Published practice guidelines require a comprehensive medical, psychological and nutritional assessment to determine the appropriate level of care for patients with eating disorders.

• Committee on Adolescence, American Academy of Pediatrics. Policy Statement: Identifying and Treating Eating Disorders. Pediatrics. 2003; 111:204-211.
  
• Society for Adolescent Medicine. Eating Disorders in Adolescents: Position
  Paper of the Society for Adolescent Medicine. J Adolescent Health. 1995; 16:476-480.
  
• American Psychiatric Association. Treatment Recommendations for Patients with Eating Disorders. Am J Psychiatry. 2006; 163(7 suppl):1-54.
  
• National Collaborating Center for Mental Health, National Institute for Clinical Excellence. Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa, and elated Eating Disorders. London: NICE, 2004.
  


• American Psychiatric Association. Treatment Recommendations for Patients with Eating Disorders. Am J Psychiatry. 2006; 163(7 suppl):1-54.
  
  "In determining a patient’s initial level of care, or whether a change to a different level of care is appropriate, it is important to consider the patient’s overall physical condition, psychology, behaviors, and social circumstances rather than simply rely on one or more physical parameters such as weight."
  
  "Hospitalization should occur before the onset of medical instability as manifested by abnormalities in vital signs... physical findings, or laboratory tests."
  
  "Weight level per se should never be used as the sole criterion for discharge from inpatient care."
  
  Level of Care Criteria for Patients with Eating Disorders (Table 8 in guidelines)
  
  

  APA Practice Guidelines (January 2000) Level of Care Criteria for Patients with Eating Disorders (A) (B)
  Characteristic	Level 1: Outpatient	Level 2: Intensive Outpatient	Level 3: Partial Hospitalization (Full-Day Outpatient Care)	Level 4: Residential Treatment Center	Level 5: Inpatient Hospitalization
  Medical complications	Medically stable to the extent that more extensive medical monitoring, as defined in levels 4 and 5, is not required.			Medically stable to the extent that intravenous fluids, nasogastic tube feedings, or multiple daily laboratory tests are not needed.	For adults: heart rate less than 40 bpm; blood pressure greater than 90/60 mm Hg; glucose less than 60 mg/dl; potassium less than 3 meg/liter; electrolyte imbalance; temperature less than 97.0 F; dehydration; or hepatic, renal, or cardiovascular organ compromise requiring acute treatment. For children and adolescents; heart rate in the 40s; orthostatic blood pressure changes (less than 20 bpm increase in heart rate or greater than 10-20 mm Hg drop); blood pressure below 80/50 mm Hg; hypokalemia or hypophosphatemia.
  Suicidality	No intent or plan			Possible plan but no intent	Intent and plan
  Weight as % of healthy body weight (for children, determining factor is rate of weight loss)(C)	less than 85%	less than 80%	less than 75%	greater[s5]  than 85%	greater than 75% (for children and adolescents; acute weight decline with food refusal even if not less than 75% below healthy body weight)
  Motivation to recover, including cooperativeness, insight, and ability to control obsessive thoughts	Fair to good	Fair	Partial; preoccupied with ego-syntonic thoughts more than 3 hours a day; cooperative	Poor to fair; preoccupied with ego-syntonic thoughts 4-6 hours a day; cooperative with highly structured treatment	Very poor to poor; preoccupied with ego-syntonic thoughts; uncooperative with treatment or cooperative only in highly structured environment
  Co- morbid disorders (substance abuse, depression, anxiety)	Presence of co- morbid condition may influence choice of level of care				Any existing psychiatric disorder that would require hospitalization
  Structure needed for eating/gaining weight	Self-sufficient		Needs some structure to gain weight	Needs supervision at all meals or will restrict eating	Needs supervision during and after all meals or nasogastric/special feeding
  Impairment and ability to care for self; ability to control exercise	Able to exercise for fitness, but able to control compulsive exercising		Structure required to prevent patient from compulsive exercising	Complete role impairment, cannot eat and gain weight by self; structure required to prevent patient from compulsive exercising
  Purging behavior (laxatives and diuretics)	Can greatly reduce purging in non-structured settings; no significant medical complications such as ECG abnormalities or others suggesting the need for hospitalization			Can ask for and use support or use skills if desires to purge	Needs supervision during and after all meals and in bathrooms
  Environmental stress	Others able to provide adequate emotional and practical support and structure		Others able to provide at least limited support and structure	Severe family conflicts, problems, or absence so as unable to provide structured treatment in home, or lives alone without adequate support system
  Treatment availability/living situation	Lives near treatment setting			Too distant to live at home
  A. Adapted from La Via et al. (245) B. One or more items in a category should qualify the patient for a higher level of care. These are not absolutes, but guidelines requiring the judgment of physicians. C. Although this table lists percentages of healthy body weight in relation to suggested levels of care, these are only approximations and do not correspond to percentages based on standardized tables. For any given individual, differences in body build, body composition and other physiological variables may result in considerable differences as to what constitutes a healthy body weight in relation to "norms." For some, a healthy body weight may be 110% of "standard," whereas for others it may be 98%. Each individual's physiological differences must be assessed and appreciated.