In fact, you may have seen it more recently than you realize. It is estimated that 9% of the population will suffer from an eating disorder in their lifetime (Harvard STRIPED, Academy for Eating Disorders, Deloitte Access Economics, 2020). One tertiary hospital recently published a study showing admission of eating disorder patients has almost tripled compared to previous years (Otto et al., 2021). These trends seem consistent throughout our nation as many eating disorder treatment facilities have long wait lists. Despite this present crisis, many medical providers describe treatment of eating disorders as being “outside their comfort zone” (Davidson et al., 2019), which is understandable—medical school may only include several hours of focused eating disorder training. Understanding how to be a detective, be a catalyst, and be an advocate, can help medical professionals strengthen their competence in treating eating disorders.
Looks are not always what they seem, especially with eating disorders. Diagnosis is challenging because eating disorders cannot be recognized by appearances, and they are not exclusive to young white females. Statistics reveal eating disorders affect individuals of all genders and ages and from every socioeconomic background. Their weight and labs often fall within normal ranges, further disguising this illness.
Do not be surprised if patients conceal or minimize their eating disorder. They may be afraid of being asked to make dietary changes. They may have alexithymia, a personality trait characterized by the inability to identify and express emotions. They may anticipate stigma or judgment. They may not understand they have an eating disorder at all. This is where the detective work comes in. It can take careful observation to piece together the clues of an eating disorder.
You’ve seen this before because eating disorder patients frequent medical facilities with presenting symptoms, including: metabolic or electrolyte abnormalities and opportunistic infections; gastrointestinal, psychiatric, gynecologic and obstetric concerns, as well as neurologic, cardiac, endocrine, hematological, renal, and dental presentations.
Have the right questions in your tool box. Simple tweaks to history gathering questions can better uncover an eating disorder. Instead of asking, “Do you eat fruits and vegetables?” a provider could ask:
If an eating disorder is suspected, follow up with more specific questions about exercise, dieting, bingeing or purging behaviors, and weight or shape concerns. Including families in the discussion can also help broaden understanding. Helpful screeners are available to integrate into your practice. The SCOFF is a rapid five question screener shown to have good sensitivity (Hill et al., 2010).
After detecting an eating disorder, become a catalyst for change by facilitating next steps. No medical provider can manage eating disorders without the right support. A comprehensive team is essential and often incorporates a dietitian, therapist, psychiatrist, and physician. Timely referrals and comprehensive treatment have been shown to improve patient outcomes (Jones & Brown, 2016). It is also necessary to consider the appropriate level of care for your patient. Though many are able to move toward recovery in an outpatient setting, the complexity of eating disorders can sometimes require increased support. Some may benefit from an intensive outpatient program (IOP.) These are available virtually and in person. Your patient may even require admission to an inpatient facility, such as Laureate Eating Disorder Program, for 24/7 supervision and care. Some patients require stabilization in the hospital prior to admission at a psychiatric facility. Many factors impact level of care including:
No matter the level of care, ongoing collaboration between treatment team members is essential.
Your influence could be the turning point in your patient’s life. Because it is difficult for patients to take steps forward and remain motivated for recovery, relationships are key. Authentic and compassionate medical professionals offer a listening ear and take what the patient says seriously. Even the briefest of interactions have been cited as a recovery motivator, or a reason for relapse. What you say has weight.
Dr. David and Hannah George became best friends in high school and are still best friends nine years into marriage. Hannah is a therapist at Laureate Eating Disorders Program. David is currently a resident in the Oklahoma State University Center for Health Sciences Pediatric Program. While both have a passion for helping their patients, they can feel tension about how to best address topics on weight. David and Hannah have both aired frustration about how to “marry” medical and mental health to ensure the most comprehensive care for patients. Like a good marriage, they have found that ongoing dialogue is essential in this complicated issue. For more information about Laureate Eating Disorder Program, visit www.saintfrancis.com/laureate/eating-disorders-program/