The primary care evaluation includes an assessment of the individual’s height and weight. Young people grow at different rates, gradually increasing both in height and in weight. When an individual goes through puberty, she may continue to get taller while her weight stays the same or drops, and such a finding—although it cannot serve as a sole determinant of anorexia nervosa, bulimia nervosa or EDNOS—may contribute to a larger picture that supports an eating disorder diagnosis.

Eating disorder sufferers have different body types and are not all underweight. A number of individuals experience substantial ups and downs in their weight, and this can lead to health problems. Patients with binge eating disorder tend to be obese. In bulimia nervosa, the physical exam may be normal although those who are at 85% or so of their ideal body weights usually demonstrate some manifestations of weight loss. Many bulimia nervosa sufferers are within the normal weight range or slightly above. While some individuals with anorexia nervosa look emaciated, others are seriously ill without appearing markedly thin.

As malnutrition progresses, it exacts a toll on every organ of the body. Skin appears dry and pale or yellow-tinged and nails are brittle. The hair on the individual’s scalp may have thinned or lost its shine. Fine downy hair, called lanugo, is often visible on the face, back and arms. Eyes can appear sunken and lips are generally dry. As the patient’s metabolism slows to conserve energy and sustain vital functioning, she becomes increasingly sensitive to cold and her body temperature drops. Her hands and feet may appear blue (acrocyanosis). Hypotension (low blood pressure) often accompanies semi-starvation. So does bradycardia (slowed heart rate), which can lead to serious cardiac arrhythmias. To test for orthostatic changes, the physician measures the individual’s heart rate and blood pressure when she is lying down and then asks her to stand for repeat readings; if rising to an upright position yields a significant elevation in heart rate or drop in blood pressure, her cardiac status is an immediate concern.

Vomiting or misuse of laxatives or diuretics increase the risk of dehydration and electrolyte imbalances, which can occur not only in the undernourished, but also in normal-weight patients with bulimia nervosa, especially those who purge frequently. In particular, a loss of potassium (hypokalemia, low serum potassium) may trigger dangerous cardiac arrhythmias and needs to be treated. Enlarged parotid and salivary glands are suggestive of binge eating and vomiting. Dental findings include cavities and erosion of tooth enamel due to stomach acid that is regurgitated along with food. Scars or calluses on a patient’s hands (as shown in photo) result from her knuckles rubbing against her teeth when she induces vomiting.

Because the serious medical events that are associated with eating disorders can strike suddenly, patients are carefully monitored. Many individuals who do receive an eating disorder diagnosis and are stable enough to be treated as outpatients are often seen weekly by their primary care physician to have their weights and vital signs checked and to learn why it is important to engage in treatment.