I wasn’t at all sure what was wrong with her. For all I knew, some other illness could have been causing her weight loss.

That’s why I pressed her to see her primary care physician.”

Lucinda’s point is key. When someone experiences unexpected weight loss, she might have an eating disorder or she might have another condition such as diabetes mellitus, thyroid disease, or inflammatory bowel disease. Sometimes an eating disorder can occur along with one of these other illnesses, and thus it is crucial for your child to see her primary care physician, pediatrician, or adolescent medicine specialist for an evaluation.

“After Anita’s primary care doctor examined her, he confirmed my worst nightmare,” Lucinda continues. “Anita had anorexia nervosa. He explained to both of us that malnutrition can progress to the point of harming every organ of the body, including the heart. He was clearly concerned about her weight loss. Her pulse and blood pressure were on the low side, and he felt this went along with her semistarved condition. The doctor assured us that Anita’s blood test results would be available within 48 hours and requested that we return to see him in seven days. Meanwhile, he wanted her to take the week off from swim practice and to start eating breakfast before leaving for school.”

“Those two recommendations did not sit well with me,” admits Anita. “To my way of thinking, my heart rate was slow not because I was ill, but because I was physically fit. A couple of days after my medical evaluation, Mom called the doctor to check on my blood work and learned that it was all normal. When I heard the news, I said, ‘See, Mom? There’s nothing wrong with me.’

What I didn’t tell her was that I’d gone running in place of swim practice that afternoon and intended to do the same every day for the rest of the week. Something inside kept telling me to exercise harder.”

Like Anita, many patients in the early stages of anorexia and bulimia have normal laboratory results, which they perceive as evidence that they don’t have an eating disorder. Furthermore, these individuals often feel fine. In fact, a person may report feeling more accomplished or better disciplined as she loses weight. This preliminary sense of well-being is likely to reinforce her resolve to continue her food-related behaviors, particularly if peers or others are complimenting her thinness.

Lucinda says, “When I phoned the doctor about Anita’s reaction to her lab report, he explained that it generally takes time for an individual with an eating disorder to admit she has a problem and that he would work with me on keeping her medically safe and on increasing her motivation to get well. By seeing Anita every week, he would monitor her health and weight, and at the same time, try to help her see the need for treatment for her eating disorder.”

“I dreaded those weekly appointments,” recalls Anita. “Every week Mom and I would fight about whether I was going. I’d say, ‘Mom, I feel okay. These appointments are so stupid.’ I’d be furious at her for making me go. Each visit started with a weigh-in and a vital sign check followed by a talk with the doctor. He would take my pulse and blood pressure while I was lying down and then ask me to stand up so he could check them again. The weighing sent my thoughts spinning. I was so upset about the number on the scale that when the doctor tried to talk with me, I couldn’t concentrate on what he was saying. And I didn’t want to.”

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