The principle of stepped-care is that with an early presentation of anorexia nervosa the clinician should first apply relatively simple remedies. Only if they fail should more vigorous and time-consuming treatments be provided. In practice, however, the patient who has avoided treatment as long as possible may first be seen when weight loss is already substantial and abnormal attitudes entrenched. If this happens it is not possible to follow a graduated sequence and a short cut may be needed to a more vigorous method including admission to hospital. Admission is also indicated in the presence of 'famine' oedema or proximal myopathy.
In the event of a truly early presentation it will be appropriate for the patient's treatment to be overseen by her general practitioner. A minimal approach should still include dietary education as to the value of nutritious (high-caloric) foods and forging an alliance with the patient's family. The patient should be asked to attend once a week to be weighed with the clear message that she must arrest the weight loss and gradually return to a healthy weight determined by the clinician and not by her.
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