If there’s any place we’d like to believe is judgment-free and emotionally safe for those with an eating disorder, it’s in therapy. Unfortunately, a recent study into the world of eating disorder specialists reveals that not even professionally trained experts are immune to stereotype or gossip.
Water Cooler Chit-Chat
A team of researchers from Yale University and the University of Hawaii looked at anonymous online questionnaires filled out by more than 300 professionals who treat eating disorders. They found that nearly half of respondents had heard colleagues making derogatory comments about obese patients, and another 42 percent believed other specialists carried stereotypes about those with eating disorders.
"Weight bias has been documented among different groups of health providers like doctors, nurses and medical students,” said lead researcher Rebecca Puhl of the Rudd Center for Food Policy and Obesity at Yale, “so there is no reason to expect that professionals who treat eating disorders would be immune to the same bias.”
Obesity was recently recognized by the American Medical Association as a disease, a move from its former classification as merely a risk factor for other diseases, such as hypertension and diabetes. In the United States, more than a third of all adults are obese (35.7 percent), according to the Centers for Disease Control and Prevention. Behind smoking, obesity is the second leading cause of all preventable death nationwide.
The disease’s prominence has trickled into social discourse, Puhl argues, and, alarmingly, has even made its way into the therapy profession. Bias against the obese has become so commonplace that snide remarks infect health professionals, too, she said.
Among survey respondents, 42 percent believed that obese patients weren’t motivated to fix their diets. And 64 percent doubted whether patients stuck to their intended treatment recommendations.
Despite the 50 percent of people who claimed witness to weight bias, nonverbal communication cut the deepest, researchers found. Therapists were found to condescend to patients and misjudge their struggles or challenges. This is risky behavior for more than social reasons, as doctors who are wrong about their patients may spend less time helping those who need care the most.
"Patients should avoid seeking treatment from therapists who may hold prejudice against people with obesity," Angelina Sutin, who studies psychological well-being at Florida State University College of Medicine, told Reuters Health.
Sutin, who wasn’t involved with the study, offered, however, that “many therapists are competent professionals that can provide quality care.”
Some four percent of girls and women suffer from an eating disorder, such as anorexia, bulimia, or binge eating. Among boys and men, the rate hovers around two percent.
The Two-Way Street
One of the hallmarks of an effective therapist is his or her ability to empathize with patients. Without a full understanding of a person’s physical limitations or personal struggles, therapists cannot make accurate assumptions about the patient’s mental or emotional state. This makes for a two-way street, Sutin says.
"If possible, talk to any friends, acquaintances, or any other contacts about the proposed provider," she said. "A good recommendation can go a long way."
In the other direction, patients have the duty to communicate their feelings to the professional, letting the therapist “know when they are feeling negative attitudes” from him or her, so that the treatment program can stay on the rails.
If obesity is to be considered a disease, one that is taken seriously in a medical context, then the necessity for serious treatment methods increases in equal measure. For many eating disorder victims, a therapist isn’t always the first line of defense; for some, it’s a last resort.
"Weight bias is a significant public health issue, and it impairs our ability to effectively prevent and treat obesity and eating disorders," Puhl said. "In many health domains, weight bias just isn't on the radar. That needs to change."
Source: Puhl R, Latner J, King K, Luedicke J. Weight bias among professionals treating eating disorders: Attitudes about treatment and perceived patient outcomes. International Journal of Eating Disorders. 2013.