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Eating Disorders and the Challenge of Working with DoctorsLast year, Glamour magazine teamed up with the Alliance for Eating Disorders Awareness, a South Florida group dedicated to education and advocacy, to test the responses of a number of primary care physicians to patients who shared and exhibited the symptoms of eating disorders. Sadly, the doctors didn’t fare too well. Their responses ranged from passive and dismissive to insensitive and even laughter when the patient didn’t fit the stereotypical “mold” for sufferers of eating disorders.

The truth is, physicians are given very little instruction in medical school about the signs and symptoms of eating disorders (not to mention sensitivity training on these and other body image issues). Some continuing education is offered, but very few doctors take advantage of it. The result: too many doctors who are ignorant about eating disorders, which is a shame considering how many women and men are afflicted.

Whether done in ignorance, embarrassment, or even with good intentions, what doctors may not realize is that their reactions can have a profound impact on the way an eating disordered patient – or any patient, for that matter – sees herself. And that impact can be devastating.

I didn’t fit the mold…

Pregnancy is a bizarre experience. Every woman’s body reacts differently to the act of carrying a child. Often times, our own mothers are relatively good predictors of how our bodies may react to pregnancy. I was fortunate to have the awareness that neither of my mother’s two pregnancies fit into the current standard of how much weight a woman “should” gain in the 10 months that her body houses another human being. With me, my mother gained 40 lbs and with my little brother she gained 50 lbs. Consequently, during my own pregnancy, when the scale started climbing at a rate that made it very clear I would be gaining more than the much-lauded goal of 25-30 lbs over the course of my pregnancy, I had the reference of my mother – and the awareness that over time she regained her pre-pregnancy figure – to reassure me that this was not a runaway train.

I am also fortunate to be a psychologist who specializes in treating eating disorders. As such, I understand how metabolism and food work in the body, how to eat optimally for my personal nutritional needs and the quirks of my own body, and how body image shifts and changes throughout the lifetime – including (and especially!) during pregnancy.

Armed with all of this knowledge, I was still taken aback when a nurse at my OB’s office flippantly commented after a month when my body decided to gain a significant amount of weight, that I might want to watch my consumption of cookies and ice cream. I couldn’t believe that someone who sees women go through pregnancy on a daily basis, who knows that every body is different, who holds a position of authority with respect to women who are coming to a doctor’s office to be reassured that the craziness going on in their bodies is a normal change in pregnancy, would have the gall to make such a comment. And I was grateful that none of my eating disordered patients had been the ones in the room.

Disappointingly, not all doctors and nurses realize the impact their off-handed or uneducated comments can have on their patients. It is hard enough to contend with an eating disorder – but then to have to educate one’s own health care practitioner on how to speak to such a patient can feel like a Herculean task.

While we at IntrinPsych Woman are fortunate to work with a number of excellent physicians who understand the complexities of eating disorders, you as a patient may need to educate your doctor about what an eating disorder is and how to treat it.

Specifically, you may need to:

  • explain to your doctor that knowing your weight or how much you have gained at a given visit is not helpful but harmful
  • remind the nurse at every visit that you prefer to get on the scale backward and not know the number
  • let your doctor know when he/she or one of the nurses say something that is inadvertently shaming

What is more, you can seek help in this area from a professional who specializes in eating disorders and request that your therapist or psychiatrist speak with your other health care practitioners.  As a psychologist I can tell you that I am more than willing to reach out to OBs, GPs and myriad other medical doctors to discuss and educate on how to best treat my client’s physical and mental state.