As eating disorder rates continue to climb following the COVID-19 pandemic, one doctor has revealed life-threating physical dangers which are often overlooked and treatment gaps leaving patients without adequate care.
Dr. Jennifer L. Gaudiani, a physician who specialises in eating disorders, has revealed how patients are falling through critical cracks – some are deemed ‘not sick enough’ by some practitioners while being considered ‘too medically compromised’ by others.
These arguments are outlined in a new edition of Sick Enough, which draws upon peer-reviewed literature to understand the risks of ignoring eating disorders and recognise when to seek help.
The “sick enough” dilemma
The urgency for improved eating disorder care has never been greater; large meta-analyses cited in the book show that eating disorder hospital admissions during the pandemic rose almost 50 per cent, while outpatient paediatrician visits for mental health concerns doubled.
Girls and teens showed especially high use of emergency department, inpatient, and outpatient services for eating disorders.
“The need for effective and responsive medical and psychological treatment is high,” writes Dr. Gaudiani, “Patients with EDs seem to be perceived as too mentally ill for medical professionals and too medically compromised for mental health professionals. They fall through the cracks.”
Dr. Gaudiani suggests one of the most dangerous aspects of eating disorders is patients’ persistent belief that they don’t warrant treatment. She explains how patients rationalize their condition, and minimalize their health concerns.
She says: “This is an extremely important point because someone who is ‘fine’ can comfortably reject what all these people are telling them about how concerned they are.
“Right at this moment, you are sick enough. Anyone with an ED is sick enough to seek help, regardless of weight, lab results, or other markers patients use to minimize their illness.”
Warning signs to be aware of
Physical warning signs, to help people identify eating disorders in themselves or others, include feeling weak, lightheaded, and sweaty when standing, muscle pain and soreness, throat and mouth pain from purging, swollen cheeks, fuzzy and unfocused thinking, constipation and digestive issues, and dangerous electrolyte imbalances that can cause the heart to stop at any moment.
Behavioral and emotional indicators include compulsive weighing multiple times daily, extreme mood swings based on scale numbers, social withdrawal from friends, family, and previously important activities, maintaining academic or work performance while health deteriorates, and rationalizing restrictive behaviors as ‘being healthy’.
In fact, far from being ‘healthy’, Dr. Gaudiani explains that some eating disorders have life-threatening consequences, which are often overlooked.
This includes purging, which carries particular risk. She explains: “When purging is involved, a person can be fine in the morning and dead by sundown. Purging can abruptly change electrolyte levels, potassium in particular, as well as hydration status; the body simply cannot adapt quickly enough. Death can occur swiftly and without warning.”
While many patients believe they are only sick enough to merit when their electrolytes are abnormal, Dr. Gaudiani emphasizes that there is no safe amount of purging.
She warns: “There is no one measure, not a lab value nor a weight, that correctly and uniquely labels the severity of an ED or its worthiness for treatment.”
Improving eating disorder care
Dr. Gaudiani advocates for significant changes to ED care. In her research, she found medical professionals receive almost no training in eating disorders during medical school and residency, contributing to missed diagnoses and inadequate care.
She says: “Mental illnesses are typically treated by one set of professionals, physical illnesses by another set, and the system keeps the two disciplines separate even though they are inextricably connected.”
This can also be extended to how family speak to one another about bodies and weight, and reframing how we speak about our health can be key in improving stigma around body health that otherwise could prove harmful. This includes pivoting the focus away from exercise to achieve a healthy body to functional questions, being gentle and compassionate about your own body, and being open to apologise if you make a mistake.
Despite the serious medical complications detailed in the book, Dr. Gaudiani maintains an optimistic outlook about recovery possibilities.
“Full recovery from an ED is absolutely possible,” she explains. “Everyone has the potential for full recovery, and most medical problems will fully resolve with recovery.”