- First areas of concern:
There are several reasons to be concerned about an adolescent who has difficulty concentrating at school, and appears thin and frail. First, it is possible that the patient has an eating disorder such as anorexia or bulimia. Diet pills are also requested, which confirms this. Secondly, the patient’s difficulty concentrating could be a symptom of malnutrition, which can affect cognitive function. Thirdly, the patient’s appearance suggests possible malnutrition, which could be a result of a lack of adequate nutrient intake, an underlying medical condition, or an eating disorder.
- Useful Screening Tools
A number of screening tools are available to help with diagnosis. The SCOFF questionnaire is the first screening tool that the clinician should use. It’s a validated tool to help screen for anorexia and bulimia. The questionnaire consists of five questions that assess the patient’s perception of their weight, control over their eating, food intake, presence of guilt, and changes in weight. Secondly, the clinician can use a nutritional screening tool, such as the Mini Nutritional Assessment (MNA), to assess the patient’s nutritional status. The MNA consists of a series of questions that assess the patient’s food intake, weight loss, mobility, psychological stress, and body mass index.
- Health Promotion Strategy:
You can discuss with your patient the impact of nutrition on cognition and how it affects health. You can educate the patient on how malnutrition affects the brain. This includes the possibility of memory loss, difficulty concentrating and lower academic performance. A clinician may provide handouts or websites that support healthy eating habits. Referrals to registered dietitians can be made for more in-depth nutritional counseling and assessment.
- Plan of care:
Possible pharmacological interventions for this patient may include medications to address any underlying medical conditions, such as thyroid disorders or depression, which may contribute to the patient’s symptoms. Other non-pharmacological treatments include family therapy, cognitive-behavioral treatment, nutritional counseling, etc. Diet pills sold over-the-counter should not be prescribed and are discouraged as they may be harmful and cause further complications.
You may order a complete count of blood (CBC) in order to determine anemia or electrolyte deficiencies, as well as liver function testing to measure liver function. If indicated, thyroid function tests can be ordered. Follow-up visits should be scheduled at regular intervals to monitor the patient’s progress and adjust the plan of care as needed.
It is important to educate patients about the dangers of diet pills and how they can affect their health. Referrals to registered dietitians for nutrition counseling, and to mental health professionals should be given for evaluation and treatment of mental disorders.
- National Eating Disorders Association (2018). Medical assessment and treatment. Retrieved from https://www.nationaleatingdisorders.org/medical-assessment-and-management.
The guideline covers medical assessment and intervention for eating disorder patients, including nutrition assessments, lab evaluations and medical management.
- American Academy of Pediatrics (2016). Clinical report – identification and management of eating disorders in children and adolescents. Pediatrics, 138(3), e20161649. doi: 10.1542/peds.2016-1649.
This report contains evidence-based guidelines for the detection and treatment of eating disorders among children and adolescents. It includes screening, diagnosis and treatment.