{"id":19539,"date":"2022-03-11T13:41:44","date_gmt":"2022-03-11T18:41:44","guid":{"rendered":"https:\/\/thepapergown.zocdoc.com\/?p=19539"},"modified":"2023-03-08T13:59:43","modified_gmt":"2023-03-08T18:59:43","slug":"making-the-doctors-office-safer-for-eating-disorder-survivors","status":"publish","type":"post","link":"https:\/\/www.zocdoc.com\/blog\/guides\/making-the-doctors-office-safer-for-eating-disorder-survivors\/","title":{"rendered":"Making the Doctor\u2019s Office Safer for Eating Disorder Survivors"},"content":{"rendered":"

I recently got some upsetting news at a doctor\u2019s appointment. It wasn\u2019t a scary diagnosis, a concerning lab result, a gargantuan bill; It was a number: my weight. While learning your weight at the doctor is standard for most people, for those in eating disorder recovery, like myself, it can be a major trigger.\u00a0<\/span><\/p>\n

Recovering<\/a> from an eating disorder is not like recovering from the flu. It\u2019s a nonlinear, often lifelong process. Many survivors have to be diligent about what they allow into their lives in order to keep the condition at bay. For this reason, although I’ve been in recovery for over two decades, <\/span>I\u2019m accustomed to turning my head when I\u2019m weighed. <\/span><\/p>\n

Yet this time,<\/span> a chatty nurse casually dropped the number while checking my vitals in the exam room. It was jarring. And it illuminated the challenges eating disorder survivors face at the doctor’s office.\u00a0<\/span><\/p>\n

\n

Around 9 percent of the U.S. population \u2014 just shy of 30 million Americans \u2014 will have an eating disorder<\/a> at some point in their lifetime, and the consequences can be dire: eating disorders are the second deadliest mental illness, surpassed only by opioid addiction. Although cultural awareness around mental health has grown in recent years, eating disorder survivors often still face insensitivity at the doctor\u2019s office.\u00a0<\/span><\/p>\n

Why? Well, whether or not a doctor knows a patient\u2019s past, most physicians <\/span>receive meager training<\/span><\/a> on eating disorders and don\u2019t necessarily know how to navigate what not to do when working with a survivor.\u00a0<\/span>Often, those in recovery can feel like they\u2019re forced to choose between forgoing medical care and facing a minefield of triggers that can lead to a relapse. <\/span><\/p>\n

Thankfully, there are things that patients and providers can do \u2014 and are doing \u2014 to create a safer, more inclusive environment.\u00a0 Read about some of these below.\u00a0<\/span><\/p>\n

\n

Triggers eating disorder survivors face<\/h2>\n

The weigh-in<\/h3>\n

Up until that recent appointment, I hadn\u2019t known my weight in years. I do not own a scale. And when I visit anywhere that has one \u2014 my parents\u2019 house, an Airbnb \u2013 I tuck it away in a closet for the duration of my stay. <\/span><\/p>\n

This ignorance is crucial to my eating disorder recovery. Research shows that people who are recovering from anorexia or bulimia really benefit<\/a> mentally from not weighing themselves.\u00a0<\/span>Although I\u2019m sure she meant no harm, this made the nurse\u2019s reveal all the more damaging.\u00a0<\/span><\/p>\n

Medical providers, of course, don\u2019t weigh patients to be cruel. Doctors use weight as an important reference point.<\/span> The U.S. Preventive Services Task Force recommends<\/a> physicians weigh all adults in order to screen for obesity.\u00a0Significant weight fluctuations can be <\/span>indicative of underlying issues<\/span><\/a>, like thyroid disease or diabetes.\u00a0<\/span><\/p>\n

However, depending on what you’re being seen for, a doctor doesn\u2019t always really <\/span>need<\/span><\/i> to know your weight. <\/span>Some experts says<\/span><\/a> it\u2019s time to rethink automatic weight checks at medical appointments. More and more doctors are giving patients a choice in the matter \u2014 some have even started handing out <\/span>cards<\/span><\/a> that patients can use to indicate their preference.\u00a0<\/span><\/p>\n

If a doctor doesn\u2019t proactively offer the choice on whether or not to be weighed, it\u2019s important to know that you can still speak up.<\/span><\/p>\n

\u201cAlmost every doctor\u2019s office will weigh patients at every visit,\u201d says Rachelle Heinemann, a New York-based therapist specializing in disordered eating. \u201cGetting weighed, however, is not mandatory. You have every right to say you do not want to get weighed. You also have the option to go on the scale backwards and ask that your weight not be shared with you or on the visit summary.\u201d<\/span><\/p>\n

Small talk slip-ups<\/h3>\n

Nurses, doctors and medical staff typically make small talk with patients to make them feel a bit more comfortable. But haphazardly making comments about a patient\u2019s body can be harmful.\u00a0<\/span><\/p>\n

\u201cSometimes, there are medical staff who make inappropriate comments about body size,\u201d says Heinemann. \u201cIf this happens, you can explain to them that that\u2019s not a helpful thing to say, or you can simply ignore them. You don\u2019t owe them any type of explanation or conversation.\u201d\u00a0<\/span><\/p>\n

For instance, a few months ago, after a medical assistant took my height and weight, she exclaimed, \u201cI never meet anyone with a body just like mine!\u201d <\/span><\/p>\n

She probably meant to create a sense of camaraderie. But to me, the comment caused my latent eating disorder to rear its head:<\/span> Was that what my body looked like? Did I want my body to look like that?<\/span><\/i><\/p>\n

\u201cHealthy\u201d advice<\/h3>\n

Exercise is good; eating a balanced diet is good; maintaining a healthy weight is good. These are all relatively uncontroversial statements. But they can become dangerous when a patient in eating disorder recovery hears them from a doctor.\u00a0<\/span><\/p>\n

Those with a predisposition toward eating-disordered thinking tend to go to extremes. <\/span>Two hallmarks of an eating disorder<\/span><\/a> are excessive exercise and an obsession with \u201chealthy eating.” So seemingly innocuous advice around diet, weight, and exercise can trigger people to fall back into old patterns. In fact, <\/span>a study<\/span><\/a> of adolescents with eating disorders found that something as simple as \u201chealthy eating education\u201d in school could trigger disordered behavior.\u00a0<\/span><\/p>\n

Personally, I\u2019ve always struggled with exercising too much. So when a doctor praises my active lifestyle, I feel not just emboldened but obligated to continue with extreme behavior for the sake of \u201chealth.\u201d Bringing up weight loss in the exam room to a survivor can also be really triggering.\u00a0<\/span><\/p>\n

\u201cIf a doctor prescribes weight loss or dieting, you can politely \u2014 or not that politely \u2014 explain that isn\u2019t an answer for you,\u201d says Heinemann. \u201cYou do not have to launch into a social justice conversation. You also don\u2019t have to share your history if you don\u2019t feel comfortable doing so.\u201d<\/span><\/p>\n

Bringing up the past<\/h3>\n

Even after recovery, for years after, eating disorder survivors may live with some physical ramifications of their disease, such as amenorrhea, which is the absence of periods, low bone density, or infertility. \u201cThose continued conversations with healthcare providers can be an emotionally difficult reminder of the impact of past behaviors,\u201d says Danica Torres, a registered nurse with the UC San Diego Eating Disorders Center for Treatment and Research.\u00a0<\/span><\/p>\n

For instance, If a doctor zeroes in on any of these ramifications, it can cause emotional distress for the patient, which may, ironically, trigger eating disorder behaviors.\u00a0<\/span><\/p>\n

\n

Making medical spaces safer<\/h2>\n

There\u2019s a long way to go to making sure medical offices are safe spaces for eating disorder survivors; and while patients should know they have agency in these situations, doctors and other healthcare providers need to get more sensitivity training.\u00a0<\/span><\/p>\n

For now providers are taking small steps to provide more inclusive care. Eating disorder advocacy groups are creating more and more educational <\/span>resources<\/span><\/a>. Two Columbia University doctors have also recently created <\/span>a free, publicly available training course<\/span><\/a> on eating disorders for medical students and general practitioners, which they said has gotten \u201ctremendous\u201d feedback so far. But while there have been calls both <\/span>stateside<\/span><\/a> and <\/span>overseas<\/span><\/a> to increase eating disorder education in medical schools, little has been done as of yet to change the curriculum.\u00a0<\/span><\/p>\n

\u201cMedical providers seem to be educating themselves more on mental health conditions and are showing more empathy to the intersection of mental and physical health,\u201d says Karlee McGlone, MFT, of the UC San Diego Eating Disorders Center.<\/span><\/p>\n

Heinemann says that it\u2019s important patients put their needs first if they\u2019re feeling uneasy at a doctor\u2019s appointment, disregarding any awkwardness you might feel: \u201cRemember, you do not need to make your provider feel comfortable should a tricky situation arise.\u201d<\/span><\/p>\n

\u201cThe patient must voice their desires,\u201d says Mary Wirtz, a Colorado-based dietitian, suggesting that patients say something like, \u201cI have a history of an eating disorder, and prefer not to be weighed or discuss my BMI. I came to this visit for X reason and want to focus on that.\u201d\u00a0<\/span><\/p>\n

Preparation can also go a long way in helping blunt triggers you might face. McGlone<\/span>\u00a0suggests practicing \u201c<\/span>Coping Ahead<\/span><\/a>,\u201d a skill used in Dialectical Behavioral Therapy (DBT). To practice this, you\u2019d anticipate and write about potentially triggering things that could happen at an appointment, and work through which coping skills you\u2019d use to deal with your feelings in the moment.\u00a0<\/span><\/p>\n

\n

There\u2019s still a ways to go before those in eating disorder recovery can feel confident they won\u2019t encounter triggers in medical settings; I can\u2019t un-know my weight, and I\u2019ll likely involuntarily learn it again. But what I can do is use my voice to communicate my needs \u2014 and, in the process, educate one more provider on what sensitive care looks like.\u00a0<\/span><\/p>\n

\n

Ready to book a doctor\u2019s appointment? Visit\u00a0Zocdoc.<\/span><\/a><\/span><\/h1>\n","protected":false},"excerpt":{"rendered":"

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