12 Tips for Doctors Treating Patients With Eating Disorders
A friend from college (who is studying to become a family physician) messaged me and asked for some advice. She wanted to know how she could have a stronger relationship with her patients and asked if I had any suggestions for how she could be the kind of doctor I had needed throughout my recovery from anorexia.
So thank you, Nicole, for reaching out and for trying to improve an overlooked aspect of medical care: the understanding of mental illnesses, especially eating disorders. This is a very important topic to me.
Before I begin, I want to be clear. I am not a medical professional. I am just going to share some information that might be helpful to medical professionals. If you are talking with someone you suspect might have an eating disorder, here is some advice to keep in mind:
1. Ask questions.
Specifically about their relationship with food and their attitudes towards their appearance and weight. When I was younger, I was very deceptive and often lied about how I felt about my body. I understand this is hard. How do you identify an eating disorder when your patient is lying to you? But there were also times I was very honest with my friends and doctors about what I had — and had not — eaten and how I viewed my size and appearance. Even after telling them my distortions, many doctors did not bat an eye. Friends often showed concern for my well-being, while doctors appeared not to care. Ask questions, get involved and show you care about their health.
2. Learn the signs of eating disorders.
It can help you recognize when someone may not have a healthy relationship with food, their weight or their body. If someone is brave enough to be explicit about their unhealthy relationship with food, listen, be attentive and make sure they receive the proper care. Here are some things to look for:
If they say things like “I’ve been on a diet,” “I want to lose x number of pounds” or “I’m afraid of gaining weight,” these may be warning signs of an eating disorder. Try to ask follow up questions about their relationship with food and their body.
If they have lost weight, ask about how they feel about their body and their weight. Ask if they intentionally lost weight. Ask if they have a goal weight. Your patient might not be honest with you. But if they are honest and they do give you a “goal weight” that seems too low, ask further questions. A goal weight lower than the recommended weight for them could be a sign of an eating disorder.
Even if your patient is at a “normal” weight, ask about their relationship with food to determine if they are at risk for an eating disorder. It is also important to understand many people have eating disorders while maintaining a “normal” weight. A lot more people than you think experience disordered eating, even if it is not a full-blown eating disorder. I think if disordered eating is addressed early, it could potentially prevent someone from developing a life-threatening eating disorder.
3. Look for the signs.
If they are not ready to open up about their eating disorder, look for signs like:
- Anxiety when asked about food, weight and their appearance
- Wearing baggy clothes
- Being constantly cold with poor circulation
- Low energy
- Dizziness when standing or fainting
- Brittle nails and dry hair that is falling out
- Cutting out certain food groups
- Withdrawal from activities or friends
- Change in mood
These warning signs are mostly for anorexia, as this is what I have personally experienced. The warning signs are slightly different for other eating disorders. Remember, knowledge is power. Do your research and learn as much as you can about these disorders.
4. Be careful when commenting on weight.
I saw medical professionals when I was at various weights (including dangerously low weights) but it never seemed low enough to the nurses and doctors I saw. I heard many comments about how I “don’t look like I have an eating disorder.” People with eating disorders come in all shapes and sizes. Commenting on my weight only fuels the eating disorder voices. Whether it’s “you’ve lost a lot of weight” (which reinforces feelings of success) or “your weight is normal, you must not have an eating disorder” (which reinforces I have to work harder at losing weight). So please be careful when talking about weight with someone you suspect might have an eating disorder and especially with someone who has specifically said, “I have anorexia.”
5. Respect a patient’s choice if they’d rather not know their weight.
I went to several nurses and doctors and specifically asked to be weighed backwards because I had an eating disorder, only to be told moments later what my weight was. It was also always on the paperwork they gave me at the end of the appointment. This was very triggering and often led me into a downward spiral. If someone asks not to know their weight, please try to avoid showing or telling them.
6. Understand this is not a phase.
I had one doctor tell me that it would be OK because this was just a phase I was going through. Eating disorders are not a phase. They are serious mental disorders that require treatment.
7. Do not advise them to start working out until they are ready.
Often, those with eating disorders struggle with compulsive exercise. Exercise should only be added when the entire treatment team agrees they are ready. Adding exercise too early in recovery could be extremely detrimental. Even though we are taught exercise can help with depression, it can often be triggering to those with eating disorders, so please be cautious when talking with patients with eating disorders.
8. Understand people come to medical professionals at various times during their eating disorder.
It might be in the beginning, before they have lost weight. It might be when their weight is shrinking or it might be when their weight is dangerously low. It might also be when someone is in the depths of their eating disorder, yet their weight has remained “normal.” Please understand at all stages of an eating disorder, they need your help. You could be the difference between life and death. Please, take them seriously.
Early detection is critical, but most only seek medical attention when their eating disorder has fully taken over. Please know the signs and symptoms and learn how to identify eating disorders before it is too late.
9. A test won’t always tell you if someone has an eating disorder.
At my lowest weight, my blood work came back mostly normal. I was, however, very sick. Lab results are not always an indicator there is a problem. Usually it’s someone’s attitudes and relationship with food, weight and appearance, that determine if they have an eating disorder.
10. Read the DSM (Diagnostic and Statistical Manual of Mental Disorders).
While the diagnoses are constantly changing, it is important to be up to date and understand how anorexia and other eating disorders are diagnosed.
11. Do not belittle mental health disorders.
After I started recovery from my eating disorder, I began to struggle with self-harm. I once had a doctor tell me since my cuts were “superficial” and since I never needed stitches, it was not much of a concern. Lab results and tests cannot diagnose mental health issues, but that does not mean they are not serious or that the person is not in need of professional treatment.
12. Most importantly, be compassionate.
Telling my doctor, “I may have an eating disorder” was one of the scariest things I’ve ever done. I was terrified of getting treatment. I was terrified of gaining weight. I was terrified everyone would know my secret. Being honest about my thoughts was extremely difficult. Please do not be dismissive, especially when someone is telling you something very hard to talk about. If someone tells you they have an eating disorder, please listen and try to understand to the best of your ability. If you do not understand eating disorders, explain this to them and refer them to a therapist or psychiatrist that can better address their health needs. In general, try to think of your patient as a loved one. If you noticed your family member lost weight and had cuts on her arms, how would you respond? Would you belittle her or would you show concern and worry? Treat them as you would your own family.
Here’s a resource you mind find helpful. NEDA is a great resource and I encourage you to explore their website if you are seeking more information about eating disorders and mental health.
As always, stay strong, keep fighting and never give up hope.
Recovery is possible. Yes, it’s even possible for you.
If you or someone you know is struggling with an eating disorder, you can call the National Eating Disorders Association Helpline at 1-800-931-2237.
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Thinkstock photo via Pablo_K.