Talking to Your Patients About Eating Disorders

Almost 10 percent of the U.S. population will experience an eating disorder during their lifetime. From a patient care perspective, eating disorders—including anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant or restrictive food intake and others—can be difficult to address. 

“The cause of eating disorders can vary from person to person and, because they can affect multiple areas of patient health, these disorders often require therapy and treatment from multiple specialists,” said Renee Riddell, L.A.C., a counselor at Inspira Health. 

Signs and Symptoms of Eating Disorders 

The signs of eating disorders are dependent on the type of disorder and its underlying causes. “Eating disorders are typically associated with those who are fixated on body weight, shape or their looks, but there can be a number of reasons behind disordered eating,” said Riddell. “For example, someone who has had past trauma could develop anorexia as a means to control an aspect of their life. Or a transgender person could experience body dysphoria that leads to an eating disorder, especially if surgical options aren’t available to them.” 

Some signs and symptoms that could indicate an eating disorder include: 

• Fixation on food, body weight or body shape 
• Frequent fluctuations in weight in either direction 
• Intense fear of gaining weight 
• Frequent skipped meals 
• Self-induced vomiting 
• Compulsive exercise 
• Misuse of laxatives, colonics or diuretics
• Brittle hair or nails 
• Muscle wasting 
• Intestinal distress 
• Nutritional deficiencies such as mild anemia or an electrolyte imbalance

Talking to Patients About Eating Disorders 

While it’s important for providers to be honest with their patients and advocate for their best health, it can be tricky navigating conversations about eating disorders. “If you suspect a patient has an eating disorder, try to ask questions using general terminology,” said Diana Alvarado, R.D.N., a dietitian at Inspira Health. “For example, ask them ‘Do you ever feel guilty after you eat?’ instead of ‘Do you purge?’” 

Riddell suggests asking patients about their current challenges, either health-wise or in general, to get to the root cause of any disordered eating patterns. 

For some people with eating disorders, talking about specific weight or categorizing weight as “good” and “bad” could be triggering. “Try not to put emphasis on the number on the scale, or ask your patients if they prefer that you don’t mention the number at all,” said Alvarado. 

When to Refer Patients to a Specialist 

Every patient is different, so referrals to specialists for eating disorders can happen in a number of ways. “If this suspected eating disorder has just begun or isn’t yet affecting the quality of someone’s life, it may be appropriate to refer them to therapy first,” said Riddell. “But if you’re seeing repercussions to their eating behaviors, whether clinically, mentally or socially, it may be time to refer them to an inpatient or intensive outpatient program such as Renfrew or Princeton House.” 

If you’re unsure about which eating disorder your patient may have, it's appropriate to refer them to a specialist for further evaluation and diagnosis. “Interdisciplinary team members for a patient with an eating disorder can include a primary care provider, psychiatrist, behavioral health specialist and registered dietitian. Patients may also need to be referred to other specialists depending on their individual symptoms, such as a dentist to address oral care due to chronic vomiting,” said Alvarado. 

Patient safety is the top priority for Inspira Health, which means our specialists work alongside primary care providers to assess patient health and guide them through treatment options. 

To refer a patient to behavioral health or nutrition, call 1-800-INSPIRA.