By the time patients present for treatment at a clinic detected to treating eating disorders, they usually have had recent visits with a variety of healthcare providers – many of whom treated a specific effect of the eating disorder without recognizing the underlying cause.
The reality is that primary care physicians, gynecologists, therapists, pediatricians, cardiologists, endocrinologists and other providers often do not recognize the symptoms of eating disorders and miss the opportunity to intervene or refer the patient to specialized care.
Yet in many cases, these are the same healthcare professionals who regularly identify conditions beyond their expertise to heal and refer patients to surgeons and specialists for treatment.
What makes this situation more difficult is the patient’s desire to be treated for symptoms and co-morbidities without having to reveal the underlying cause. In denial about their eating disorders or actively hiding them, these patients certainly aren’t going to announce their real problem or write “eating disorder” on an intake form.
So how can healthcare professionals do a better job spotting patients with eating disorders and help them get the care they need? One way is to understand presentations common linked to the underlying issue.
Eating disorders can cause a range of gastrointestinal issues such as gastroparesis, constipation, bloating, or laxative abuse. Other red flags include endocrine abnormalities, thyroid issues, elevated cortisol levels, missed menstrual cycles, and low testosterone levels.
While eating disorders are more common in females, males also can develop the diseases and shouldn’t be overlooked. It also is important to remember that eating disorders cross socioeconomic boundaries and age groups.
Primary care physicians are most likely to identify patients with or at risk for eating disorders, simply because they see a high volume and wide variety of patients. In addition, gastroenterologists, endocrinologists, cardiologists, and gynecologists are the specialists who tend to treat conditions caused by anorexia, bulimia and other eating disorders, even if they are not aware of what triggered the problems.
Of course, psychiatrists, psychologists, and therapists often identify eating disorders during broader treatment and need to refer patients for specialized care.
If a patient’s complaint or other factors raise suspicions that an eating disorder might be present, a series of screening questions can help determine if further intervention is necessary.
A good technique is the SCOFF questions, developed by researchers in London:
• Do you make yourself Sick because you feel uncomfortably full?
• Do you worry that you have lost Control over how much you eat?
• Have you recently lost more than One stone (14 lb.) in a 3-month period?
• Do you believe yourself to be Fat when others say you are too thin?
• Would you say that Food dominates your life?
Follow up positive answers with additional questions such as whether the patient uses laxatives or purges and what a typical day’s diet is like.
When an eating disorder is suspected, soothingly talk to the patient about it, keeping in mind that he or she is likely to be embarrassed or ashamed and deny the possibility at first. Gentle probing and reassurance might help the patient open up and speak more freely about fears and eating habits.
Parents should be brought into the discussion when the patient is a child, and permission should be sought from teen – and even many adult patients – to involve family members. Obtaining permission is worth the effort because family support can be critical in helping a patient overcome an eating disorder.
If the patient or family members become concerned during the discussion, reassure them that eating disorders are treatable and that they can get help from specialists with extensive experience treating the disease. People with eating disorders – and their loved ones – often worry that their situation is hopeless, and that no amount of intervention is going to ever help them eat normally.
Another stumbling block is that patients might be highly resistant to changing their eating habits because of deep-rooted psychological issues and simply want to shut down all discussion.
Counter that with reassurance that eating disorders are not a matter of willpower and that there is no shame in accepting help. Explain that the entire process of treating eating disorders is founded on compassion and understanding that patients can’t fight the disease on their own.
By being on the lookout for patients who need help overcoming eating disorder, medical professionals can help preserve patients’ health, improve their wellbeing and potentially save their lives.