My Doctor Online The Permanente Medical Group

Common Signs and Symptoms

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Common signs and symptoms of anorexia include:

• Believing one is fat, in spite of being thin
• Weight loss in a short period of time
• Continued dieting, although already very thin
• Excessive focus on food or food rituals
• Skipping meals, eating very little, and eating slowly
• Obsession with exercise
• Dizziness
• Excessive hair loss
• Loss of menstrual periods

Other problems may develop as a result of anorexia, including extreme sensitivity to cold, weak or brittle nails, and growth of fine hair on the arms, face, shoulders, and back.

Left untreated, the disorder can lead to serious health problems with the heart, brain, and bones:

• The heart and circulation can weaken.
• The brain can shrink.
• The bones can lose calcium, making them weak.

Taking vitamins, calcium, or other supplements does not protect against malnutrition.

Because people with eating disorders are quite good at hiding the signs, identifying an eating disorder can be difficult. If you suspect an eating disorder, contact us for an evaluation. The longer the person goes without treatment, the more challenging it may be to successfully treat the eating disorder. 

Diagnosis

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During the clinic visit, we will assess the person's physical and mental health before diagnosing an eating disorder. We conduct a medical history and physical exam, including a check of weight and height. We may also ask about eating and exercise behaviors to see if they are within normal ranges.

Since malnutrition commonly occurs with eating disorders, we will also check for physical signs that involve heart rate or blood pressure, as well as examine the teeth, skin, hair, and nails. We will order lab tests to check for signs of malnutrition.

If we suspect further complications from an eating disorder, we may order additional tests. 

We may ask about sleeping and eating patterns, sadness, anxiety, and stress levels. Typically, we assess eating habits, exercise routine, and the person's feelings about her current health status. We may want to know about thoughts on body image. If a young woman is suffering from an eating disorder, we may ask about the regularity of her menstrual cycle.

Often, people with eating disorders are secretive about their eating patterns, so we might ask further questions such as:

• Do you vomit after eating to feel better?
• Do you feel distressed after eating?
• Do you eat in secret or hoard food?
• Do you take laxatives or diuretics? 

Causes

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We do not know what causes anorexia, but we do know that a number of factors can influence the development of an eating disorder, including:

• Family and peer pressure
• Chemical imbalances
• Genetics
• Emotional problems
• Images of “ideal bodies” in the media
• Sports or activities that emphasize low body weight (ballet, gymnastics, wrestling)
• Positive or negative events in one’s life

People with anorexia often suffer from low self-esteem and feelings of helplessness. Many with anorexia are perfectionists and have a strong desire to be in control. They often set unrealistic goals for themselves.

Treatment

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Treatment usually involves a team, including medical doctors, mental health professionals, and nutritionists. Family therapy may be part of the treatment plan. Our team will work with family members to help them understand anorexia and learn new techniques for coping with it. In some cases of severe malnutrition, a hospital stay may be necessary. Treatment can be difficult and require hard work from the patient and the family. Treatment for anorexia is most successful if the problem is recognized early.

If you think you have anorexia nervosa:

• Talk to an adult you trust – like a parent, teacher, or your doctor or nurse practitioner – about getting help.
• It’s common and okay to feel ashamed or depressed about your relationship with food and to be scared about treatment. Many people with anorexia have the same feelings.
• Recognizing that you may have unhealthy eating habits and unrealistic thoughts about food is the first step to getting better.

How can you help your child with anorexia?

If you think there might be a problem, don’t be afraid to talk to your child’s doctor. The earlier treatment begins, the better the outcome. It can help if you:

• Learn about eating disorders.
• Let your child know that you care and you want to help.
• Don’t pressure them about eating or talk about weight or food (yours or theirs).
• Are patient. It is more than a matter of eating.
• Are prepared for resistance. They may deny the problem, get angry, or refuse to get help.

It’s very important that you bring your teen in for treatment even if they don’t want to come – his or her health depends on it. We can help them begin treatment. We know that dealing with eating disorders can be stressful and scary. We can support you and your family during treatment. 

Your Care with Me

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During the clinic visit, we will assess the person's physical and mental health before diagnosing an eating disorder. We will check height, weight, and blood pressure, and we may order lab tests to look for signs of malnutrition.

We may ask questions about eating and exercise behaviors, the regularity of thoughts on body image, feelings of sadness, anxiety, and stress levels. If we suspect further complications from an eating disorder, we may order additional tests.
You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

• For nonurgent questions or concerns, you can e-mail me using this site. You can also book an appointment online to see me in person.
• If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or book an appointment for you.

How We Coordinate Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting care easier.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay current on your health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are next due for a well child visit (checkup) and immunizations. We can discuss and schedule any preventive tests that may be needed.
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we talked about during the visit. You can refer to it if you forget what we discussed, or if you just want to recheck your height, weight, or vital signs.   

If you schedule a telephone appointment

• In addition to in-person visits, we now offer the option of telephone appointments for certain common pediatric concerns. Depending on your symptoms, you may have the option to schedule a telephone appointment with me or another pediatrician, if I am unavailable. We will call you at an agreed-upon time, at whichever phone number is most convenient for you.
• Many teens like this new option, but if you prefer to be seen in person, it’s always your choice. Just let the telephone staff know what type of visit you prefer.
• Telephone appointments are not appropriate for all health concerns. The advice nurse can help you decide what type of care is best for you.

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments as needed.

Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically, in advance.

If refills are needed in the future, you can:

Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.

• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy.
• If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, such as X-rays, we will schedule an appointment with the Radiology Department.

When the results are ready, we will contact you with the results by phone. We may ask you for a phone number where you can receive your results confidentially.  If you do not have a cell phone, we may ask you to call us for the results instead, to ensure that we protect your privacy.  

If I refer you to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your condition. In some cases, I may contact them during your visit, so we can discuss your care together. If we decide you need a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.
 

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Convenient Resources for You

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My goal is to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available to help you manage your care at any time that is most convenient for you. From my home page you can sign up for kp.org and:

Stay on top of your health

• Manage your prescriptions and refills.
• Schedule well visit and non-urgent appointments.
• View your preventive health reminders to see whether you are due for any immunizations or well visits.
• View and send secure e-mail messages*

*Secure means e-mail communication between you, me, and other members of your health care team is behind our firewall and password protected.  Anyone who can act on your behalf (for example, your parents) will have access to this e-mail box.  If you want to talk confidentially, l encourage you to call me or make an appointment to see me in person, instead of sending a secure message online.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition. 
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• Check to see if you are due for a well teen visit or need any immunizations.
  

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