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A LOOK AT NURSING MANAGEMENT OF MAJOR EATING DISORDERS
IN ADOLESCENTS IN PRIMARY HEALTH CARE: A NARRATIVE
LITERATURE REVIEW
Helton Camilo Teixeira1
Abstract: Adolescence is a stage of human development marked by intense biopsychosocial changes,
which may increase vulnerability to mental health problems, including eating disorders. In the context
of Primary Health Care, these conditions require early, continuous, and coordinated interventions that
consider the territory, the family, and the adolescent’s individual characteristics. This study aims to
describe, based on the scientic literature, the psychosocial nursing management of eating disorders,
with emphasis on Anorexia Nervosa and Bulimia Nervosa among adolescents within Primary Health
Care in Brazil. This is a descriptive and reective narrative literature review, conducted using the Virtual
Health Library (VHL), as well as books, technical manuals, and legislation related to mental health,
psychiatry, primary health care, and nursing practice. The ndings indicate that nurses in Primary
Health Care play a strategic role in the early identication, welcoming, and longitudinal follow-up of
adolescents with eating disorders, being a central and essential professional in this process. Nursing
management should involve physical and mental assessment, mental status examination, and, when
necessary, the request for laboratory tests according to Ministry of Health or institutional protocols, in
addition to qualied listening, health education, articulation with the psychosocial care network, and
shared care with the Primary Health Care team. It is concluded that nursing management of eating
disorders during adolescence requires a comprehensive, humanized, and territory-based approach,
grounded in bonding, continuity of care, and network articulation. At the same time, gaps in the
national scientic production regarding the role of nurses in this eld are recognized, reinforcing the
1 Master’s degree in Nursing from the Federal University of Amazonas (UFAM), Professor in the
Nursing Course at São Lucas Porto Velho – RO
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need for investments in research and continuing education.
Keywords: Adolescent mental health; Comprehensive care; Professional nursing practice.
INTRODUCTION
Adolescence is recognized as a phase of human development marked by intense physical,
cognitive, emotional, and social transformations. The World Health Organization (WHO) denes
adolescence as the period between 10 and 19 years of age, highlighting that experiences and behaviors
established during this phase exert a signicant inuence on health throughout life (WHO, 2023).
Similarly, the United Nations Children’s Fund (UNICEF, 2022) emphasizes that, although
adolescence represents a stage of opportunity, it is also a period of greater vulnerability, especially
in contexts of social inequality, which demands public policies and intersectoral actions aimed at
promoting health and comprehensive protection. In Brazil, the Statute of the Child and Adolescent
(ECA, 1990) denes adolescence as the age range between 12 and 18 years of age, which, in exceptional
situations, may extend up to 21 years of age.
Adolescence is a phase with several biopsychosocial transformations, which increase
vulnerability to health-related risk behaviors. This vulnerability may be related to both social aspects
and the characteristics of this developmental phase, such as the search for new experiences (Silva et
al., 2022).
Currently, the dictatorship of thinness, the cult of the perfect body, is generally accompanied
by examples of individual success, inuencing mainly young people and adolescents with the idea
of perfection, leaving them increasingly vulnerable to the emergence of these disorders (Ferreira,
2018). In this context, adolescence develops in a society that values thin, dened, and idealized body
standards, widely disseminated through social media.
Continuous exposure to edited images, lters, and unattainable body types fosters constant
comparisons, intensies body dissatisfaction and appearance-related anxiety, and reinforces
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discriminatory practices such as fatphobia and the overvaluation of aesthetics at the expense of health.
In this context, adolescents become particularly susceptible to developing eating disorders (EDs),
since the construction of identity and self-image occurs intensely during this period of the life cycle.
Body dissatisfaction associated with the internalization of unrealistic aesthetic standards can
promote inadequate eating behaviors, constituting important risk factors for eating disorders.
According to Carmo, Pereira, Cândido (2014), eating disorders (ED) are psychiatric illnesses
characterized by severe alterations in eating behavior that mostly affect female adolescents and young
adults, and can lead to biological and psychological harm, as well as increased morbidity and mortality.
These conditions involve complex changes in the relationship with the body, weight, and food, going
beyond isolated food choices and constituting signicant harm to mental health, especially during
adolescence.
In the context of the Unied Health System (SUS), Primary Health Care (PHC) is dened as
a set of individual, family, and collective actions that encompass health promotion, disease prevention,
diagnosis, treatment, rehabilitation, harm reduction, palliative care, and health surveillance, developed
by multidisciplinary teams in dened territories, with sanitary responsibility over the assigned
population (Brazil, 2017).
Furthermore, according to Brasil (2013), Primary Health Care (PHC) is responsible for
identifying and monitoring mental health problems that manifest in the daily demands of healthcare,
including psychological distress and conditions that affect the relationship with the body and food. In
the Brazilian context, PHC professionals are encouraged to work in an integrated manner, considering
the unique characteristics of each territory and population, and to promote welcoming, therapeutic
bonding, and continuous care at the community level.
Thus, as the main gateway to the SUS (Brazilian Public Health System) and coordinator of care
within the Health Care Network, Primary Health Care plays a strategic role in the early identication
and continuous monitoring of mental health needs, including eating disorders in adolescence, through
relationship building, qualied listening, and network coordination.
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The nurse’s role is supported by Law No. 7,498/1986, which regulates the professional
practice of nursing, as well as its regulatory decree, ensuring that nurses have competencies related to
comprehensive care, health education, prevention of illnesses, and monitoring of individuals, families,
and communities (COFEN, 1986).
In this sense, the nurse’s role in mental health care nds legal support in COFEN Resolution
No. 678/2021, which approves and regulates the performance of the nursing team in mental health
and psychiatric nursing. The document recognizes the nurse’s role in promoting mental health,
providing support, active listening, identifying psychological distress, and developing educational
and comprehensive care actions (COFEN, 2021). These responsibilities legitimize the nursing practice
in managing eating disorders in primary health care, strengthening practices focused on prevention,
continuous care, and coordination with the Health Care Network.
Within the context of Primary Health Care, nurses play a central and multifaceted role in
the management of eating disorders, acting as educators, caregivers, and care coordinators. Their
strategic role contributes to the early identication of signs and symptoms, qualied reception, and
longitudinal follow-up of adolescents, favoring timely interventions and positively impacting the
quality of life of this population (Cardoso, Andrade, Marques, 2024).
Nurses face signicant challenges in caring for people with mental disorders, related to the
complexity of cases, the stigma associated with psychological distress, and adherence to treatment. In
this context, continuing health education in primary health care is fundamental to improving clinical
management and strengthening interpersonal skills, based on welcoming, active listening, and health
education, contributing to the construction of comprehensive, humanized, and effective care, focused
on the user and their family (Silva, Nasi, Fiorini, 2025).
Given that adolescence is a period of high vulnerability to the development of eating
disorders, which have signicant repercussions for physical, mental, and social health, primary health
care assumes a strategic role as the gateway to the Brazilian Unied Health System (SUS) and a
privileged space for early identication, longitudinal follow-up, and coordination of care.
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Given this scenario, the present article aims to analyze, through a narrative literature review,
the nursing management of eating disorders, with an emphasis on Anorexia and Bulimia Nervosa in
adolescents within the context of Primary Health Care, due to the scarcity of scientic publications
that specically address this issue.
METHODOLOGY
This is a narrative literature review (NLR) of a descriptive and reective nature, aiming to
analyze nursing management of the main eating disorders in adolescents within Primary Health Care
(PHC). The choice of this type of review is based on the possibility of integrating different scientic
productions, allowing for a broad, critical, and contextualized analysis of care practices developed at
this level of care (Ogassavara et al., 2023).
The search for scientic articles was conducted between September and December 2025 in
the Virtual Health Library (VHL), using the Health Sciences Descriptors (DeCS): “eating disorders”,
“nursing”, “primary health care”, “adolescents”, and “psychosocial management”, combined using
the Boolean operators AND and OR. Books, technical manuals, protocols, and normative documents
were selected from the researcher’s personal physical and virtual collection, composed of recognized
works in the areas of mental health, primary health care, and mental health and psychiatric nursing.
Publications from 2010 to 2025 in Portuguese and English that addressed or were related to
the role of nurses in managing eating disorders in primary health care (PHC) were included. Although
eating disorders encompass a broad range of clinical conditions, this review focused on anorexia
nervosa and bulimia nervosa due to their higher prevalence in adolescence and clinical relevance in
this context. Duplicate studies, studies without full text access, or studies without a direct relationship
to the topic were excluded.
The analysis of the materials was qualitative and thematic, resulting in the organization of
the content into three categories: (1) Adolescence and eating behavior: a biopsychosocial reection, (2)
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Eating disorders in adolescence: conceptual and clinical aspects, (3) Nursing management in primary
health care for eating disorders in adolescence.
Since this research was based on secondary and publicly available sources, there was no
need to submit it to the Research Ethics Committee (CEP) in accordance with CNS Resolutions No.
466/2012 and No. 510/2016.
RESULTS AND DISCUSSION
Adolescence and eating behavior: a biopsychosocial reection
Adolescence is a phase of the life cycle that demands attention, as it is a period marked by
discoveries, comparisons, heightened emotions, and personal and family conicts. These experiences
can increase vulnerability to psychological distress and contribute to the development of mental
disorders, including eating disorders.
From this perspective, puberty can be considered a transitional milestone between childhood
and adolescence. Within this developmental period, puberty is characterized by well-dened biological
changes that are linked to a continuous process of psychosocial development, in which emotional,
cognitive, and relational aspects are under construction (Itiba, 2010).
These transformations typical of adolescence directly impact the individual’s relationship
with their body, health, and eating habits, making eating behavior a sensitive eld of biological,
emotional, and social expression during this period of life.
According to Devine, Hill, and Gallagher (2023), these transformations typical of adolescence
mean that eating behavior becomes inuenced by multiple factors that go beyond nutritional knowledge,
reecting interactions between individual, social, and contextual dimensions.
Body image dissatisfaction and its associated challenges have been linked to poorer health
outcomes among adolescents in various contexts, including disordered eating behaviors, symptoms
of depression, and anxiety. Despite the importance of these ndings, the most recent estimates on the
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prevalence of these problems, as well as on positive eating attitudes and behaviors such as intuitive
eating and body appreciation, remain outdated in many contexts, limiting current understanding of
the extent and nuances of these experiences among adolescents (Babbott, Consedine, Roberts, 2023).
Eating behavior, although it may seem like a common aspect of everyday life, is a complex
human phenomenon of central importance both in societies and in people’s subjective experience
(Dalgalarrondo, 2019).
However, eating behavior is a rather broad term that encompasses various decisions about
what to eat, when to eat, and how much to eat. Therefore, understanding eating behavior is important,
since food choices have signicant implications for the individual and society (Emilien, Hollis, 2017).
Given this complexity, eating behavior can be understood from three fundamental dimensions,
as observed in owchart 1, which are interrelated and inuence food choices throughout life, allowing
for an integrated view of the phenomenon.
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Image 1 - Basic dimensions of eating behavior
Source:Adapted from Bernard, Trouvé (1976); Rossi (2014).
From the perspective of the owchart presented and considering the adolescent phase, eating
behavior in adolescents cannot be understood in a restricted or fragmented way, limited to a single
determinant, as it is a multifaceted phenomenon in which different dimensions are dynamically
articulated at this time and throughout the individual’s life.
According to Bernad, Trouvé (1976) and Rossi (2014), the physiological-nutritional dimension
refers to the metabolic, endocrine and neurobiological mechanisms responsible for regulating hunger,
satiety and the satisfaction of nutritional needs.
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While the affective-relational dimension encompasses the links between food, pleasure, and
satisfaction, recognizing that the act of eating goes beyond biological function, evidence indicates that
family practices of body objectication negatively inuence adolescents’ body perception and eating
behavior, associating with greater body dissatisfaction, lower self-esteem, and disordered eating
patterns, such as bulimic symptoms and less adherence to intuitive eating (Tanguay et al., 2025).
In turn, the social and cultural dimension refers to the norms, values, and practices
historically constructed around food, conguring itself as a socially shared behavior inuenced by
family, cultural, and peer group contexts, aspects that take on special relevance in adolescence due to
the search for belonging and social recognition.
Body transformations and the construction of body image play a central role in the subjective
experience during adolescence, as this is a period in which the body becomes the object of constant
evaluation, both by the adolescent themselves and by the social environment, which can intensify
feelings of dissatisfaction, comparison, and inadequacy.
During adolescence, individuals can become especially sensitive to tensions and conicts
present in their social and family context, internalizing dysfunctional aspects of their environment. In
this scenario, self-criticism and dissatisfaction with weight are frequent, which can result in changes
in body image perception and a progressive withdrawal from social activities. Furthermore, the
recurrent adoption of restrictive diets is observed, which tend to be maintained even in the face of
signicant weight loss, potentially leading to disproportionate weight for height and risky eating
behaviors (Araújo, 2016).
The experiences lived through at this time can have repercussions throughout the course
of life, signicantly inuencing eating patterns, mental health, and overall well-being. Therefore,
understanding eating behavior at this stage must consider the centrality of body image, social
relationships, and the developmental context (Neumark-Sztainer et al., 2018).
Within the context of social relationships experienced during adolescence, experiences of
symbolic violence, such as bullying, also exert a signicant inuence on eating behavior. Evidence
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points to an association between experiencing bullying and the occurrence of eating disorders among
adolescents (Santos et al., 2023).
In light of the discussions presented, it becomes necessary and fundamental to consider
the adolescent in their uniqueness, recognizing their particularities, emotions, and feelings specic
to this stage of development, attributing value and voice to them in processes related to health
care. Understanding eating behavior in adolescence requires a broader perspective, sensitive to the
physiological, affective, and sociocultural dimensions that permeate this stage of life.
Eating disorders in adolescence: conceptual and clinical aspects
Adolescence represents a phase of high vulnerability to mental health, in which bodily,
emotional, and social changes can trigger different manifestations of psychological distress. In this
context, mental disorders, especially eating disorders, emerge not only as diagnostic categories, but as
expressions of complex processes that permeate identity construction, the relationship with the body,
and social bonds.
According to the APA (2023), eating disorders are characterized by a persistent disturbance
in eating or eating-related behavior, resulting in altered food consumption or absorption, which
signicantly compromises the individual’s physical health or psychosocial functioning.
Eating disorders (EDs) have a complex and multifactorial etiology, not yet fully understood,
resulting from the interaction between biological, psychological, social, environmental, and cultural
factors. A higher incidence of these conditions is observed in sociocultural contexts that overvalue
thinness as an ideal of beauty, success, and social acceptance, a phenomenon frequently described as
body worship (Rathke; Barros, 2014).
According to Araújo (2016):
“Oral disorders can originate from various causes, such as: a history of obe-
sity, humiliation, and associated social failures. Children and adolescents de-
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monstrate negative attitudes and conceptions towards obesity; in some cases,
obesity can be an escape valve for certain psychological maladjustments, se-
eking to resolve frustrations and obtain immediate gratication, creating only
another problem.”
These disorders have a multifactorial etiology, being determined by a diversity of biological,
genetic, psychological, sociocultural, and family factors that interact with each other to produce and
perpetuate the disease. In addition to presenting complications in various body systems, more recent
studies are relating body dissatisfaction and eating disorders to immune system dysfunction and the
triggering of an inammatory response (Carmo, Pereira, Cândido, 2014).
Reecting on psychodynamic theories, the development of an eating disorder is based on an
unsatised feeling of separation-individuation. When situations arise that threaten the vulnerable ego,
feelings of lack of control over one’s own body (self) emerge. Behaviors associated with food and food
intake generate feelings of control over one’s own life (Towsend, Morgan, 2021).
In this context, the high prevalence, clinical severity, and signicant mortality rates related
to eating disorders, as well as the increase in their rates worldwide, highlight the need to improve
diagnostic criteria and develop more precise instruments capable of promoting early identication and
the implementation of timely and effective interventions (Bertoletti; Antunes, 2023).
According to Ferreira (2018), anorexia and bulimia nervosa are eating disorders that are
growing worldwide every day and result not from just one, but from a multitude of factors that
inuence their appearance in the individual. From a psychopathological point of view, the intense
fear of gaining weight is a central element in eating disorders, manifesting itself in different ways
depending on the clinical picture. In anorexia nervosa, this fear leads to food refusal even when
hungry, differentiating it from other conditions associated with weight loss. In bulimia nervosa,
the fear of obesity is momentarily relieved by episodes of binge eating followed by compensatory
behaviors, while in binge eating disorder these episodes occur without purging practices (Rathke;
Barros, 2014).
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According to Sadock, Sadock, Ruiz (2017, p. 509), the expression anorexia nervosa is derived
from the Greek term for “loss of appetite” and a Latin word implying nervous origin. It is characterized
by a distorted body image and intense food restriction, which can result in signicant weight loss
(Sgarbim et al., 2023).
According to APA (2023), AN has three essential characteristics: (A) persistent restriction of
caloric intake, (B) intense fear of gaining weight or becoming fat or persistent behavior that interferes
with weight gain, and (C) disturbance in the perception of one’s own weight or shape, in addition to
being classied into two important subtypes as shown in the image below.
Table 1 -Subtypes of Anorexia Nervosa (AN)
Regarding the clinical picture, AN usually begins with progressive dietary restrictions, such
as the exclusion of foods considered high in calories, often justied by the pursuit of a “healthy” diet.
Over time, there is a reduction in the quantity and variety of food, accompanied by weight loss or
failure to achieve the expected weight gain, which can progress to malnutrition (Appolinario, 2022).
People with anorexia nervosa (AN) have high rates of psychiatric comorbidities, such as
depression, obsessive-compulsive disorder (OCD), personality disorders, as well as possible problems
related to the use of psychoactive substances (Carvalho, Gonçalves, Araújo, 2025).
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The term bulimia nervosa derives from the terms for “hunger of The word “bulimia nervosa”
comes from the Greek word for “ox” and the Latin word for “nervous involvement.” For some patients,
bulimia nervosa may represent a failed attempt at anorexia nervosa, sharing the goal of becoming very
thin, but occurring in people with less capacity to maintain prolonged semi-starvation or extreme
hunger, such as those with classic restrictive anorexia nervosa (Sadock, Sadock, Ruiz, 2017).
Bulimia nervosa, on the other hand, involves recurrent episodes of excessive food intake in
a short period of time, followed by the adoption of inappropriate compensatory behaviors to avoid
weight gain, such as self-induced vomiting and the use of laxatives and diuretics (Sgarbim et al., 2023).
According to the APA (2023, p. 388), there are three essential aspects in bulimia nervosa:
(A) recurrent episodes of binge eating, (B) recurrent inappropriate compensatory behaviors to prevent
weight gain, (C) binge eating and inappropriate compensatory behaviors must occur on average at
least once a week for three months, (D) self-evaluation unduly inuenced by body shape and weight,
to qualify for the diagnosis.
According to Appolinario (2022), the clinical picture is marked by episodes of binge eating,
characterized by excessive food intake associated with a feeling of loss of control. These episodes
usually occur after periods of food restriction or in situations of emotional dysregulation, frequently
involving foods rich in carbohydrates and fats. They generally occur covertly and are accompanied by
intense feelings of guilt, shame, and psychological suffering. People with bulimia nervosa (BM) have
a higher frequency of psychiatric comorbidities, such as bipolar and depressive disorders, and anxiety
disorders may also be present (APA, 2023).
Nursing Management in Primary Health Care for Eating Disorders in Adolescence
The management of eating disorders (EDs) in adolescence requires a multidisciplinary and
coordinated approach, involving different areas of health, due to the clinical complexity of these
conditions, demanding the integrated action of professionals such as psychiatrists, nutritionists, nurses
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and therapists, as well as other specialists as needed (Carmo, Pereira, Cândido, 2014).
This highlights the need for a structured primary health care system capable of organizing
care and improving care practices in the face of the complexity of eating disorders in adolescence,
emphasizing the role of the nurse as a strategic professional in this process, especially in coordinating
care, providing support, listening attentively, and offering longitudinal follow-up for adolescents and
their families.
It is also considered that adolescents with eating disorders often initially seek out healthcare
professionals who are not specialists in mental health, motivated by nonspecic emotional, physical, or
behavioral complaints. This makes it essential that all professionals involved in healthcare, including
those in primary care, nutritionists, and physical education teachers, are trained to recognize warning
signs and make timely referrals to specialized services, thus promoting early intervention and reducing
complications (Muzy, Carvalho, 2025).
In this sense, the National Policy for Comprehensive Healthcare for Adolescents and Young
People (PNAISAJ) recognizes adolescence as a strategic period for mental health interventions,
emphasizing the strengthening of healthy social and emotional behaviors and the early identication
of risk situations (Brazil, 2010). This guideline reinforces the understanding of eating disorders as
biopsychosocial phenomena, demanding preventive, educational, and care actions within the scope of
primary care, in accordance with the principles of comprehensive and territorial care.
Given this scenario, in the context of primary health care, nurses have legal support to
request complementary examinations in adolescence, as established by Law No. 7,498/1986, provided
that this practice is included in protocols, public health programs, and institutional routines. This
attribution strengthens the professional autonomy of nurses and contributes to the early identication
of problems, clinical monitoring, and longitudinal follow-up of adolescents with eating disorders,
promoting comprehensive and effective care.
Therefore, nursing management of eating disorders in adolescence requires an integrated
clinical approach, including physical and mental assessment of the adolescent, a psychiatric
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examination, and monitoring through laboratory tests. These elements guide the early identication
of problems, the planning of interventions, and the longitudinal follow-up of care.
For this to happen, it is essential to establish a solid therapeutic relationship between the
nurse and the patient, starting with a comprehensive assessment that involves physical examination
and the identication of nursing diagnoses, because it is from this process that the nurse, together with
the patient and their family, develops a care plan according to the identied needs (Ferreira, Viana,
Silva, 2024).
Image 2 –Components in the Management of Eating Disorders in Adolescents in Primary Health
Care.
Source: Own work (2025).
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In the context of routine consultations, especially during the initial assessment, nurses can
use screening tools and specic questionnaires aimed at identifying eating disorders, such as the
SCOFF (Sick, Control, One Stone, Fat, Food Questionnaire), which assesses signs suggestive of
anorexia nervosa and bulimia nervosa, among other protocols appropriate for Primary Health Care
(Teixeira et al., 2021).
The SCOFF is not a diagnostic tool and should not be used as a substitute for a complete
clinical evaluation; however, based on the ndings of the initial screening, it becomes possible to
make timely referrals of adolescents for multidisciplinary follow-up, favoring the early initiation of
care and the reduction of possible complications (Lima, 2012).
Table 3 –SCOFF Instrument Questions
Nº QUESTIONS SIM NO
1 Do you induce vomiting because you feel uncomfortably full?
2 Are you worried that you’ve lost control over how much you eat?
3 Have you recently lost more than 6 kg in a 3-month period?
4 Do you believe you are fat even when others say you are too thin?
5 Would you say that food dominates your life?
Interpretation after the instrument has been applied by healthcare professionals, whether or
not they are specialists in mental health, within the context of primary health care.
• 1 point: low risk (initial suspicion of a possible eating disorder);
• 2 points: moderate risk (likely ongoing eating disorder);
• > 3 points: high risk (high potential for serious eating disorder).
The use of standardized instruments, validated internationally or nationally, is fundamental
for assessment and management by nurses in primary health care. In addition, Gurgel et al. (2023)
emphasize that the initial assessment of adolescents suspected of having eating disorders should be
based on a detailed medical history, including current, minimum, maximum, and desired weight, as
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well as, in the case of girls, the age of menarche and menstrual pattern.
According to the author cited earlier, dietary patterns should be investigated, including
restrictions, fasting, preferences, and peculiar behaviors, as well as the frequency of episodes of
overeating, vomiting, and the abusive use of anorexigenics, diuretics, laxatives, or other medications.
The assessment should also encompass body image distortion, the adolescent’s level of understanding
of the harms associated with the disorder, physical exercise patterns, and a complete physical
examination, providing information to support the planning of multidisciplinary care.
Regarding the assessment of nutritional status, Carvalho (2025) emphasizes that the nurse
should measure weight and height, using the Body Mass Index (BMI) as one of the main indicators
for comparison with reference standards for age and sex, enabling the monitoring of the degree of
malnutrition and the clinical evolution of the adolescent throughout the follow-up.
In addition to clinical aspects, the adolescent’s life history is a central element in nursing
assessment, since family, school, and social experiences can directly inuence eating behavior and
mental health.
Investigating situations of bullying, family conicts, patterns of aesthetic pressure, family
history of mental disorders, and recent stressful events contributes to understanding eating disorders
in their biopsychosocial dimension, favoring individualized interventions that are sensitive to the
adolescent’s life, as observed below.
Table 4 –Aspects and considerations in Nursing Assessment
Source: Adapted from: Marclona, Castro (2013).
The mental examination, therefore, consists of an analysis that is carried out using information
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collected in the interview/history, associated with verbal expression and observation of behavior,
taking as a reference the sociocultural and family reality of the person being evaluated, as well as
the characteristics of the health care service. The ten psychic functions are evaluated throughout the
interview and, at the end of the examination, the ndings identied in each of them are described
(Marcolan, Castro, 2013).
Nursing assessment in the care of adolescents with eating disorders should encompass not
only physical and nutritional aspects, but also the emotional and behavioral components involved in
the illness, considering the psychological nature of these conditions.
Table 5 –Aspects and/or mental functions observed in the mental status examination.
Source: Adapted from: Marclona, Castro (2013); Sadock; Sadock; Ruiz (2017)
It is necessary for the nurse to integrate the mental status examination of the adolescent with
eating disorders, whether anorexia nervosa or biochemical bipolar disorder, during their assessment,
as it is an important component for identifying nursing problems, constructing nursing diagnoses
(ND), and consequently, short-, medium-, and long-term nursing interventions.
In the management of eating disorders, biochemical tests play a complementary role to
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clinical evaluation, allowing the identication of organic repercussions resulting from food restriction,
purging, or binge eating, considering the request and evaluation of complete blood count, blood glucose
levels, lipid prole, electrolytes, renal function, hepatic function, hormone levels, electrocardiogram
(ECG), and urine tests.
Electrolyte imbalances, metabolic disorders, anemia, hypoglycemia, and hormonal changes
are frequent ndings, especially in more severe cases. Although the request and interpretation of these
tests are shared with the medical team, it is the nurse’s responsibility to monitor the results, track risk
signs, and coordinate care, ensuring continuity of care and the adolescent’s safety in primary health
care.
According to Pinto et al. (2023), nurses need to be able to guide and conduct high-quality
and efcient clinical follow-up for patients and their families, focusing on establishing bonds of trust,
emotional support, and guidance on the pathology and its physical consequences.
Nursing aims to maximize clients’ positive interaction with their environment, increase their
level of happiness, and reinforce their degree of autonomy. Care for these patients is continuous;
therefore, the nurse must understand the illness to educate the patient to understand themselves and
emphasize the importance of family. in the process, since patient follow-up goes beyond hospitalization
(Pinto et al. 2023).
From this perspective, the management of eating disorders in adolescence, within the scope
of primary health care by nurses, is structured around three fundamental axes, as observed in the
image below.
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Image 3 –Nursing strategies in the management of eating disorders in adolescents.
Source: Adapted from Cardoso, Andrade, Marques (2024).
These elements complement each other and reinforce the nurse’s role as a strategic professional
in the prevention, comprehensive care, and promotion of the mental health of adolescents monitored
by them in primary health care.
In this sense, nursing management takes place during physical and psychological assessments,
in regular meetings during nursing consultations, home visits, or through operational groups developed
within primary health care, with the inclusion of family members as a fundamental support network
in this process.
According to Townsend and Morgan (2021), nursing interventions in the care of adolescents
with eating disorders should be systematized, continuous, and focused on clinical safety, nutritional
recovery, and emotional support. The nurse acts in monitoring physical status, preventing
complications, providing support during meals, and mediating care with the multidisciplinary team,
always considering the biological and psychosocial dimensions of the illness, and may consider the
following nursing interventions:
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• MonitMonitor food intake, weight loss and gain, with daily weighing under standardized
conditions;
• Regularly assess vital signs, paying attention to orthostatic hypotension and bradycardia;
• Observe hydration, skin turgor, and mucous membrane conditions;
• Accompany the patient during meals, offering support and establishing time limits;
• Perform postprandial surveillance to prevent purging behaviors;
• Maintain a detailed record of clinical and nutritional progress;
• Instruct the patient and family about the therapeutic plan, reinforcing adherence to
treatment;
• Avoid focusing exclusively on food, prioritizing listening and addressing emotional
aspects;
• Encourage the recognition of feelings and conicts associated with eating behavior. of
feelings and conicts associated with eating behavior.
It is important for nurses to reect on their competencies and skills in caring for adolescents
with eating disorders within primary health care, knowing when to communicate with the team’s
physician and when to refer them to specialized care.
Given that a person suffering from severe eating disorders that put their life in danger, total
lack of impulse control over food intake, persistent refusal to eat, presence of suicidal ideation or
behavior, presence of delusional-hallucinatory ideation, weight below 75% of expected weight, and
physical complications should be referred (Rathke, Barros, 2019).
Regarding eating disorders such as anorexia and bulimia nervosa, improvement and cure
only occur when food and weight cease to be a constant concern in the lives of patients; and the
contribution of the nursing professional is essential for the patient and their family to understand that
human beings are more than just physical characteristics dictated by single standards, and that the
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pursuit of a healthy life is what truly matters (Coras, Araújo, 2011).
It is clear that nurses play a crucial role in managing eating disorders in adolescents within
primary health care. However, many times nurses working in this context develop barriers that need
to be overcome to (re)build competencies and skills in the eld of mental health, thus offering truly
comprehensive and responsible care within the health care network.
FINAL CONSIDERATIONS
The ndings of this narrative review show that eating disorders in adolescence constitute
complex and multifactorial problems, strongly related to the biopsychosocial transformations inherent
to this period of development, since the construction of identity, the relationship with the body, and
the inuence of sociocultural factors make adolescents particularly vulnerable.
In the context of Primary Health Care (PHC), its strategic role as the entry point to the Unied
Health System (SUS) and a privileged space for welcoming, early identication, and longitudinal
follow-up of adolescents with eating disorders stands out. In this scenario, the nurse assumes a
central position in coordinating care, establishing the therapeutic bond, providing qualied listening,
conducting comprehensive assessments, and coordinating with the psychosocial care network,
contributing signicantly to the comprehensiveness, continuity, and effectiveness of mental health
care.
Despite the relevance of the nurse’s role in this eld, there is a signicant gap in national
scientic production regarding nursing management of eating disorders in adolescence, especially
within the context of primary health care. This nding points to the need for investments in research,
care protocols, and continuing education processes that strengthen evidence-based practices,
contributing to the improvement of care, the reduction of stigma, and the promotion of mental health
among adolescents in these communities.
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