Many People Have Disordered Eating Patterns

Eating Disorders Awareness Week (EDAW), is February 26-March 3, 2024! It is an annual campaign to promote education about eating disorders. This week is also intended to provide hope and support for individuals and families affected by eating disorders. Awareness is key for both the public and the healthcare community.

We, as pelvic health providers, have the privilege to work with people of all genders with complex and often complicated medical histories. What are we really missing? What do we read (or not read) between the lines? What are cries for help that we are not hearing or noticing? As pelvic providers, we just need to keep our eyes, ears, and hearts open to our patients. The art of listening, observing and respectfully inquiring may be our greatest superpower. Imagine we are doing a puzzle without the puzzle box. Often it will take us time to gather the pieces and start to see the fuller picture. As health care providers, we carefully look at the whole puzzle - not just one piece… and sometimes this does take time. 

Let’s take a look at a typical day in our busy clinical lives. Maybe you can relate. On our first visit with our patient, we are working hard (and sometimes fast) to try to get a thorough history, have appropriate functional outcome measures completed, ensure that all of the necessary “paperwork” is completed for our office or health care system, do our objective examination, pelvic muscle assessment, establish a prognosis, goals, a plan of care, etc. Does this sound familiar? How much can we fit into the time we are allotted at our workplace to get a picture of our patient? During this first visit do we get all of our answers? Or do we instead have a lot more questions? 

We all see people struggling with eating disorders or people who have been recovering from an eating disorder - whether we are aware of this or not. The important thing to remember is that we do not treat eating disorders - we treat the individual who walks into our office with pelvic pain, constipation, abdominal pain, abdominal bloating, fecal incontinence, pelvic organ prolapse, urinary urgency, urinary incontinence, etc. We can ask some questions, do some observation, and have some conversations with our patients. 

Many people have disordered eating patterns - perhaps eating too much or too little, following fad diets, having ideals of what they want their body should look like, etc. However, for some, their life may take a path that they did not expect from a multitude of biological, psychological, and social factors. Some of these factors include genetics/ family history, environment, societal / health care weight stigmas,  trauma, sexual abuse,  personality traits, brain chemistry, negative energy balance, hormonal levels, social support (or lack of), family dynamics and comorbid medical and/or mental health conditions (to name a few). 

Eating disorders are mental illnesses with serious and sometimes fatal medical complications. Please understand - this illness is not about the food. Just eating “more” or “less” is not going to “cure” the illness. It is not that easy. What triggers an eating disorder may not be what keeps someone in the grips of it. Living with an eating disorder is distressing, consuming, life-sucking, isolating, secretive and painful. Having an eating disorder is NOT a choice. Treatment for eating disorders requires a team of support including mental health professionals, dieticians, primary care practitioners and specialists skilled with working with these individuals. We can be a part of this team. These disorders cause GI distress and nutritional rehabilitation for those who have to bring more nutrition into their body also causes GI distress. Recovering from an eating disorder is a complicated and often bumpy journey and we have the skills to help these people! 

Here is a secret about eating disorders - they often ARE secrets. This is not something that someone may openly offer or even know for sure themselves. People with eating disorders are in all body sizes, genders, races and ages. We cannot make assumptions based on a person's weight or body size. Truthfully, people with atypical anorexia nervosa are often in bodies that would not trigger a clinical “alarm”, however, these individuals suffer from the same medical issues and complications as people with “typical” anorexia nervosa. Individuals in larger bodies may be utilizing purging behaviors such as vomiting, laxative use, may be binging and/or restricting food intake the same as someone in a smaller body. We cannot expect just a young, white, thin woman to have an eating disorder. They certainly may - but so may the person you just saw the hour before who is a thirty-year-old transgender woman, the 18-year-old male wrestler from the day before,  the mother who is 2 months postpartum who is coming in this afternoon,  or the 74-year-old woman you saw two hours ago. 

We may see a person who avoids a mirror or is constantly checking their appearance. We may notice a person who is always cold and wearing layers. We may have someone who when we ask them about their relationship with food, clearly avoids the topic or tells us that they eat “ultra clean” and have limited many types of food groups in their “diet”. We may hear someone tell us many times how they do not want to gain weight so they will not consider eating more frequently, despite their painful constipation, because they “fast” for 22 out of 24 hours a day. They may also be able to give us calculated accounts of how much or how little they ate. Or, maybe they will tell us that they are so ashamed that they eat so much when they are stressed and how they cannot help it. Possibly, we may hear our patients tell us that they exercise every day, despite the weather, and sometimes more than once a day. Maybe they tell us that they haven’t been hanging out with their friends anymore and that no one understands them. 

If you do notice that there are concerns, talk to your patient, let them know why you are concerned, and offer to help them find resources to provide support for them. If you do suspect someone is struggling with an eating disorder, provide them resources if they are agreeable. National Eating Disorders Association (NEDA), National Association for Anorexia Nervosa and Associated Disorders (ANAD), Eating Disorder Hope, National Alliance on Mental Illness (NAMI), Eating Recovery Center (ERC) are just a few of the great places to start.

Try to build a network of dieticians, mental wellness providers, primary care providers, GI specialists, and other practitioners who have interest, knowledge and expertise with people with eating disorders. This will likely not be easy to find. We have the skills to help these individuals during distress with active disorders and during recovery. 

Join us in Eating Disorders and Pelvic Health Rehabilitation on April 6 and 7 to discover more about eating disorders and ways that we, as pelvic health professionals, can provide assistance and relief to these individuals as they struggle and as they recover. Learn more about the dangerous medical complications with eating disorders,  how to identify individuals who may need support, and treatment options to assist these individuals on their journey to improved health. Explore ways to grow your clinical practice with this patient population. Looking forward to seeing you there!