Augustine: Doctors need sufficient eating disorder education

Kathryn Augustine, Assistant Opinion Editor

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Mental and physical health are sometimes seen as two distinct entities. Generally, mental health concerns are allocated to therapists or counselors, and physical ailments are brought to medical doctors. In certain cases, that separation is sufficient and does not generate any complications. What happens, though, when certain mental illnesses are closely intertwined with physical health?

The gap between the realms of mental and physical health is strikingly apparent in treatment for eating disorders. While eating disorders fall into the category of mental illness, this cluster of disorders takes a toll on the body. The surfeit of bodily complications can span from a heightened risk of heart failure or rupturing the esophagus to dehydration and an imbalance of electrolytes.

Despite the obvious physiological ramifications of eating disorders, very few programs exist that provide medical clinicians with training on how to approach and treat patients with eating disorders. Out of 637 medical training programs surveyed spanning five disciplines, 514 did not provide rotations specifically for eating disorders. Even out of 113 general psychiatry programs, only 35 offered rotations in eating disorders.

Naturally, minimal education on eating disorders — ranging from two to six hours on average in medical school — is correlated with low confidence in interacting with these patients. A 2012 study on clinical reactions to patients with eating disorders reports that clinicians consistently shared strong feelings of a lack of competence in treating eating disorders.

This suggests that a significant number of doctors are not adept at working with patients diagnosed with eating disorders, and unfortunately, I can testify to that fact.

At the end of spring quarter last year, I woke up and was immediately met with a wave of nausea. After hours of throwing up continuously, I booked an appointment at Northwestern University Health Services. During the appointment, the doctor noted aloud that I had struggled with bulimia.

Just as I prepared to leave, the physician reasoned cheerily that since I’d been bulimic, surely this case of the stomach flu would deter me from ever forcefully throwing up again. I was taken aback by the sheer ignorance of such an assumption. Ironically, in conflict with that doctor’s logic, the stomach flu proved to be a triggering experience for me.

Regardless, the notion that recovery from an eating disorder is as simple as consciously deciding not to engage in unhealthy behavior at the doctor’s office is mythical. The path to recovery is rarely linear, and breaking behavioral and thought patterns requires intense effort.

Believing that an individual will be motivated to overcome an eating disorder because of a physical illness that induces vomiting is honestly laughable. Individuals want to recover from eating disorders for a myriad of reasons — perhaps to regain a sense of control, alleviate external concerns or restore personal health. Something as trivial as the stomach flu is not a decisive factor.

From that experience, I was forced to face the reality that many clinicians have a minimal understanding of eating disorders.

The true danger of insufficient education, however, is not patient frustration from comments that display misunderstanding. What poses the largest threat is the risk of eating disorder patient fatalities.

Beyond learning to speak in a sensitive and informed manner to eating disorder patients, all doctors need training for detection and treatment of eating disorders. Without a formal diagnosis and recommendation for recovery, individuals face not only lasting bodily damage but the potential of death. Every 62 minutes, an individual dies as a result of an eating disorder, and perhaps that amount could be reduced with more informed doctors that can initiate early intervention.

I am not blaming any physicians for a lack of knowledge about eating disorders. The responsibility entirely lies in what medical schools and programs prioritize and the regard of eating disorders as an area that is not deserving of focus and training. This is ultimately the result of the immense stigma and negative perceptions of eating disorders that are perpetuated in our society. The first stride toward addressing the meager education surrounding eating disorders is attacking the underlying cause — that eating disorders are not prioritized as a health issue.

Kathryn Augustine is a Medill second year. She can be contacted at kathrynaugustine2022@u.northwestern.edu. If you would like to respond publicly to this op-ed, send a Letter to the Editor to opinion@dailynorthwestern.com. The views expressed in this piece do not necessarily reflect the views of all staff members of The Daily Northwestern.

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