Eating Disorders and Physical Health Checks – North Cumbria Adult Eating Disorder Service

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Introduction
- Eating disorders are linked to a lower quality of life and physical health.
- If eating disorders are not treated they can cause serious, life-threatening health problems.
- All patients in the service have physical health assessments and sometimes need to go for further tests.
- This leaflet tells you how eating disorders can cause health problems and lists the health tests we may use. If you are not sure about anything in this leaflet please ask a member of staff.
- The following sections explain some of the effects of eating disorders on the body.
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Low blood sugar (hypoglycaemia)
Low blood sugar levels (readings of less than 4) are common in underweight patients with an eating disorder. They are caused by not eating enough food and having low stores of energy in the body. Levels are worse if you exercise too much and make yourself sick. If your blood sugar levels are low this can be very dangerous. It can cause nausea, anxiety, loss of consciousness, seizures and poor concentration.
Because of these risks, we may ask you not to drive if your blood sugar levels are below 4. This is to keep you and other people on the road safe. You will not be able to drive again until you have four normal blood sugar level readings in a row (levels more than 4). We check your blood sugar levels with a blood test.
You can be underweight for a long time and have no symptoms. But this can mean there may be no warning signs before you become very ill and need medical attention.
Blood sugar levels may become normal when your BMI returns to 16 or more. But, this sometimes only happens if your BMI is in the normal range of 18.5 to 24.9.
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Low body weight and driving
The brain is affected during starvation so it can be difficult to concentrate on a task. Also, thoughts about food and weight can make it difficult to focus on anything else.
The DVLA does not have specific guidance around driving with a low weight, but research shows attention is often impaired when your BMI is below 16kg/m². Therefore, we advise patients with a BMI below 16 not to drive as it could be dangerous for you and others on the road .
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Dehydration
Dehydration is when there is not enough fluid in your body. We will ask you how much you drink and if you feel dizzy or faint, especially when standing up from sitting. We will also check your skin, blood pressure and do some blood tests.
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Heart health
Your heart is a muscle. The size and strength of your heart can be affected if you lose weight quickly and it cannot pump blood as well as it should. This may make you feel light-headed and dizzy if you stand up too quickly. The size and strength of your heart can go back to normal with better, regular eating.
Chemicals in your blood are essential for a regular heartbeat. Using laxatives, diuretics, or frequent vomiting can cause fluid loss, which can change the balance of these chemicals. This may lead to an irregular heartbeat and possible cardiac arrest, which is where your heart stops beating. It is important to get your blood checked regularly. You might have to take supplements to help keep the chemicals in your blood at a steady level.
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Bone health
Diets that lack nutrition can result in weak bones, called osteoporosis. Our bones are constantly changing and growing, especially during adolescence. Poor nutrition can change levels of hormones that are needed for bone development. Low levels cause slow growth and even bone loss. Bones become fragile and can break easily. We might ask you to have a bone scan to check this.
Better, regular eating and treating your eating disorder can prevent further damage. It is important to have a well-balanced diet. It should include calcium, vitamin D and vitamin K. Also, too much exercise lowers calcium in the body. Working towards a healthy body weight is important to maintain bone health.
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Bowel and stomach health
Vomiting, using laxatives, appetite suppressants and food restriction can change how the stomach and bowels work. Slower digestion can occur which causes more problems. These include bowel blockage, varying blood sugar levels, constipation, infections, nausea and vomiting.
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Swelling of face and body
For many different reasons fluid can build up in your body and cause swelling. This will improve after recovery.
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Irregular periods
Eating disorders can lower hormone levels. This can cause irregular, or loss of, periods. Some people also experience fertility problems. There is a high risk of complications if you become pregnant while at an unhealthy weight. You may be asked about your periods during treatment.
Absent or irregular periods can have a negative impact on bone health and increase the risk of osteoporosis.
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Thyroid problems
Eating disorders can cause problems with the thyroid gland in your neck. These problems can include feeling tired and a change in your bowel habits. We might ask about these during treatment and check the thyroid levels in your blood.
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Mood
Eating disorders can cause difficulties with sleep and emotions. You may notice feeling irritable, overthinking and worrying more. Gaining weight can be scary and it may be difficult to control urges. Having an eating disorder can disrupt the normal functioning of your body, which can also affect your mood.
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Diabetes
If you have diabetes it can be even more dangerous to have an eating disorder too. Controlling your blood sugar levels is important as diabetes makes it hard for your body to do it by itself. If you do not eat enough food your blood sugar levels can fall. Overusing your insulin can also cause this. You might need emergency help if this happens.
You also have a higher risk of long-term problems if your diabetes is poorly managed such as worsening eyesight and kidney problems
Blood tests to check your blood sugar levels help the team to monitor your diabetes. Working together with the team will help you stay healthier. -
Driving
Low weight and low sugar levels are dangerous when driving. You must tell the DVLA if you have an eating disorder and it affects your ability to drive safely. Ask a health professional if you’re not sure if your eating disorder will affect your driving. If you are told by a health professional that it is unsafe for you to drive then you should stop driving and inform the DVLA.
Do not restart driving until you are told to do so by the DVLA. The DVLA may need a report from the team about your eating disorder and may ask you to attend an appointment.
You can be fined up to £1,000 if you do not tell the DVLA about a medical condition that may affect your driving. If you are involved in an accident, you may be prosecuted.
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Safe refeeding
If you have eaten minimal amounts of food for more than five days then you could be at risk of becoming unwell if you suddenly begin to eat more. A meal plan provided by a registered dietitian can help to slowly increase your food intake safely.
We will take regular blood tests to check the chemicals in your blood are in a safe range. If the chemicals in your blood are low, you might need tablets to replace them. If they are very low, you might need replacement directly into the blood. This would be given to you in hospital.
We will need to monitor you when you are refeeding. We may need to do this in hospital.
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Physical health examinations
Regular checks up by the team are important. This will help us identify if you are at high risk of developing any problems linked to eating disorders.
We would complete the following at your appointment –
- Measure your weight and height and check your BMI
- A squat and sit up test to check your muscle strength
- Observations:
Heart rate
Blood pressure (lying down and standing up)
Dizziness or fainting when standing up from sitting. - A physical examination to look for signs of infection and weight loss. We will also examine your skin and check your temperature.
- ECG (Electrocardiograph)
If you have lost a lot of weight, or are on medication that can affect the heart. - Blood tests to make sure your kidneys, liver, thyroid, blood cells and blood sugar levels are okay
You may be at a higher risk of becoming seriously unwell if you are experiencing any of the following:
- You are exercising too much and are at a low weight
- You have blood in your vomit
- You are not drinking enough fluids as well as not eating properly
- You have lost a lot of weight quickly
- You have been through a stressful life event
If we think that you are at a higher risk of becoming physically unwell we may arrange to check your physical health more often.
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Extra help and questions
If you have any concerns or questions about your health or things mentioned in this leaflet, please ask a member of the team or your GP. Recovering from an eating disorder can be a difficult journey with lots of new things to learn about. We are all here to help you through it.
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Interpreters
Staff can arrange an interpreter if you need one.
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What if I have a comment, suggestion, compliment or complaint about the service?
If you want to make a comment, suggestion, compliment or complaint you can:
- talk to the people directly involved in your care
- ask a member of staff for a feedback form, or complete a form on the Trust website
- telephone the Complaints Department Tel: 0191 245 6672
- email [email protected] Please note that information sent to the Trust via email is sent at your own risk
We are always looking at ways to improve services. Your feedback allows us to monitor the quality of our services and act upon issues that you bring to our attention. You can provide feedback in the following ways:
- the quickest way for you to do this is to complete our short online survey at www.cntw.nhs.uk/yourvoice
- complete a Your Voice survey, available on wards, reception areas or from staff
- other options for sharing your feedback and experience www.cntw.nhs.uk/yourfeedback
Patient Advice and Liaison Service (PALS)
PALS provide confidential advice and support, helping you to sort out any concerns that you may have about any aspect of your or your loved ones care.We act independently when handling patient and family concerns, liaising with staff, managers and, where appropriate, relevant organisations, to negotiate prompt solutions. If necessary, we can also refer patients and families to specific local or national-based support agencies.
North of Tyne
Tel: 0800 032 0202
Email: [email protected]
Post: FREEPOST PALS9am – 4.30 pm, Monday to Friday
An answerphone is available at all times for you to leave a message. A member of the PALS team will aim to return your call as soon as possible. -
References
- BEAT eating disorders (2019). Beat Eating Disorders. [online] Beat. Available at: https://www.beateatingdisorders.org.uk/.
- Driver and Vehicle Licensing Agency (2016). General information: assessing fitness to drive. [online] GOV.UK. Available at: https://www.gov.uk/guidance/general-information-assessing-fitness-to-drive.
- Medical Emergencies in Eating Disorders. (2024). Medical Emergencies in Eating Disorders. [online] Available at: https://meed.org.uk/.
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Published by the Patient Information Centre
2025 Copyright, Cumbria, Northumberland, Tyne and Wear
NHS Foundation Trust
Ref, PIC/923/0125 January 2025 V1
www.cntw.nhs.uk Tel: 0191 246 7288
Review date 2028