Eating disorders in the ED

Podcast – Eating Disorders in the Emergency Department

Welcome to the St Emlyn’s Podcast, your go-to source for the latest insights, developments, and discussions in emergency medicine and critical care, with in-depth analysis, evidence-based practices, and practical advice to enhance your clinical practice and professional development. Whether you are a seasoned practitioner or just starting your journey in the field, our podcast aims to provide valuable knowledge and foster a community of learning and support.

This post accompanies the podcast ‘Eating Disorders with Anna Kyle at the Premier Conference 2024’. This was recorded live at the Hope Church in Winchester as part of the PREMIER conference. We are grateful to the organising team for hosting us and allowing us to use the audio. The PIER and PREMIER websites are full of amazing resources for anyone working in Paediatric Emergency Medicine, and we highly recommend them.

Listening Time – 16:25


Eating disorders are a critical health concern that tragically lead to numerous deaths, especially among young women during their transition age. Anorexia nervosa, in particular, is the most deadly psychiatric condition with a 10% lifetime mortality risk. Recent coroner reports highlight significant medical failings and a dire lack of knowledge among healthcare providers. Given the 90% increase in eating disorder admissions over the last five years, this issue demands urgent attention.

Prevalence and Impact of Eating Disorders

Eating disorders are increasingly prevalent, and their deadly nature cannot be overstated. About 20% of deaths from eating disorders are due to suicide, with the remaining 80% resulting from medical complications. The medical community’s current understanding and training on eating disorders are woefully inadequate, with only about two hours of training provided to undergraduates over five years.

Recognising the Signs

Patients with eating disorders often present symptoms related to starvation and malnutrition, affecting almost every bodily system. The common signs include:

  • Gastrointestinal Issues: Constipation, abdominal pain, bloating, and gastroparesis are prevalent due to slowed gut movement from inadequate energy intake.
  • Reproductive Health: Secondary amenorrhea is a clear sign of inadequate nutrition, reflecting the body’s evolutionary adaptation to conserve energy during famine.
  • Bone Health: Low bone mineral density and increased fracture risk later in life due to low estrogen, IGF1 levels, and high cortisol levels.
  • Thyroid Function: Sick euthyroid syndrome characterized by low T4 and T3 but normal TSH, which should not be treated with thyroxine but with nutritional rehabilitation.
  • Haematological Issues: Neutropenia is common, serving as a good indicator of nutritional status. Improvement in neutropenia often follows weight gain.
  • Neurological Effects: Slowed cognition and poor concentration due to the brain prioritizing essential functions amid energy scarcity.
  • Cardiovascular Problems: Bradycardia, heart block, junctional rhythms, and pericardial effusion are significant concerns. Notably, asymptomatic pericardial effusion affects about a third of young girls with eating disorders.

Comprehensive Risk Assessment

Healthcare professionals, particularly those in emergency departments, play a crucial role in risk assessment. The primary goal is to determine if a young person with an eating disorder can be safely discharged or requires admission. The Managing Medical Emergencies and Eating Disorders (MEED) guidance provides a helpful framework with a red-amber-green rating system to assist in this assessment.

Key Red Flags

  • Rapidity of Weight Loss: More critical than BMI, rapid weight loss is a significant concern.
  • Heart Rate and Blood Pressure: Bradycardia (heart rate below 40) and significant postural tachycardia or blood pressure drops are alarming signs.
  • Muscle Function: The sit-up squat stand (SUSS) test assesses muscular strength and function.

Effective Communication Strategies

Effective communication is vital when dealing with young patients and their families. It’s essential to:

  • Understand the Fear: Recognize the terror that patients experience with food intake and approach them with empathy.
  • Separate the Patient from the Disorder: Differentiate the eating disorder from the individual, helping them and their families understand that manipulative behaviors stem from the disorder, not the person.
  • Avoid Minimizing the Illness: Clearly communicate the severity of the condition, avoiding phrases that may minimize the disorder’s seriousness.
  • Steer Clear of Blame: Emphasize that eating disorders are not lifestyle choices or parental failings. Families often feel immense guilt and shame, and it’s crucial to provide support without judgment.

Treatment Focus

The treatment goal for hospitalized patients is not just weight gain but establishing a regular eating pattern, managing exercise, and providing psychological support. Weight gain will naturally follow as health improves.


Eating disorders require the same empathy, attention, and rigorous medical intervention as other severe health conditions like leukemia or pneumonia. Recognizing the deadly nature of these disorders, understanding their broad impacts, and implementing effective risk assessment and communication strategies can significantly improve patient outcomes.

Further Resources

  1. Beat Eating Disorders
  2. National Centre for Eating Disorders
  3. Mind
  4. Young Minds
  5. NHS UK
  6. Men Get Eating Disorders Too (MGEDT)
  7. Anorexia & Bulimia Care (ABC)
  8. SEED – Support and Empathy for people with Eating Disorders
  9. The Priory Group
  10. Student Minds
  11. The Eating Disorder Foundation (SCOTLAND)
  12. Bodywhys (IRELAND)

Podcast Transcription

The Speaker – Anna Kyle

Anna is a consultant general Paediatrician in Somerset with an interest in adolescent health & eating disorders and a MA in medical ethics & law.

Anna Kyle

Where to listen

You can listen to our podcast in numerous ways, ensuring you never miss an episode, no matter where you are or what device you’re using. For the traditionalists, Apple Podcasts and Google Podcasts offer easy access with seamless integration across all your Apple or Android devices. Spotify and Amazon Music are perfect for those who like to mix their tunes with their talks, providing a rich listening experience. If you prefer a more curated approach, platforms like Podchaser and TuneIn specialize in personalising content to your tastes. For those on the go, Overcast and Pocket Casts offer mobile-friendly features that enhance audio quality and manage playlists effortlessly. Lastly, don’t overlook YouTube for those who appreciate a visual element with their audio content. Choose any of these platforms and enjoy our podcast in a way that suits you best!

Cite this article as: Iain Beardsell, "Podcast – Eating Disorders in the Emergency Department," in St.Emlyn's, July 3, 2024,

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