You are a healthcare provider: an emergency room doctor, a pediatric nurse, a physician assistant. You’ll meet a young woman whose partner found herself unresponsive after vomiting, an adolescent boy who trained for his school’s athletics team and failed to meet growth goals, or a man prescribed a weight-loss drug who is now self-isolating due to strict food rules.
When we hear these scenarios, one of our first thoughts is “a possible eating disorder.” But if you’re like most medical professionals worldwide, you have little to no training in eating disorders. Maybe you’re not considering a diagnosis of an eating disorder, suspect one but aren’t sure what to ask, or worry that you’re asking something in the “wrong” way.
These situations happen too often. Medical providers, not mental health professionals, are often the first – and sometimes only – stop for patients with an eating disorder.
As specialists in the field of eating disorders, we strongly believe that all medical providers can provide the basic principles of good care for these patients. We also understand that non-specialists may not be up to the task, and for good reason. Most residency programs and medical schools are lacking clinical training or classroom learning about eating disorders. About medicine, nursingand even power supplystudents and professionals say they are not as prepared as they would like.
More training has long been essential. However, the toll of the Covid-19 pandemic on mental health was equivalent to one worldwide increase in the number of eating disorders. The influence was greater than other mental health conditions, such as anxiety or depression, and highest among teenagersa generation already experiencing a mental health crisis. More people show up in all treatment settings than ever before, but misconceptions about who develops an eating disorder remain widespread and lead to delays in diagnosis and care.
Solving the problem requires creativity, humility and steadfastness.
To overcome the barriers that have traditionally compartmentalized experience and expertise, let’s meet students where they tend to look for information: online. Various research groups, including ours, are working on this. A short one video training made by the Strategic Training Initiative for the Prevention of Eating Disorders (STRIPED) at Harvard T.H. Chan School of Public Health improved screening and referral at pediatricians. Our freely available curriculum, Prepared (available in both English and Spanish), offers short, independent modules, and it better knowledge and attitude among nurses and nutrition trainees. Australia InsideOut Institute developed The essencea virtual program that reaches national providers who improved skills and readiness of users working with eating disorders.
But this material means nothing if people don’t have access to it, and we know there are many competing demands on the medical workforce. When developing educational materials, we must collaborate with healthcare providers early and throughout the process. Prioritizing brevity will increase buy-in and perhaps downstream impact.
Let us not only create new educational opportunities, but also utilize existing ones.
For example, starting in July, the Accreditation Council for Graduate Medical Education will do this require pediatric interns to spend four weeks learning about mental health. Eating disorders, which are uniquely positioned at the intersection of physical and psychological health, should be included in this initiative, alongside psychiatric illnesses that typically receive more attention.
In healthcare education, case material is used in all disciplines. Weaving in examples of eating disorders can show that these are the most common eating problems no underweight; that men and people of color are affected by this; There are sexual and gender minorities increased risk; And those who are not rich are not spared. Through clinical simulations, students can muddle through discomfort and find language that feels most natural to identify and help those in need.
Education should also focus on current providers who already encounter these patients while supervising trainees. The knowledge gap is gradually being recognised Congress And state legislators. A 2016 federal law was the first to include provisions aimed at strengthening eating disorder training. In 2020, Kentucky has a Eating Disorders Council within the Cabinet Office for Health and Family Services, charged in part with overseeing the development and implementation of eating disorder education. Colorado, Texas and Vermont followed suitthat each seek to fill should improve prevention and referral to services in their respective states. More recently, the SERVE Act, part of the National Defense Authorization Act 2022certain requirements in the field of eating disorders continuing education for medical providers in the military, a subgroup at increased risk of eating disorders.
Training for seasoned caregivers should recognize and address concerns they have about discussing eating behaviors and unusual weight management efforts, such as inducing vomiting, drinking teas that promote a laxative effect, or performing specific exercises to counteract eating to make. In a culture full of talk about diets and the idealization of thinness, doctors need guidance in talking about trends like intermittent fasting and eliminating gluten or dairy products without medical support. We can reduce uncertainty about the boundaries between normal eating, disordered eating, and eating disorders by sharing what is known about how people across the spectrum decide what to eat and how much guilt or shame they feel afterward.
Conversations about weight can be emotionally charged for both the patient and the provider, but weight monitoring is a well-recognized part of eating disorder care. Improved training should include guidance on discussing weight patterns, rather than just one measurement, and do so sensitively, without shame or praise based on a number on the scale.
The common ingredient of effective treatments for eating disorders is behavior change, an essential step before psychological improvements can follow. Behavior change is difficult, but it is easier when providers are trained in strategies that make it possible. This includes asking patients about eating and exercise patterns.
We can also use our knowledge of behavior change to shape the progress of doctors. Adjustments to the electronic medical record can help. It is now common for healthcare providers in medical settings to ask questions about mood and anxiety. Small changes to routine visit forms can remind doctors to assess everyone for eating disorders as well. A few judiciously placed warnings—for example, about noticeable weight change or blood test results that may indicate purging or malnutrition—and prompts for nonjudgmental follow-up questions can keep the symptoms of an eating disorder top of mind.
Eating disorders can be fatal second Of the psychiatric illnesses, only opioid use disorder exists, but they are also treatable.
The young woman who becomes unresponsive after vomiting should be asked about purging and taught the risks and ineffectiveness of this behavior. The adolescent boy and his parents need to be told that he still has growing to do and that his progress needs to be closely monitored. The man who is losing his social life in addition to his weight needs help evaluating his weight-loss medications and treatment recommendations that take into account the risks he faces. Every clinical encounter is an opportunity. Let’s ensure medical providers are ready, willing and able to meet the moment.
Deborah R. Glasofer, Ph.D., is an associate professor of clinical medical psychology at Columbia University Medical Center and a practicing clinical psychologist in New York City, focused on eating disorder education for both professional and public audiences. Evelyn Attia, MD, is a professor of psychiatry at Columbia University and Weill Cornell Medical Centers who has been committed to advancing the understanding and treatment of eating disorders for more than 30 years.