Eating Disorders and Attitudes

Obesity, Bulimia, Anorexia or Other--A Review of New Research

Nov 8, 2009

Doctors lack respect for their obese patients. Bulimics have an increased risk of suicide. The risks of other disorders have not been taken seriously enough.

After working in a weight loss clinic and seeing patients who said their other doctors did not listen to them or seem to care, Dr. Mary Huizinga of John Hopkins School of Medicine decided to research how physicians see their obese patients. The results confirmed what her patients were telling her.

Doctors Have Less Respect for Obese Patients

Using 238 patients and 40 physicians, the study analyzed questionnaires filled out by both patient and doctor following care visits. Patients had an average basal metabolic index, or BMI, of 32.9. According to the National Heart Lung and Blood Institute, normal BMI is below 25. A BMI of 25 to 29.9 is considered overweight, and a BMI of 30 and above indicates obesity. In the John Hopkins study, patients who had greater BMIs were less respected by their doctors than patients with lower BMIs. The researchers did not know what effect, if any, this had on care or outcomes, but there is anecdotal evidence to support a negative impact on care. Dr. Huizinga warns that respect is critical because some patients will avoid care altogether.

That was the case for the author's friend and neighbor, a 39-year-old Mexican American mother of four who had a BMI of 33.7 and was seen in a county health clinic for high blood pressure. She reported that the doctor talked to nurses about her in English, believing she only understood Spanish, and said he did not want to see such a fat person. The woman refused to return for care and suffered a devastating stroke before the end of the year.

"Less Severe" Eating Disorders Have Higher Death Rates

Doctors who don't respect clients may not offer help and referrals, believing no benefit will come from diet and support programs. Physicians may also not treat eating disorders, other than bulimia and anorexia nervosa, as seriously as is merited. Research at the University of Minnesota found that "eating disorders not otherwise specified" (EDNOS), a diagnosis used for those not bulimic or anorexic, had higher mortality rates than anorexia and bulimia. Prior to this study, EDNOS were considered less severe and less in need of treatment.

The study looked at 1,885 patients over eight years. Anorexic (10% of participants) was defined as a BMI under 17.5 with fear of weight gain. Bulimic (48% of participants) was defined as a BMI of 17.5 or more with binge/purge behaviors. The remaining 42% were EDNOS. 95% of the patients were female.

The study accessed the National Death Index database and found a 5.2% mortality rate for EDNOS, which is higher than 4.0% for anorexia and 3.9% for bulimia. Death from suicide was .5% higher in bulimics than the other two categories.

This is vital information for those with obesity, eating disorders, and the doctors who treat them. Compassionate and comprehensive care cannot be provided unless respect is a part of the doctor-patient relationship. Patients, families, and care providers need to be aware of the risks of all types of eating disorders, including the possibility of suicidal depression.

Mary M. Huizinga, M.D., et.al., Johns Hopkins University School of Medicine, Journal of General Internal Medicine, November, 2009

Scott Crow, M.D., et.al., University of Minnesota, Minneapolis, American Journal of Psychiatry, Oct. 15, 2009

The copyright of the article Eating Disorders and Attitudes in Weight Loss is owned by Mary Earhart. Permission to republish Eating Disorders and Attitudes in print or online must be granted by the author in writing.