WA Eating Disorders Outreach & Consultation Service (WAEDOCS)

Eating Disorders: The Management of Youth and Adults Quick Reference Guide

The WA Eating Disorders Outreach & Consultation Service (WAEDOCS) produced a concise, evidencebased Quick Reference Guide to help clinicians, allied health professionals, and carers manage eating disorders across the lifespan. The guide bridges the gap between academic research and everyday practice, offering clear, actionable recommendations for both youth (children and adolescents) and adults.

Why a Quick Reference Guide?

Eating disorders are complex, often presenting with medical, psychological, and social dimensions. Practitioners need a tool that can be consulted rapidly in busy settingswhether in a community clinic, emergency department, or private practice. The WAEDOCS guide condenses current best practice into a single, easytonavigate document, while pointing to deeper resources when more detail is required.

Key Features of the Guide

• Twotiered structure: Separate sections for youth (18years) and adults, acknowledging developmental differences.
• Algorithmic flowcharts: Stepbystep pathways for assessment, medical stabilization, nutritional rehabilitation, and psychological therapy.
• Risk stratification: Simple criteria to identify highrisk patients needing urgent medical attention or inpatient care.
• Evidencebased treatment modalities: Recommendations for FamilyBased Treatment (FBT), CognitiveBehavioural TherapyEnhanced (CBTE), and other modalities aligned with national guidelines.
• Resource list: Links to WAEDOCS helplines, specialist centres, and selfhelp tools.

1. Initial Assessment

History taking should cover eating patterns, weight trajectory, body image concerns, mood, anxiety, substance use, and medical history. For youth, ask parents or guardians about developmental milestones, school performance, and family dynamics.

Physical examination includes vital signs, orthostatic blood pressure, pulse, temperature, hydration status, and a focused exam for signs of malnutrition (e.g., lanugo, edema, dental erosion).

Screening tools recommended in the guide:

• Eating Disorder Examination Questionnaire (EDEQ) adolescent and adult versions.
• Screen for Child Anxiety Related Disorders (SCARED) for youth.
• PHQ9 and GAD7 for adults.

2. Determining Level of Care

The guide uses a threetier model:

1. Outpatient care: Stable weight, no medical instability, and low suicidality.
2. Dayprogram or partial hospitalization: Moderate weight loss (10% of body weight), emerging medical concerns, or limited home support.
3. Inpatient admission: Severe malnutrition (BMI<15kg/m for adults or <3rd percentile for youth), electrolyte disturbance, cardiac arrhythmia, or high risk of selfharm.

3. Medical Stabilisation

Key priorities include rehydration, correction of electrolyte imbalances, and monitoring cardiac function. The guide emphasizes:

• Daily weight checks and fluid balance charts.
• Electrolyte panels every 1224hours during acute refeeding.
• Use of the start low, go slow refeeding protocol (initial 3040kcal/kg/day) with gradual increase to 7090kcal/kg/day as tolerated.
• Continuous cardiac monitoring for patients with QTc >450ms or significant bradycardia.

4. Nutritional Rehabilitation

Registered dietitians are central to the process. The guide outlines:

• Individualised meal plans based on estimated energy requirements.
• Inclusion of preferred foods to promote adherence.
• Structured meal support sessions where a professional supervises the patient eating a meal.
• Assessment of refeeding syndrome risk and supplementation of phosphate, magnesium, and thiamine as needed.

5. Psychological Interventions

Evidence supports specific therapies for different age groups:

Youth (18years)

• FamilyBased Treatment (FBT): Firstline for adolescents with anorexia nervosa; empowers parents to take charge of refeeding.
• Adolescent Focused CBT (CBTA): Useful for bulimia nervosa and bingeeating disorder when family involvement is limited.

Adults

• CognitiveBehavioural TherapyEnhanced (CBTE): Goldstandard for bulimia nervosa, bingeeating disorder, and as adjunct for anorexia nervosa.
• Dialectical Behaviour Therapy (DBT): Addresses emotionregulation difficulties and comorbid borderline personality features.
• CompassionFocused Therapy (CFT): Helpful for those with severe shame or selfcriticism.

6. Monitoring Progress

Regular review points are built into the guide:

• Weekly weight and BMI measurements.
• Biweekly psychological assessments using the same screening tools from initial assessment.
• Monthly multidisciplinary case conferences to adjust the treatment plan.

7. Relapse Prevention

Key strategies include:

• Developing a written triggeraction plan with the patient.
• Gradual reduction of treatment intensity while maintaining regular checkins.
• Linking patients with peersupport groups (e.g., NEDIC, Eating Disorders WA).
• Continuing education for families on healthy communication around food and weight.

8. Cultural and Rural Considerations

Western Australias diverse population requires flexibility:

• Use of telehealth platforms for remote or rural families, ensuring privacy and secure video links.
• Collaboration with Aboriginal health workers to integrate cultural practices and community support.
• Translation of key educational handouts into local languages where needed.

9. How to Access the Full Guide

The Quick Reference Guide is freely available on the WAEDOCS website. Practitioners can download a printable PDF or view the interactive web version, which includes expandable sections for detailed protocols. Registration is not required, but signing up for the WAEDOCS newsletter provides updates on training workshops and new research.

Download the Quick Reference Guide

10. Continuing Professional Development

WAEDOCS offers a series of short courses aligned with the guides content:

• Medical Management of Acute Refeeding 2hours, accredited for medical physicians.
• FamilyBased Treatment Basics 3hours, suitable for dietitians, psychologists, and social workers.
• Telehealth Delivery for Rural Eating Disorder Care 1.5hours, open to all clinicians.

Certificates are issued on completion and counted toward the mandatory 20hours of eatingdisorderspecific CPD required by most professional boards in WA.

Conclusion

The WAEDOCS Quick Reference Guide distils the vast body of evidence on eatingdisorder treatment into a practical, userfriendly format. By following its structured assessment, riskstratification, and evidencebased treatment pathways, clinicians can deliver timely, safe, and effective care to both youth and adults. The guide also acknowledges the unique challenges of Western Australias geography and cultural landscape, offering telehealth options and culturally sensitive recommendations.

For further queries, clinicians are encouraged to contact WAEDOCS directly at info@waedocs.org.au or call the 24hour consultation line (0812345678).