Jillian Rigert, D.M.D, M.D. 

Oral Medicine Specialist & Patient with Lived Experience 

The University of Texas M.D. Anderson Cancer Center 

To provide high quality care to patients with potentially life-threatening eating disorders, it is imperative to dismantle the faulty beliefs that the conditions are mostly about food, exercise, weight, and body image. From my perspective as a healthcare professional and a patient who has lived with anorexia nervosa, portrayals of people with eating disorders described in medicine, media, and Hollywood are superficial, misguided, and contribute to harm. 

Due to the complex nature of eating disorders, the education provided in medical schools and residencies remains suboptimal.¹ From my experience, teachings continue to portray an individual with anorexia in a reductionist manner (i.e., as a young, Caucasian cisgendered woman fixated on calorie control and exercise with intense fear of gaining weight). The reality is that restrictive eating disorders may impact patients of all gender identities, ethnicities, and body sizes. While the clinical manifestations of eating disorders appear to revolve around food, exercise, weight, and body size, these signs warrant a comprehensive evaluation of the patient’s psychosocial-spiritual and physical wellbeing. 

Demystifying eating disorders through improved education will hopefully increase the quality of care provided. Change is urgently needed to reduce patient harm and address unmet needs which include the following: 

1. Delays in diagnosis: Weight biases in medical practice often contribute to delays or missed diagnoses of eating disorders in normal to higher weight patients. Further, weight loss is often celebrated without identifying if the change was accomplished using harmful methods. It is important to accept that people with restrictive eating behaviors may present overweight or at normal weight, and thus patients of all body sizes must be screened to detect disordered eating. Delays in diagnosis may worsen a patient’s prognosis and invalidate the harm an eating disorder has on their mental and physical health.^2,3

•  Siloed care: Eating disorder education, research, and treatments are often inappropriately separated from other psychiatric conditions and considered a specialty of psychiatry. About 95% of patients with eating disorders have a co-occurring affective illness, thus improved training in medical and psychiatry residencies is needed.⁴ Up-to-date, research-based knowledge needs to be published in mainstream medical journals rather than specialty-specific journals, and patients need to be provided concurrent treatment for co-occurring conditions.⁴

3. Therapeutic gaps: The majority of people with eating disorders never receive any intervention,⁴ and for those who do receive treatment, many approaches hyperfocus on improving the patient’s energy-balance as the outcome measure for recovery. While an essential part of treatment, a properly fueled body is often able to feel what the eating disorder has numbed. Energy-balance should not be the end point, but rather marks the beginning – a time when further therapeutic healing modalities should be explored. Disordered eating has multifactorial etiologies and thus warrants a multidisciplinary approach. Each patient must be evaluated as an individual and provided personalized care that addresses needs across psychosocial, spiritual, and physical dimensions.

Takeaways

1. Increase the education about eating disorders in medical training; aim to reduce and/or eliminate biases.
2. Evaluate personal biases (especially of weight-related issues) which may contribute to harmful delays in access to compassionate, comprehensive eating disorder care.
3. When screening and treating patients, focus on providing a safe space and listen with compassionate curiosity. 
4. Consider the role(s) that disordered eating behaviors may have in a person’s life that go deeper than some overt signs imply. Provide holistic, multidisciplinary care according to each patient’s individual needs, fostering psychosocial-spiritual and physical wellbeing. 

References 

1. Mahr F, Farahmand P, Bixler EO, et al. A national survey of eating disorder training. Int J Eat Disord. 2015;48(4):443-445. doi:10.1002/eat.22335

2. Lebow J, Sim LA, Kransdorf LN. Prevalence of a history of overweight and obesity in adolescents with restrictive eating disorders. J Adolesc Health. 2015;56(1):19-24. doi:10.1016/j.jadohealth.2014.06.005

3. Neumark-Sztainer D. Higher weight status and restrictive eating disorders: an overlooked concern. J Adolesc Health. 2015;56(1):1-2. doi:10.1016/j.jadohealth.2014.10.261

4. Haynos AF, Egbert AH, Fitzsimmons-Craft EE, et al. Not niche: eating disorders as an example in the dangers of overspecialisation. Brit J Psych. 2023:1-4.  doi:10.1192/bjp.2023.160.

Financial Disclosure

J. Rigert receives support from the National Institute of Dental and Craniofacial Research Diversity Supplement 3R01DE028290-02S1 for the project “Utilizing novel advanced imaging techniques with clinical biomarkers to predict and prevent radiation-attributable oro-dental sequelae.” This manuscript was written during time unrelated to my funding support hours.