Food Intake

Knowledge Translation Commentary

Be sure to be very specific when asking about food intake.

It may sound like she's eating an adequate amount of food because she is eating at meal times and having an evening snack, however, the meals are extremely restricted.

Most importantly, the patient's fluid and caffeine intake should be documented and monitored as one marker of their hydration status. However, when patients are in a catabolic state, they can be extremely dehydrated even when they are drinking large amounts of water as their bodies must excrete large amounts of fluid with the byproducts of muscle breakdown.

The meals and snacks eaten during the course of a day should be documented, including careful documentation of food quantities, use of diet products, and whether the patient measures their food. This will assist you in monitoring their course of illness, in addition to the more objective monitoring of their weight, vitals, and blood work. Patients often monitor their daily caloric intake and can provide a history thereof, although they typically overestimate it.

Patients also tend to eat a very restricted number of foods that they deem to be "safe" foods, and they also have "forbidden" foods, which are foods that they may love but not allow themselves to enjoy because of their high calorific and fat content.

Patients with anorexia nervosa typically consume diets low in carbohydrates and fat and high in protein and fibre. They often eat alone and have food rituals, such as cutting their food into very small pieces, and over-spicing their foods.

Red flag: Patients may present with an orange discolouration of their palms and soles as a result of their diet. This is due to carotenoderma, a condition that results from diets rich in carotenoids and the anorexia nervosa patient's associated hypothyroidism. Diets that have a very high fruit and vegetable content can produce this condition.