Questions You Should Ask Every Patient About Their Relationship With Food
Whether in-person or virtually, you’re invited to assess, assess, assess! In school, we clinicians are taught to ask questions—so many questions. We are taught to ask about our patients’ history, their current happenings, and their future hopes and dreams. We are taught to ask about easy things and hard things. We are taught to ask about things that aren’t socially appropriate and would be extremely uncomfortable outside of medical and mental health settings. We are trained to ask questions about substance use, depression, anxiety, suicide, sexual behaviors, and peculiarities of the human body and its functioning.
Yet, so often, we forget to ask questions about one of the things that sustains life: FOOD! We know that to survive, we need to eat. From conception to the moment of death, we are required to consume, in some way, calories that feed and nourish the systems within the body. Why, then, do we shy away from asking questions about this life-giving, life-sustaining human behavior?
Anecdotally, I hear medical and mental health providers say, “We have never had training,” “I don’t know what to ask,” and “I’m not sure what to do if it seems as though there might be a problem.” However, in the same way that we all learned how to ask, respond to, or intervene following questions about suicidal ideation or even substance use, we can all learn to become more comfortable integrating questions about eating disorders into our patient assessments.
Why should we ask all patients about eating disorders?
Well, the honest answer is this: If we don’t ask, we will miss it. It seems essential that we add this area of assessment into our patient evaluations, given that 9% of the U.S. population, or 28.8 million Americans, will have an eating disorder in their lifetime (ANAD) and that a person dies due to eating disorder-related complications every 52 minutes.
In addition, the stereotypical eating disorder patient is underweight and suffering from body dysmorphia. In reality, fewer than 6% of people with eating disorders are medically diagnosed as “underweight” (ANAD). Asking screening questions of only those who “tip the scales” – high or low – means we miss a vast majority of individuals who may be actively struggling with their relationship with food. Questions about eating disorders, as well as screening assessment tools and measures, need to consider that weight may not always tell the full story of a person’s relationship with food.
To truly learn each person’s story, we need to ask questions designed with disordered eating and eating disorders in mind. We must go beyond visible signs to assess whether a patient’s relationship with food warrants further attention and care.
Screening is always important, and it’s especially important now. Many people experienced worsening eating disorder symptoms during the last couple of years, and many others developed them for the first time. We must address a clear need: Millions are currently suffering from eating disorders, many of them all by themselves.
It’s time to integrate questions about food into our practice. The earlier eating disorders are identified and treated, the better the outcomes will be.
How should we ask patients about their relationship with food?
- Do you worry about your weight and body shape more than other people?
- Do you avoid certain foods for reasons other than allergies or religious reasons?
- Are you often on a diet?
- Do you feel your weight is an important aspect of your identity?
- Are you fearful of gaining weight?
- Do you often feel out of control when you eat?
- Do you regularly eat what others may consider to be a large quantity of food at one time?
- Do you regularly eat until feeling uncomfortably full?
- Do you hide what you eat from others, or eat in secret?
- Do you often feel fat?
- Do you feel guilty or depressed after eating?
- Do you ever make yourself vomit (throw up) after eating?
- Do you use your insulin in ways not prescribed to manage your weight?
- Do you take any medication or supplements to compensate for eating or to give yourself permission to eat?
- Do you exercise for the sole purpose of weight control?
- Have people expressed concern about your relationship with food or your body?
Take some time to read these questions and make them your own. Asking these questions in a way that fits you, your clinical style, and your personality will allow them to feel more authentic and like something a patient can respond to honestly.
If a patient answers “yes” to two or more of the questions, a further assessment should be considered. At that time, you could refer them to The Emily Program for a comprehensive assessment by calling 1-888-364-5977 or by completing our online referral form. If you want to assess further in your own practice, you could consider the EAT-26. If there is a concern, the best course of action is a referral for a comprehensive assessment done by an eating disorder specialist.
What happens following a referral to The Emily Program?
Providers often ask what happens following a referral. Patients who receive a referral undergo an intake assessment (either virtually or in person) with a dedicated intake therapist. They are asked about their current and historical relationship with food, including questions about their specific food intake and any eating disorder behaviors (restriction, bingeing, purging, selective eating, etc.).
Following these guidelines increases positive outcomes in treatment. One of the greatest gifts the referring provider can give their patient is their support of the level of care (LOC) recommendation. Hopefully, knowing that the professional who made the recommendation used these universal standards and “prescribed” the treatment at that LOC—holding the patient’s best interest in mind—allows you, as a referring provider, to support, encourage, and uphold the recommendation made to your patient. It is very helpful for the patient’s recovery journey when all treatment providers support the patient. Your patient will then be admitted into the recommended LOC. Prior to the treatment start date, patients may need a medical appointment to ensure it is safe for them to begin programming at the recommended LOC. We highly recommend that a patient complete the care plan their treatment team recommended. You can stay informed – with your patient’s permission – as they progress through treatment.
We hope you will join us in helping change the attitudes and stigma associated with eating disorders and providing treatment for those who struggle every day. Without you, the first line of providers, screening regularly and often, we will miss many of those who struggle. Together, we can make a difference in their lives and the lives of families impacted by eating disorders today.
ABOUT THE AUTHOR
Krista Crotty, LMFT, PsyD
Krista is the National Director of Brain-Based Therapies and a Clinical Education Specialist. Clinically she draws from a variety of methods, including TBT-S, EMDR, cognitive behavioral therapy (CBT), FBT, and acceptance and commitment therapy (ACT), and often incorporates the use of the creative process in conjunction with the more traditional therapeutic process. She earned her Masters of Science from Fuller Theological Seminary, School of Psychology and her Doctorate in Clinical Psychology with an emphasis in family and pediatrics from Azusa Pacific University. She trained at Harbor UCLA Medical Center and Loma Linda Children’s Hospital in neuropsych. Away from work, Krista loves being a mom to her three boys, playing outside, going on adventures with her family, skiing, hiking, biking, and camping.