Why Don’t People with Eating Disorders Want to See Doctors

A common concern for people with eating disorders, especially when it’s chronic, is the lack of doctors knowledgeable about how to treat these illnesses. Many people even opt out of medical care—unless it’s urgent—because of negative experiences with doctors.

Why are there so few doctors who know how to treat people with eating disorders?

First, doctors learn to practice medicine in hospital settings, both inpatient and outpatient. For the most part, hospitals don’t offer adequate, and sometimes any, treatment for eating disorders. Instead, people tend to go to various treatment centers run by non-medical clinicians or, increasingly, private equity companies. Doctors may consult in these settings but only as needed.

The result is that few senior doctors in hospital settings know how to treat eating disorders so trainees aren’t exposed to situations to help them learn about these illnesses. In any field, doctors will see people with eating disorders but won’t have enough structure or learning opportunities to know how treat these people effectively. After finishing training, young doctors are likely to not want to treat eating disorders due to lack of knowledge and experience.

The second issue is that eating disorders are the rare psychiatric condition with serious and potentially life threatening medical consequences. When doctors see people who are quite ill but don’t have the knowledge to treat them, their first instinct is to refer them to another doctor. The result is that people with eating disorders see lots of doctors without much benefit.

The third issue is the institutionalized fat phobia in medicine. Doctors across the board believe being fat is the cause of many medical illnesses despite the lack of evidence. Accordingly, doctors will either praise underweight people with eating disorders or focus on weight loss for people with higher weight and an eating disorder. The weight bias often leads to both ignorant and often hurtful comments from doctors who not only can’t treat eating disorders but say things that make the illness worse.

Nowhere in medicine is there an opportunity for doctors to learn about eating disorders unless they seek the knowledge and experience on their own. The disconnect from hospital-based medicine, where young doctors learn, and the outpatient world where most doctors practice means this pattern doesn’t seem to be changing any time soon. The inherent bias in medicine allows doctors to justify ignorant and cruel comments to patients with eating disorders, who often decide instead not to seek medical care. Clearly, these options for people with eating disorders are completely unacceptable.