Background: Adults with eating disorders are often failed by the medical system. In this workshop, eating disorder clinicians will be empowered to interpret both subtle and critical medical complications of both restricting and purging, with a focus on how to translate problems to the client to support and motivate treatment.
- Introduction
- Scope of the problem
- What are the problems our patients encounter with the medical system presently? How does this impact their level of motivation for recovery and relationship with treatment?
- How to help our patients who purely restrict: case and organ-system discussion
- Defying the “your labs are ok” problem
- Refeeding syndrome: how to make it real (phosphorus and edema)
- Vital sign abnormalities: low heart rate, low blood pressure, fast heart rate
- Hypoglycemia: not something to trivialize
- Liver dysfunction: why it matters
- Bone marrow failure: an objective measure of body suffering
- Gastroparesis: removing a physical impediment
- Osteoporosis: the one thing that may be irreversible
- How to help our patients who purge: case and discussion
- Electrolyte abnormalities: we can do better in fixing them
- Preventing rebound edema: clarifying why it happens, how to make treatment go smoothly
- Laxative abuse: perils of tapering, and how to help things get started naturally again
- Medical take on some of the most commonly asked questions
- Is my metabolism ruined?
- Where are all these calories going?
- What about the refeeding belly?
- Do men recover differently from women?
- Do older adults recover differently from the younger patients?
- “There’s no hope”
All too often, patients with eating disorders have suboptimal interactions with the medical system. Patients who purely restrict face lack of medical provider awareness of the common physiologic problems of underweight—bradycardia, hypoglycemia, liver dysfunction, bone marrow dysfunction, gastroparesis, and osteoporosis—and use provider discomfort or unfamiliarity as part of the denial system that frustrates appropriate treatment. Patients who purge may face similar barriers—a medical system that gets impatient with frequent emergency visits for dehydration, a “band-aid” approach to electrolyte abnormalities that in fact reflect a profound psychologic need for greater intensity of care, and poor medical practices that ironically push patients directly back into the arms of their disorder rather than laying a great foundation of medical stability and giving hope that recovery is possible. On ACUTE, we see some of the most medically compromised patients from around the country, and hours at the bedside have yielded good ways of translating these medical problems—and their evidence-based solutions—to patients in a postive, motivational, reassuring way. Clinicians in this workshop will learn ways of discussing both subtle and life-treatening medical issues with their clients (and perhaps with their clients’ medical providers!), in order to help patients move forward in recovery and gain confidence and hope that they can get well.
Jennifer L. Gaudiani, MD, CEDS, is the Assistant Medical Director of ACUTE and is an Associate Professor of Medicine at the University of Colorado School of Medicine. She oversees the clinical, strategic, and administrative management of ACUTE, attends on the service, and maintains engagement with the patients when not attending clinically. Dr. Gaudiani completed her undergraduate work at Harvard College, earned her medical degree from Boston University School of Medicine, and completed her residency and chief residency in Internal Medicine at Yale. Dr. Gaudiani has lectured and published extensively on the medical complications of eating disorders.
