How to Recognize Eating Disorders in Your Patients Over the Holidays

A doctor's desk with a laptop, notebooks, and stethoscope

The busy season is here.

In holiday calendars full of shopping, baking, decorating, and wrapping, many people are also squeezing in routine check-ups and impromptu visits to the doctor. Clinic lobbies and waiting rooms are hosting college students home on winter break, workers using holiday PTO, and insurance holders maximizing healthcare benefits before the year’s end.

Seeing through secrecy to recognize an eating disorder

Because denial and shame are common in people struggling with eating disorders, it is rare for those affected to disclose the thoughts, feelings, and behaviors they may be experiencing in the midst of their illnesses. Providers, therefore, should tread gently from the start of each appointment, remaining mindful of the possibility of an eating disorder and staying alert to any indicators.

With the appropriate knowledge and care, you can recognize changes in a patient’s health that may go unnoticed by friends and family during this busy time of year. That’s why these visits are a valuable opportunity to recognize and address signs of an eating disorder. If you know what to look for in your patient, eating disorders may actually be more apparent during the holidays than at other times of the year. The stress generated by trying to cope with food-centric events and family pressure may mean that your patient’s defenses are down.

There are many physical signs of eating disorders, but look for tell-tale emotional and verbal signs as well. Does your patient talk about wanting to diet despite being a normal weight? Do they seem hesitant to step on a scale? Have they gained weight because they have been stress eating? Healthcare providers are integral players in eating disorder detection and recovery. You just need to know what to look and listen for.

Watch and listen for eating disorder-adjacent signs or complaints. Your patient may not explicitly name their eating disorder, but they may refer to other conditions associated with it. Stay alert to the following signs:

  • Menstrual irregularity/amenorrhea
  • Sore throat
  • Gastroesophageal reflux
  • Dizziness
  • Dry skin and nails
  • Hair loss
  • Stomach cramps or abdominal pain
  • Muscle weakness
  • Cold intolerance
  • Leg cramps

Upon completing a patient’s physical assessment, bear in mind that “normal” results do not rule out an eating disorder. Continue to screen for the illnesses with questions about the patient’s relationship with their body, food, and exercise.

Use neutral, non-judgmental language to address eating disorder signs

Conversations about food and exercise are often triggering for those with eating disorders, so it is wise to open these conversations with broad, non-leading questions. “Tell me about your diet and exercise,” for example, may invite conversations that “Are you eating and exercising enough?” or “Are you losing/gaining weight in a healthy way?” do not. People with eating disorders often have highly distorted beliefs about food, weight, and exercise, and providers can work to uncover these distortions with open-ended questions.

It is also essential to maintain a weight-neutral approach when asking patients to step on the scale. Even well-meaning comments (“I wish the scale was this kind to me!”) can be damaging to those experiencing or at risk of developing an eating disorder. Such comments can sound especially legitimate from a healthcare provider and reinforce dangerous behavior.

If you do suspect an eating disorder, follow up with questions that specifically screen for these illnesses. Walk your patient through the eating disorder quiz on our website.

A study published in the Journal of General Internal Medicine also recommends some questions you might find helpful in starting the conversation:

  1. Are you satisfied with your eating patterns?
  2. Do you ever eat in secret?
  3. Does your weight affect the way you feel about yourself?
  4. Have any members of your family suffered with an eating disorder?
  5. Do you currently suffer with or have you ever suffered in the past with an eating disorder?

Asked in an open, non-judgmental manner, these questions fit as part of a standard medical assessment and can quickly alert providers to eating disorders in their patients. Providers should refer any patients exhibiting an eating disorder to specialty care, where the symptoms can be identified, evaluated, and properly treated.

Learn how The Emily Program can assist you and your patient in treating an eating disorder. If you are concerned that a patient is suffering, please visit our Get Started page or call 1-888-364-5977. 

Source

Cotton, M. A., Ball, C., & Robinson, P. (2003). Four simple questions can help screen for eating disorders. Journal of General Internal Medicine, 18(1), 53–56. doi:10.1046/j.1525-1497.2003.20374.x

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