I recently got some upsetting news at a doctor’s appointment. It wasn’t 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.
Recovering from an eating disorder is not like recovering from the flu. It’s 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, I’m accustomed to turning my head when I’m weighed.
Yet this time, 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.
Around 9 percent of the U.S. population — just shy of 30 million Americans — will have an eating disorder 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’s office.
Why? Well, whether or not a doctor knows a patient’s past, most physicians receive meager training on eating disorders and don’t necessarily know how to navigate what not to do when working with a survivor. Often, those in recovery can feel like they’re forced to choose between forgoing medical care and facing a minefield of triggers that can lead to a relapse.
Thankfully, there are things that patients and providers can do — and are doing — to create a safer, more inclusive environment. Read about some of these below.
Triggers eating disorder survivors face
The weigh-in
Up until that recent appointment, I hadn’t known my weight in years. I do not own a scale. And when I visit anywhere that has one — my parents’ house, an Airbnb – I tuck it away in a closet for the duration of my stay.
This ignorance is crucial to my eating disorder recovery. Research shows that people who are recovering from anorexia or bulimia really benefit mentally from not weighing themselves. Although I’m sure she meant no harm, this made the nurse’s reveal all the more damaging.
Medical providers, of course, don’t weigh patients to be cruel. Doctors use weight as an important reference point. The U.S. Preventive Services Task Force recommends physicians weigh all adults in order to screen for obesity. Significant weight fluctuations can be indicative of underlying issues, like thyroid disease or diabetes.
However, depending on what you’re being seen for, a doctor doesn’t always really need to know your weight. Some experts says it’s time to rethink automatic weight checks at medical appointments. More and more doctors are giving patients a choice in the matter — some have even started handing out cards that patients can use to indicate their preference.
If a doctor doesn’t proactively offer the choice on whether or not to be weighed, it’s important to know that you can still speak up.
“Almost every doctor’s office will weigh patients at every visit,” says Rachelle Heinemann, a New York-based therapist specializing in disordered eating. “Getting 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.”
Small talk slip-ups
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’s body can be harmful.
“Sometimes, there are medical staff who make inappropriate comments about body size,” says Heinemann. “If this happens, you can explain to them that that’s not a helpful thing to say, or you can simply ignore them. You don’t owe them any type of explanation or conversation.”
For instance, a few months ago, after a medical assistant took my height and weight, she exclaimed, “I never meet anyone with a body just like mine!”
She probably meant to create a sense of camaraderie. But to me, the comment caused my latent eating disorder to rear its head: Was that what my body looked like? Did I want my body to look like that?
“Healthy” advice
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.
Those with a predisposition toward eating-disordered thinking tend to go to extremes. Two hallmarks of an eating disorder are excessive exercise and an obsession with “healthy eating.” So seemingly innocuous advice around diet, weight, and exercise can trigger people to fall back into old patterns. In fact, a study of adolescents with eating disorders found that something as simple as “healthy eating education” in school could trigger disordered behavior.
Personally, I’ve 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 “health.” Bringing up weight loss in the exam room to a survivor can also be really triggering.
“If a doctor prescribes weight loss or dieting, you can politely — or not that politely — explain that isn’t an answer for you,” says Heinemann. “You do not have to launch into a social justice conversation. You also don’t have to share your history if you don’t feel comfortable doing so.”
Bringing up the past
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. “Those continued conversations with healthcare providers can be an emotionally difficult reminder of the impact of past behaviors,” says Danica Torres, a registered nurse with the UC San Diego Eating Disorders Center for Treatment and Research.
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.
Making medical spaces safer
There’s 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.
For now providers are taking small steps to provide more inclusive care. Eating disorder advocacy groups are creating more and more educational resources. Two Columbia University doctors have also recently created a free, publicly available training course on eating disorders for medical students and general practitioners, which they said has gotten “tremendous” feedback so far. But while there have been calls both stateside and overseas to increase eating disorder education in medical schools, little has been done as of yet to change the curriculum.
“Medical providers seem to be educating themselves more on mental health conditions and are showing more empathy to the intersection of mental and physical health,” says Karlee McGlone, MFT, of the UC San Diego Eating Disorders Center.
Heinemann says that it’s important patients put their needs first if they’re feeling uneasy at a doctor’s appointment, disregarding any awkwardness you might feel: “Remember, you do not need to make your provider feel comfortable should a tricky situation arise.”
“The patient must voice their desires,” says Mary Wirtz, a Colorado-based dietitian, suggesting that patients say something like, “I 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.”
Preparation can also go a long way in helping blunt triggers you might face. McGlone suggests practicing “Coping Ahead,” a skill used in Dialectical Behavioral Therapy (DBT). To practice this, you’d anticipate and write about potentially triggering things that could happen at an appointment, and work through which coping skills you’d use to deal with your feelings in the moment.
There’s still a ways to go before those in eating disorder recovery can feel confident they won’t encounter triggers in medical settings; I can’t un-know my weight, and I’ll likely involuntarily learn it again. But what I can do is use my voice to communicate my needs — and, in the process, educate one more provider on what sensitive care looks like.