For various reasons, I have been in a number of doctor offices in the past few months - for myself and for others of various ages. (Not to worry, everyone is okay.) Today, for example.

I have stopped counting, but not stopped smarting, from the times a doctor has advocated something disordered. All the things that in the eating disorder world we ask patients NOT to do, I have witnessed a doctor recommending:

Detailed food logs. Cutting out entire categories of food. Stop eating "bad" "processed" "modern" "unhealthy" foods. Take laxatives when you feel too full. Fasting on fluids is the same as eating. Read food labels. Calling a child "overweight." Telling a child to eat less. Don't eat foods that make you uncomfortable. Weighing in hallways. "If you don't let us weigh you then we won't file this visit with your insurance company." Weight is about personal choices. Eat less. Eat less. Eat less.

Between seething and ranting about all this I realize how far one must drift from the toxic mainstream to see it for what it is: unscientific, falsely authoritative, insidiously moralistic, chaotic, and logically under-powered.

The task is enormous, even with science behind us: to convince the medical world to stop prescribing eating disordered behaviors. For potential ED patients, the cost is tragic. For the rest of us, the cost is still far too high.


  1. I don't know how you fix the medical curriculum.

    It would be easier if you could blame it on older doctors, overworked offices & outdated ideas. You could at least think that the next wave of physicians would be better informed & more sensitive.

    But what they're teaching us is awful. Not because it's upsetting or triggering-- but because it's just outright wrong. It's bad science and it's bad medicine.

    Our nutrition class (which is only a month & a half long) is all about US keeping meal records, calculating our BMIs & finding ways to incorporate less eating/more activity. One or two classes are guest taught by a former biggest loser contestant.

    It's infuriating to me, but from the position of a medical student I'm not sure how you'd begin to change this.

    A lot of M2 is taught with the USMLE in mind, and the USMLE mock questions contain the quality gem I posted a few weeks back.

  2. I went to a new doctor this year and asked to not be weighed and she refused. She said, "Out of all of my 200 patients, no one has ever reacted like this. And I once worked with an anorexic girl." I finally agreed to be weighed (backwards). I admit, I was a total anxious spaz afterwards but all she could say was, "Okay, do you take anxiety medicine because this is not normal." followed by "Do you have an eating disorder?" (asked very bluntly). Um, yeah, I have never been a good patient and - I agree - I am a super difficult patient - All my maturity goes out the window. But geez!

  3. Oh yeah, and one time a doctor told me to gain weight by "Eating a lot of vegetables.... even more than you do now" And, "If, by the end of the day, you don't think you've had enough extra, just let yourself gorge on lots and lots of chocolate!" Said with a laugh and a smile.

    I am a nervous crazy person at doctor's offices. But I've also had my share of crazy doctors too!

    The worse is, when the doctors are bad like that, I get so freaked by them that I lie to them about my behaviors.

    Finally, I met one doctor who was so understanding and patient that I told him the truth. And that was the catalyst for a lot of other good stuff.

  4. Yes, yes, yes.... This is a massive frustration for me as a medical student, and these dieting beliefs are so deeply ingrained that I need to be up for a big argument every time I call them on it. So I used to do that every time, and now, often I'm just too tired.

  5. Yup. Took recovered d to the doc yesterday for her 12 year old check..."are you staying away from red meat and eating your veggies?" My d just looked at me and rolled her eyes! It is crazy and so frustrating that this sort of group think persists in the medical/nutritional/educational systems...Show me the data or else don't bring it up. jeez.

  6. Chartreuse, I know exactly what you mean--I used to try and push back on people's disordered beliefs about eating but it just becomes exhausting after awhile.

    The weighing in the hallway is awful--I had a doctor who did this.

    And listening to all the dieting talk by the receptionists in the waiting room... I won't even go there.

  7. We took our 15-year-old son (who is healthy and doesn't have eating issues) to the pediatrician, who commented: "Wow, with that muscle definition, you could be really ripped if you worked out and used protein powders." I was really upset about it ... he's an active kid, happy, and now wondering if he should be taking supplements and doing weight work vs. playing basketball, swimming, riding his bike, walking the dogs, and boogie-boarding at the beach.

  8. I'm all too familiar with this! I recently had a doctor's appointment where I was honest with him that I was struggling to maintain the weight my nutritionist wanted and I was struggling to cut down on exercise and his response was, "I don't see why it would hurt for you to lose some weight by exercising!" He also said this without having any real info about what I'm taking in v. what I'm putting out. That comment has *not* made things easier! My team was incensed.

    I think it's absolutely abhorrent that all doctor's aren't better education about nutrition in general and eating disorders specifically.

  9. The lack of education in the medical field re eating disorders is really frustrating. There ARE some good docs out there, but it's really important to speak up when one does or says something inappropriate.

    Keep up the great work Laura!

  10. ED clinic nurses and staff having discussions in the halls about how bad this or that is for you. All the while you sit with your emaciated child thinking how thoughtless people are.

  11. I would use a different word than "dismayed," Laura. I would call my feelings on this "betrayed." I am paying some of these people large sums of money because they theoretically know more about medicine than I do. I procrastinated for over 6 months on seeing any sort of MD because I dreaded the types of comments they might make, and the educating I would have to do.

    People need to start seeing EDs as an illness with concrete risk factors, such as malnutrition. Period.

  12. Betrayed is the right word. Exactly. You've nailed it.

    I think that's what all of us seem to be feeling.

  13. I've been ill otherwise I would have commented on this sooner, I'm just now catching up on all your blog entries...

    My doctor STILL has me making detailed intake/outtake logs, though I've told her it has a reverse effect of making me want to eat less.

    I was told, it doesn't really matter if I started eating slightly less, because my weight has stabilized and she could tell my percent body fat was getting to where it needed to be.

    She determined this by grabbing onto my arm and pinching the fat... I cringed.

    She told me she did not want me gaining any more weight, though my weight is actually right on the border of being underweight.

    I told my best friend this, as a reason for why I was justified to cut out certain things - because my doctor told me she didn't want me gaining weight... My friend was not amused and told me I could not use a doctor's ill advice to aid my eating disorder.

    I think my friend had a point.

  14. I'm intrigued by Chylo's comments, because our med school had very little nutritional curriculum in the first two years. We talked about obesity, but mainly in the context of the peptides involved in signalling appetite, etc. When I started into the wards, I felt like I was learning about calories, healthy balance, etc. haphazardly as I started having to counsel patients with type II diabetes, chronic lower back pain, and hypertension who continued to think that twelve powdered sugar donuts constituted an appropriate breakfast and patients severely underweight who thought that a piece of fruit and a thing of low fat yogurt was enough fuel to make it through the day. Luckily, I've had some good mentors on the clinical rotations who have helped me see the balance.
    I think if you're going to see a generalist rather than a specialist in eating disorders, and you have special needs, you're going to have to be proactive about things.
    Ex: "I've struggled with eating issues and prefer to be weighed backwards and not be told my weight."
    "My therapist doesn't think that it's a good idea for me to keep intake logs; could we just talk about whether I'm meeting 100% of my meal plan?"
    There are some insensitive physcians, who won't care, but I think most of them will be receptive if you frame it as expressing a need rather than an attack on their mode of practice.
    I think, though, that if your doc knows you have an eating disorder and is telling you to ignore the weight goals you've set with your nutritionist or pinching your arm to illustrate your body fat to you, you either need to directly confront them or move on to a new physician, because that's obviously inappropriate.
    I think the level of education among health professionals about eating disorders is improving, but change isn't going to happen overnight.


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