Mnemonic for Care of Eating Disorders: WHATS UP DOC

Lane Therrell FNP, MSN, RN

When providing quality care for patients with eating disorders, the mnemonic WHATS UP DOC can help nurses at all levels of proficiency remember that there are multiple psychosocial factors and emotional subtleties involved. Whether your patient is suffering from anorexia, bulimia, binge eating, or any number of other recognized eating disorders or their precursors, this mnemonic can help you cover all your bases so you can provide your patient with the best possible care.

This memory aid is promoted by the National Eating Disorders Association (see link in the "Sources and Resources" section below), and has been edited for allnurses.com readers in this article.

W= Weight

Weight is a "heavy" concept for patients with eating disorders. in other words, the idea of weight is loaded with meaning for the patient. The number that shows up on the scale is far more than a measurement to the patient, who is likely to attach a deep psychological meaning to the number, transforming it into a status symbol, a representation of self-worth, and/or a benchmark of self-control.

H= Height

While height is an important measurement necessary for calculating a patient's ideal body weight, it is only one of many factors to be considered when assessing the progress of a patient with an eating disorder. Family history (yes, eating disorders run in families), individual nutrition and exercise patterns, weight history, and overall health status can be as important as height-weight ratios, and must be considered.

A= Anorexia

Anorexia is not the only eating disorder. While anorexia tends to receive the most attention from researchers and the media, other eating disorders such as bulimia and binge eating disorder are more prevalent in certain populations, are more difficult to diagnose, and may co-exist alongside anorexia. Providers and caregivers must consider all the possibilities and the big picture in order for the patient to receive proper care.

T= Trauma, Trust, and Truth

Trauma is often a precipitating factor for eating disorders; the disorder emerges as a coping mechanism for dealing with the pain caused by unprocessed or improperly processed emotions. Keeping that in mind, nurses must work hard to build trust with their patients so the truth can emerge in a safe environment.

S= Sequelae

The sequelae, or consequences, of eating disorders are both psychological and physiological and can be life threatening. Because the consequences of eating disorders intensify slowly over time, it can be difficult for patients to understand the long-term harm they are doing to themselves. The immediate effects of most eating disorders can be attributed to other causes. Patients need to be educated on both the short-term and long-term consequences of their behaviors.

U= Universality

Eating disorders are not limited to affecting young women. An eating disorder can strike virtually any age group: females of any age, males of any age, prepubescent children. Any socioeconomic, cultural, or ethnic group is fair game. The prevalence of eating disorders is growing worldwide due to the influences of the media and the Internet.

P= Purging

While it can be tempting to equate purging with vomiting, it is important to understand that purging is a concept that can encompass numerous practices the patient might use for maintaining or regulating weight. Examples include: diuretics, laxatives, supplements, enemas, over-the-counter diet pills, prescription medications, excessive exercise, over-indulgence in alcohol or other substances to the point of nausea, and other methods. Notice that there are substances as well as behaviors in this list. Be sure to ask what the patient does to maintain or lose weight.

D= Dieting

Excessive dieting is a precursor to most eating disorders. By honoring the topic of dieting as something that is very serious and worthy of in-depth exploration, you can provide your patients with the necessary education and support, including a true knowledge of the downsides and dangers of the long-term consequences of hypometablism and malnutrition. Providers and patients must take diet and nutrition seriously and approach the subject rationally.

O= Office

What messages is your office sending to patients regarding weight management? Everything from the magazines in the waiting room to the language providers and staff use regarding weight matters. Ask yourself sincerely, "Could our office be inadvertently contributing to the proliferation of eating disorders?"

C= Consistent, Compassionate, Comprehensive, Care

This is what nurses do, anyway, but it is critical to recognize that great nursing care alone is not enough to treat an eating disorder. Your patients who are suffering from eating disorders need to be under the care of mental health specialists. Eating disorder sufferers must have compassionate care that is comprehensive and ongoing.