What Health Professionals Should Know about Eating Disorders
By Alex Raymond, RD, LD
Unfortunately, in the health field there is TONS of stigmas surrounding eating disorders. I think the media and even what we learn in school perpetuate these stigmas. I recall in my dietetics classes, we barely touched the subject of eating disorders. When we did, I remember learning just the basics and reading a case study about a woman who was severely struggling with anorexia. If you don’t get the proper education surrounding eating disorders, so much information about the truth of the disease can be missed.
I love busting myths. After all, it’s part of my job as an eating disorder dietitian 😉 I hope this blog will shed some light to the health field on the truth of eating disorders. And most importantly, what you should be keeping in the back of your mind to screen your patients for an eating disorder.
1) Eating disorders don’t discriminate.
I can’t emphasize this enough! You can probably find information about this everywhere on our blog. It’s so important to remember that ANYONE can have an eating disorder (just like anyone can struggle with alcoholism, or anxiety or depression). A human being of any shape, size, gender, age, race, ethnicity, background, and socioeconomic status can have a seriously disordered relationship with food. It is so dangerous for a single depiction of an eating disorder to exist. Firstly, it may discourage those who struggle from getting treatment. They may think, “I can’t have an eating disorder because I don’t “look” like I should have one.” Secondly, this is the image that can impose subconscious bias on health practitioners. If we have a single idea of what an eating disorder looks like, we may not screen everyone or miss important signs from those who do not “look” the part.
It’s important to ask screening questions to anyone who steps into the office. It can be as simple as asking about eating habits or if a patient worries about food/spends too much time thinking about it. I could teach a whole course about screening for eating disorders (and maybe I will ;)), so I won’t be able to go into too much detail now. But, I do challenge you as a healthcare practitioner to challenge what types of bias and assumptions you may have about eating disorders.
Some resources I recommend:
- The National Eating Disorders Association (NEDA) website has SO much great information on there
- The Academy of Eating Disorders has a “purple booklet” for health care providers called the Medical Care Standards guide.
- The SCOFF Questionnaire is a quick way to screen for eating disorders. It’s only 5 questions! See below
- Do you make yourself Sick because you feel uncomfortably full
- Do you worry you have lost Control over eating?
- Have you lost more than One stone (about 14lb or 6.35kg) in a three-month period?
- Do you believe you are Fat when others say you are too thin?
- Would you say Food dominates your life?
2) In adolescents, a drop in a growth curve should be a concern
In the large majority of cases, any teen or young child losing weight should be a concern. I don’t care if the child is overweight or obese. A dietitian must address this, preferably one who has experience in the eating disorder field, to assure that this is not an underlying cause of something more. Weight loss, especially in teen years, can be a very slippery slope to dieting and disordered behaviors. Falling of the growth curve could be an early and important sign of an eating disorder (see image below for an example). Unfortunately, I have had far too many clients whose eating disorder started in high school or before. But because they were “overweight” as a child, it was “okay” that they lost weight. So, they did not seek treatment until later in life. Of course, I am honored I can support them! But, my hope is more health professionals recognize eating disorders early on.
Another red flag is rapid weight gain off the chart charts outside of puberty. There could be something emotional as well as physical underlying that weight gain. Again, I would recommend to refer to an eating disorder dietitian to screen for ED.
3) Weight loss for binge eating disorder (BED) is not recommended.
Binge eating disorder is a mental illness. This means there are lots of underlying issues for what has caused the binge eating and why the bingeing continues. Did you know about 35% of people seeking weight loss help could be clinically diagnosed with binge eating disorder? Research shows that individuals who diet are more likely to develop an eating disorder during their lifetime. Additionally, research also shows that 95% of diets fail and dieters regain the weight within 1-5 years. Many dieters have lost and gained weight over and over again throughout the lifetime. I love this video by Evelyn Tribole. She says “dieting in part may actually be related to the current obesity epidemic.”
The cycle of dieting with BED is an exhausting, painful one.
Diets are not sustainable.
However, they feel like dieting is the only solution to “weight problems,” especially for those with BED. The solution would be to address the underlying issues of bingeing. Weight loss will not “fix” the disorder. It will often contribute to the restriction that will follow another period of binge eating. It is possible your patient may “feel better” after losing weight. They receive compliments on their smaller body without much thought to the restriction that was unsustainable that got them there. But this feeling of “feeling better” is only fleeting without addressing the emotional issues. For many people, in order to achieve this weight loss, they have restricted their diet so much that they often have low energy and even avoid social settings with food. That can be very isolating.
Telling someone with binge eating disorder that they “need to lose weight” or helping them to lose weight is only playing into the scenario where their weight is a problem that needs to be fixed by any means necessary and continues to degrade their self worth. It’s important that someone with binge eating find a “healthy weight.” A healthy weight is the weight their body wants to be at naturally. A dietitian can also address any health factors separate from weight. The best thing they can do to stop the restrict/binge cycle is to work on building their relationship with food. If the focus is weight loss, then the cycle will continue.
4) Overweight or obese individuals can struggle with restriction.
Picture this. You have an “overweight” or “obese” client step into your office. They tell you all about this new diet they are on where they are only allowed to eat certain foods. Or they have to follow a strict regimen. Or they have to drink protein shakes for all meals. Ask yourself, “if this client was a normal weight or underweight, would it be okay for them to eat the way they are?” Chances are, if a normal weight client stepped into your office and describes a restrictive diet, you would be concerned. Why then, is it okay for individuals who “need” to lose weight to follow these diets. They are clearly not getting the nutrition they need, otherwise it would be okay for everyone to follow it, right?
I love the quote that Rebecca Bitzer brought back from the iaedp (international association for eating disorder professionals) conference. This is not a direct quote, but it was something like:
“How we tell a fat person to lose weight would be considered disordered eating in a normal or underweight person.”
I urge you that if you have a client step into your office and they are talking to you about cutting out foods or following a certain diet trend, to question that, no matter his or her weight. It could be a red flag of an eating disorder.
5) Even if the labs look “normal,” the client may not be “fine.”
This is a very tricky concept to remember. If you are aware one of your patients has an eating disorder, please be careful about telling them they are “fine.” Oftentimes, especially with anorexia nervosa, patient’s labs look okay even when a client is medically unstable. Telling a patient that they are “fine” can actually be detrimental to their progress. Clients struggling and sometimes families latch onto the idea of “normal” or “fine.” They then do not believe further treatment is necessary.
I have had clients who needed a high level of care because the eating disorder thoughts and behaviors were so strong, but because a previous health practitioner said everything was “fine,” they were reluctant to continue treatment and/or obtain a higher level of care which would promote recovery. You may want to consider taking a closer look at the following to explain to a client why they need treatment for an eating disorder:
- EKG (is this abnormal?)
- Bone density scan
- Anxiety surrounding foods
- Rigidity surrounding foods
- Food rules. Some examples:
- Cutting foods into small pieces
- Only eating certain foods
- Not eating certain foods
- Eating only at certain times/not eating at certain times
- History of dieting
- Recent, dramatic weight loss (no matter where their starting point was)
6) Encouraging someone to “lose weight” is not the answer.
When has ever telling someone “you should lose weight?” actually worked in a healthy way? I’m just going to say probably never. Telling someone they need to lose weight is something that can make people feel shameful. It could make them go about weight loss in an unhealthy manner. Or in some cases, that phrase can trigger the beginnings of an eating disorder. I also believe that weight stigma is a real problem in the health field. In my experience, I have found there are people who do not go to the doctors or dietitian’s office because they are worried about what the provider will say about their weight. So, there are people who aren’t getting the medical or nutritional care they need! And that is a huge problem because what if they need something to be treated.
If you are truly concerned about a client’s eating, please refer them to a dietitian. She or he can support that client in meeting his/her health goals. Eating healthily should not be about weight loss. It should be about addressing health concerns, improving how a client feels, taking care of themselves, incorporating exercise, and having an overall balanced diet. In my opinion, that means eating and enjoying all different types of foods. It means sometimes having donuts (!!!) with your family or friends, but also having a salad with lots of veggies sometimes. While food has a huge impact on our health, I firmly believe the more time we spend worrying about what we eat, the less healthy we are. An eating disorder dietitian can help restore that balance. Consider screening all your clients for potential disordered eating and know where you can help your client find treatment. As a place to start, The International Federation of Eating Disorder Dietitians has a treatment finder page.
Once again, early detection and treatment are key! Do your part as a provider to get educated. I am more than happy to answer any questions you may have about screening and treating eating disorders. Please feel free to email me at email@example.com or call my office at 240-670-4675.