Eating disorders and doctors: don’t ask, and definitely don’t tell?
I’m not saying that Nicole Richie had, or has, a clinical eating disorder. But that is one very small woman to carry two babies full-term. Here’s hoping her ob/gyn took note of that “inability to put on weight” she was treated for. Conclude what you will about the long list of ultra-thin celebrities who actually manage to ovulate, but women – I implore you – don’t try the eating-disorder-pregnancy thing.
Obvious risks to you, and your unborn child, should go without saying. But according to a new study in the Journal of Women’s Health, your ob/gyn probably won’t catch on and intervene, either – because they opt not to ask. I speak from experience when I say that eating disorders can be more powerful than any oppositional motivation to get help: pleas of your family, falling in love, even your own mortality. So it’s no surprise that women who become pregnant while suffering from eating disorders can’t just turn a blind eye to their unhealthy relationship with food, weight or exercise.
But what does surprise me is that specialized medical professionals, trained to treat and care for young women, don’t consider it part of their job description to screen for eating disorders among their patients (who, I think we all know, are also a population group very likely to have an eating disorder). Study authors sent questionnaires to 968 ob-gyns, asking them what kind of check-ups they performed, their attitude about eating disorders and whether or not they evaluated patients for symptoms or a history of ED. The results:
A majority of obstetrician-gynecologists assess body weight, exercise, body mass index, and dieting habits. Less than half assess ED history, body image concerns, weight-related cosmetic surgery, binging, and purging. Over half (54%) of generalists believed ED assessment falls within their purview. Most (90.8%) generalists agreed or strongly agreed that EDs can negatively impact pregnancy outcome. A majority rated residency training in diagnosing (88.5%) and treating (96.2%) EDs as barely adequate or less.
The implications of suffering from an eating disorder before or during pregnancy are staggering. Even a woman who dealt with an ED during adolescence can have a poorly developed pelvis, which may inhibit the growth of her baby years later. Other risks include preterm delivery, miscarriage, low birth weight and an increased chance of breech delivery or C-section.
So a vast majority of ob/gyns think that eating disorders can be dangerous during pregnancy. Rightly so. But few are adequately trained to examine patients for signs of a problem, and only half actually do? I mentioned earlier that eating disorders tend to be persistent. A woman won’t just “snap out of it” when she’s got a baby on the way. Plus, eating disorders tend to be secretive ailments and have a high rate of relapse: both obvious no-brainer reasons an ob/gyn ought to be on the lookout.
If you think a simple weigh-in or BMI check is enough of a screening, the study authors rightly point out that neither metric will do the trick:
Other missed opportunities arise when physicians do not further investigate eating patterns in women with high BMI scores. This is concerning due to the fact that there are high rates of Binge Eating Disorder (BED) in overweight populations….These missed opportunities can result in negative health consequences for mother and baby, as well as greater financial costs and longer hospital stays.
I’m still terrified of the damage I may have done to my own body. I can’t imagine a future child of mine suffering the consequences as well. But that’s a reality for me, and thousands of other women. Doctors screen and warn against all kinds of behaviors, issues and risk factors for pregnant women: drinking, smoking, even eating sushi. Sadly, it’s about time we add eating disorders to the list.
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[...] had plans to meet Katie for hot yoga right after work, so in addition to tons of water, I snacked on a Kashi crunchy granola [...]
Thank you for plain talk about eating disorders, a topic normally downplayed or downright taboo or both.
I have observed eating disorders from two perspectives. One perspective comes from my teaching of university students; they study in-depth reporting and writing with me at perhaps the top journalism school in the world. They are always talented, usually high strung, and often battling eating disorders. Excuse what might be a stereotype, but most of the students who tell me about their eating disorders are physically attractive, painfully thin young women. But I also have listened to the painful disclosures of more normal sized young women and occasionally young men.
My other perspective is personal. I am a compulsive overeater, now age 61. Until age 35, I was extremely thin, so never considered compulsive overeating a problem. In fact, I didn’t know the term “compulsive overeating.” I started gaining weight gradually, and now I am probably 75 pounds too heavy by any standard. I’m still athletic, and I’ve never suffered from co-dependencies such as alcohol, tobacco or illegal drugs. But I sure hate the sight of me in the mirror.
The few times I’ve attended Overeaters Anonymous, I’ve been the only male in the group, and the only person without problem co-dependencies.
In other words, there is lots to learn about eating disorders, so Katie’s words are welcome.
Thank, you, so much, Steve. I think even I still fall into the trap of associating eating disorders with thin, young women. But statistics show that this is not the case – as does your story.
I was pretty shocked when this study came out and nobody reported on it. There is, as you say, still lots to learn about eating disorders – medical professionals included! I guess that’s why I try to be so open about my own history, in hopes that other people will start talking, sharing opinions and stories – and learning!