Why your primary care doctor might miss your eating disorder

When struggling with eating and weight concerns, people often reach out to their primary care doctor for help fist. These doctors are a trusted source of guidance and are well trained in the prevention and consequences of obesity. Many people suffering from binge eating and bulimia, however, aren’t obese. A new study suggests that many doctors aren’t comfortable diagnosing eating disorders.

The study, released online this week, surveyed primary care residents across the country about their training and attitudes towards eating disorders.  Over 600 residents participated from internal medicine, family medicine, and pediatrics. These residents were in their final years of training, surrounded by experienced colleagues, and learning the latest medical research. 

The researchers identified several factors that predicted whether residents would be more or less comfortable diagnosing and treating eating disorders. As one might expect residents with more exposure to eating disorders (through faculty, programs in their hospital, previous experience) tended to be most comfortable making a diagnosis, but not necessarily offering treatment. In examining gender differences, female residents were more interested in eating disorders than male residents. Pediatric residents were less interested in eating disorders compared to internal and family medicine residents.

It’s tough to generalize these findings to physicians in private practice, but we know from other studies that such physicians often feel limited in their abilities to diagnose and treat eating disorders, and often don’t follow up with appropriate referrals in a timely manner after actually diagnosing an eating disorder. Residency is perhaps an ideal time to increase physicians' competence related to eating disorders.

It may be particularly difficult for people suffering from binge eating to get help from their doctors who are better equipped to identify eating disorders via purging (bulimia) or restriction/low weight (anorexia).  It's often hard for doctors (or even patients) to distinguish between general over eating and actual binge eating (here’s one way to make that distinction).

What are people suffering now supposed to do if they can’t depend on their primary care physician? If, after speaking to your doctor, you are left wondering how to get help, consider reaching out to a psychiatrist or psychologist directly. Many sites can help connect you (like NEDA). Alternatively, a nearby university medical center may have an eating disorder research program offering free screenings and treatment.  

Have comments or questions? Discuss them on the facebook page or contact Dr. Gupta directly

Dr. Gupta is a professor at Barnard College of Columbia University and provides individual therapy at Tribeca Psychology

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