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August 1, 2019

Fostering Open, Judgment-Free Communication with Patients about Eating Disorders

Fostering Open, Judgment-Free Communication with Patients about Eating Disorders

As a medical provider, you may be the first person to recognize that a patient has an eating disorder. That’s because eating disorder behaviors often occur in secret, and those struggling are typically very good at keeping their eating disorder a secret from the people in their lives.

Eating disorders are often apparent in a medical setting because we check weight, assess vital signs, and spend time discussing physical symptoms with patients. Signs of eating disorders that could be recognized even in a routine check-up may include dramatic changes in weight, menstrual irregularity, dizziness, dry skin, leg cramps, hair loss, and bruising. If you’re lucky, your patient may view an appointment as a natural time to share that they are experiencing eating disorder thoughts and behaviors. However, many patients are not forthcoming and the medical system is very poorly designed to talk to people about food and body issues.

Usually, the first thing that happens when a patient walks into a provider’s office is that they are asked to step on the scale. Patients are usually told their weight or it is written on a piece of paper.  After that, patients are taken into an office and asked several questions about medications, habits, and health concerns. The patient may see one or two providers before seeing their primary medical provider.

Then, the reality is that you may only have 5-10 minutes to spend with a patient. Understandably, you may focus on the chart that has been filled out by other staff and develop preconceived ideas about the purpose of the visit. This can make it difficult to keep an open mind throughout the appointment. Both you and your patient have a shared goal of building a relationship, but these barriers make that challenging, especially when you’re trying to have an open, non-judgmental discussion about food, body, size, and shape.

My primary advice is to ask questions and get to know your patients. Don’t rely completely on the numbers, the charts, and the notion that weight is the biggest problem a person can have and that if they aren’t overweight, their health is okay. When someone has an eating disorder, the signs and symptoms are typically subtle. Most patients won’t come right out and tell you they have an eating disorder. But they may drop clues. They may mention that they are on a strict diet, or that they are obsessed with exercise. They may express that they eat uncontrollably and feel ashamed. Encourage them to talk more about these thoughts and behaviors. Walk them through our online quiz to determine whether they have serious issues with food. Explain that they are experiencing common issues that millions of people struggle with, but eating disorders are treatable.

The only way to truly know what is happening is to have real conversations, sometimes over an extended period of time. Remember that people with eating disorders are not overtly trying to make themselves sick; eating disorders are an illness like any other. If you approach your patient with that in mind and let go of the external weight-focused environment that we are all locked into, you will have a much higher chance of finding out what is really going on and getting your patient into specialty treatment.

If a patient does say they are struggling with eating, you have one job: schedule an eating disorder assessment. You don’t have to be an expert on eating disorders, but you do need to connect your patient to a treatment center that can complete an assessment. From there, both you and your patient can work alongside a treatment team to ensure a holistic approach to eating disorder treatment and recovery.


Mark Warren headshot

Mark Warren, MD

Mark graduated from the Johns Hopkins University School of Medicine and completed his residency at Harvard Medical School. His practice focuses on bringing the most up-to-date research into evidence-based care.

He serves on the faculty of Case Western Reserve School of Medicine and teaches at University Hospitals of Cleveland and The Cleveland Clinic Foundation. Dr. Warren is a Distinguished Fellow of the American Psychiatric Association and a Fellow of the Academy of Eating Disorders, where he leads the SIG in Males and Eating Disorders. He is a two-time recipient of the Exemplary Psychiatrist Award of the National Alliance for the Mentally Ill and a winner of the Woodruff Award.

Dr. Warren co-chairs the Academy of Eating Disorders Presidential Task Force for Medical Care and serves on the FEAST Medical Advisory Board and the London-based Succeed Foundation Medical Advisory Board. He has presented extensively at the International Conference on Eating Disorders, The Renfrew Foundation and the Multidisciplinary Eating Disorder Association.

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