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GP Report


Feed Your Instinct (FYI) is an interactive tool designed by the Victorian Centre of Excellence in Eating Disorders in consultation with experts in the field and parents. It aims to support and inform parents of children experiencing eating and/or body image problems. This parent has observed the following warning signs of an eating disorder:


These questions relate to a young person's food choices, eating patterns and attitudes towards nutrition.
Have you noticed any of the following?
A change in eating pattern, such as skipping meals
Eating alone, eating secretly, or having 'rituals' around food or meal times
Avoiding family meals or eating with others
Hiding, or secretly throwing away uneaten food
Leaving the table during a meal and avoiding finishing their food
Frequently reporting to have eaten elsewhere, or being dishonest about their eating
Limiting the variety of foods eaten
Eating according to strict food rules, such as no carbohydrates, or no sugar
Suddenly becoming vegetarian or vegan
Development of food 'intolerances'
A strong preference for 'diet' or 'low fat' products
Frequently talking about losing weight, or making comments about being 'fat'
Displaying a high level of concern about the calorie content of food
A strong focus on what others are eating, interest in cooking or interest in cookbooks without actually eating
Evidence of over eating (large amounts of food disappearing from household, hidden wrappers and packaging)
Finding it hard to stop eating once they have started
A history of 'picky' eating
Rigidity around food preparation and eating such as cutting food into tiny pieces, or 'hovering' in the kitchen whilst others are cooking
Anxiety, irritability, anger and hostility at mealtimes


These questions relate to a young person's physical health and any unhelpful behaviors they may be participating in.
Have you noticed any of the following?
A fluctuation in weight over a few weeks (weight gain or loss)
Significant weight change as a result of illness, travel or increased participation in sport and exercise
A growth spurt without any weight gain
Any evidence of vomiting after meals
Excessive, obsessive or ritualistic exercise
Having problems sitting still, and standing, twitching or pacing whenever possible
Evidence of exercising in secret (e.g. in the middle of the night or in their bedroom)
Engaging in intense exercise with no pleasure
Exercising to compensate for eating
Packets of diet pills or laxatives
Constipation, or unexplained stomach pains
Cold hands, or feet, or regular complaints of feeling cold
Fainting or complaining of dizziness
A delayed onset of periods (if female), or a loss of menstrual cycle


These questions relate to thinking patterns and personality traits of a young person.
Have you noticed any of the following?
Very low self-esteem
Rigid, black and white thinking (e.g. good/bad or right/wrong)
Increased perfectionism
Body dissatisfaction e.g. a strong conviction they need to be thinner
A strong focus on perceived flaws of their body or a particular part of their body
Constantly seeking reassurance about body size
Obsessive body checking e.g. weighing, pinching, excessive time in front of the mirror
An interest in weight loss blogs, websites, magazines, books or images of thin people


These questions relate to changes in the way a young person is interacting with others.
Have you noticed any of the following?
Increased social isolation or withdrawal
Perceiving others to be judgemental
Experiencing difficulty talking about emotions

Red Pathway – Immediate redirection to emergency department

Cardiac instability:
Refer ViCTOR charts for age specific observations:



Heart rate (pulse):  under 50 bpm

Blood pressure 80/50mm Postural changes ( lying to standing) Tachycardia 30 bpm

Postural Blood Pressure drop 20 mm

Recurrent syncope

Arrhythmia (including sinus bradycardia less than 50bpm)

  Electrolyte changes:

Hypokalaemia -Present

Abnormal renal function

  Other: Hypothermia 35.5 deg C

Amber Pathway – Urgent referral to local specialist medical service and mental health service

Abnormal other investigations (Neutropenia, Thyroid Function Test)
Ongoing weight loss (move to red pathway if more than 500gm-1kg per week for consecutive weeks)Amenorrhea (change of menstrual pattern because of weight loss)Monitor weight, vital signs (including postural changes) with pulse rate and blood pressure regularly (weekly-fortnightly)

Green pathway – Referral to local specialist ED service or mental health service

Medically stable but warning signs present.

Mental Health assessment to determine if Eating Disorder present and begin evidence based treatment.

Monitor weight, vital signs (including postural changes) with pulse rate and blood pressure regularly.


  Screening, Examination or investigation Purpose

Acute complications

ECG Check bradycardia; prolonged QTc
  Electrolytes Potential hypokalaemia if purging;
hyponatraemia if water loading;
impaired renal function if dehydrated
Rarely may reveal other medical cause of weight loss eg Addison’s disease
  LFT May have biliary sludging with increased bilirubin
  Calcium/Magnesium/Phosphate Abnormalities with refeeding; low calcium if low albumin
  BSL Hypoglycaemia
Excludes diabetes as a cause of weight loss
  FBC Nutritional anaemia ( micro or macrocytic)
Low platelets may occur with malnutrition

To detect other possible cause or comorbidity

ESR Inflammatory bowel disease
Rheumatological disease
Chronic infection
  TFT Abnormalities may reflect sick euthyroid or hyperthyroid as rare cause of weight loss
  Coeliac screen May present with weight loss
Determine chronic complications of malnutrition B12/folate
Iron studies
Vitamin D
Low levels reflect malnourishment
If amenorrhoea post puberty
  Bone density (not urgent) Determine effect of malnourishment on growing bones or after period of a menorrhoea. (PBS subsidy if over 6 months)
Bone age x-ray necessary in conjunction with bone density for under 18yo

Further notes for GPs:

  • If parents are concerned it is essential to take their concerns seriously, as they see their childs behaviours every day and are an important resource for treatment.
  • Parents are essential resources and are responsible for making sure a young person with eating and body image problems, or an eating disorder, is safe and complies with vital treatment. Parents should be included for a period of all consultations, with clear boundaries around confidentiality and risk.
  • Unfortunately there is not one conclusive examination or investigation which clearly indicates at eating disorder. Results should be considered in a holistic manner taking into account the history and family concerns.
  • Regular appointments and ongoing assessment is essential. Young people can become medically compromised quickly and unpredictably.
  • Sustained weight loss of greater than 500gm-1kg per week for any young person is concerning, regardless of their actual weight.

Further notes for Parents:

  • It is advisable to book a double GP appointment to allow sufficient time for a comprehensive assessment.
  • It can be helpful to speak to GP before the appointment to alert them of your concerns.
  • If you have a record of your childs height or weight development for any period of time from birth up until the current day (such as a yellow book), bring this to the appointment as it has vital information that can aid the assessment.
  • It may be useful to determine how confident your GP is in identifying eating disorders via prior phone call, as not all GPs have expertise in this specialist area.

This report is based on the following clinical guidelines:

RANZCP clinical practice guidelines for the treatment of eating disorders, 2014​Publications/CPG/Clinician/Eating-Disorders-CPG.aspx

NICE guidelines (2004)


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