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 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
Comorbid disorders (substance abuse, depression, anxiety) Presence of comorbid 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.