If anorexia nervosa is suspected:

• Enquire about symptoms, for example menstruation patterns, muscle weakness, cold sensitivity, sleep disturbance, fainting or dizzy spells, dental problems, and digestive problems.
• Physical assessment should include (as a minimum):
• Height and weight:
• Ideally the person should be weighed before referral. This can usually be achieved with explanation of why it is necessary (to assess physical risk), but it is also important to maintain the therapeutic relationship. If weighing is not possible, the person should be referred with as much information as possible about their physical appearance and psychological state to enable a physical risk assessment to be made.
• Some people are so concerned by unwanted interventions by healthcare professionals that they will falsify their weight by drinking copious amounts of water beforehand or by hiding heavy objects in their clothes.
• In children and adolescents, comparison with previous growth parameters may be revealing. It is important to make an early diagnosis in children because they are at risk of irreversible growth impairment.
• Calculation of body mass index (BMI). Use centile charts if the person is younger than 18 years of age.
• Pulse and blood pressure.
• Findings on examination may be normal, especially if it is early in the course of the illness, but the following may be helpful to assess the risk of physical complications:
• Core temperature (this is easily done using an ear thermometer).
• Examination of peripheries (circulation and oedema).
• Cardiovascular examination, including postural hypotension.
• Test of muscle power, for example:
• The sit up test — the person lies flat on a firm surface such as the floor and has to sit up without, if possible, using their hands.
• The squat test — the person is asked to rise from a squatting position without, if possible, using their hands.

If bulimia nervosa is suspected, physical assessment is often unremarkable and is of less help in assessing physical risk. However, physical signs suggestive of complications may be present.