Ana is a 15-year-old high school student who is active in school activities, loves to run and bike, and has a 3.95 grade point average. She has a close group of friends that she spends her free time with; her parents are very proud of her for her outstanding academic performance School Nurse Visit: Ana being seen at the school clinic for a sore throat and fever. The nurse takes her height (5’3″) and weight (107 lb). Ana is diagnosed with strep throat infection and is given antibiotics Sports Physical Visit: Ana is seen 4 months later (in early fall) by her pediatrician for a sports physical, since she is planning to join the cross-country running team. Weight t this time 96 pounds. The physician notes that Ana seems to be tired and has lost weight since her most recent visit to the clinic. Ana replies that she has had a lot of sinus and other infections, which causes her to lose her appetite. She also notes that she has been training hard to make the cross-country team but that her training should become less intense now that she has made the team. Ana assures the physicians that she will try to eat more in the future. They physician encourages her to eat more carbohydrates and protein to improve her sports performance. Pre-employment Physical Visit: Ana is seen by her family physician for a preemployment physical in early June. At this time her weight is 91 pounds. The physician is concerned about her weight, but Ana assures her that she looks and feels fine. The MD refers her to the outpatient clinical dietitian. During the interview with the dietitian, it is noted that Ana eats only twice a day, with many diet beverages in between these meals. The dietitian suggests that Ana increase her weight to at least 95 pounds, but she refuses, stating that at this weight she would “have too much fat in her thighs” for running. When asked about the use of diet pills, laxatives, and other diet aids, Ana states that she doesn’t need these because she has enough willpower to reduce her food intake on her own. She also denies vomiting after eating. When asked about her willingness to reduce her running so that she could reach a more healthy weight, Ana get agitated. The dietitian asks Ana how she determines how much or how long she needs to run. Ana states that she runs as long as she needs to so that she can use up all of the calories she has eaten. When the dietitian suggests that this is compensatory exercise and is a form of purging, Ana becomes upset and leaves. The dietitian looks for her parents in the waiting room, and lets Ana’s mother know that she thinks there may be an eating issue that the family should deal with. The mother thanks the dietitian for letting her know and leaves, as Ana has already gone to the parking lot. The dietitian confers with the physician and her parents are sent information about eating disorders, . at.. including possibly outcomes and treatment options. Three months later, the clinic is notified that Ana has fainted at gym class in school and that the hospital where she was taken has referred her for an in-patient eating disorder evaluation.