Eating disorder myths debunked [PODCAST]

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes

“When people think of eating disorders, the image is often of an emaciated, white teenage girl in the hospital hooked up to feeding tubes. In fact, eating disorders are varied in how they present in a person, and they certainly do not ‘look’ a certain way.

Eating disorders occur in all cultures, ethnicities, age groups, genders, and socioeconomic groups. Eating disorders do not discriminate.

So, no, eating disorders do not ‘look’ a certain way, and you cannot tell by looking at a person if they for sure have an eating disorder.”

Melissa Geraghty is a psychologist and can be reached on Twitter @mindfuldrg.

She shares her story and discusses her KevinMD article, “3 eating disorder myths that health care professionals should debunk.”

Did you enjoy today’s episode?

Rate and review the show so more audiences can find The Podcast by KevinMD.

Subscribe on your favorite podcast app to get notified when a new episode comes out.

Click here to earn 1.0 AMA PRA Category 1 CME for this episode.

Also available in Category 1 CME bundles.

Powered by CMEfy – a seamless way for busy clinician learners to discover Internet Point-of-Care Learning opportunities that reward AMA PRA Category 1 Credit(s)™. Learn more at about.cmefy.com/cme-info

Do you know someone who might enjoy this episode? Share this episode with anyone who wants to hear health care stories filled with information, insight, and inspiration.

Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow.

Today we welcome back on the show Melissa Geraghty. She is a psychologist, and her KevinMD article is “3 eating disorder myths that health care professionals should debunk.” Melissa, welcome back to the show.

Melissa Geraghty: Thank you for having me again.

Kevin Pho: So for those who didn’t get a chance to listen to our first show together, just briefly share your story and journey to where you are today.

Melissa Geraghty: Absolutely. So as you said, I’m a clinical health psychologist and CEO of Phoenix Rising with Dr. G. I specialize in chronic illness, complex medical, and eating disorders. I’m also an international workshop presenter, a medical gaslighting sensitivity trainer for health care professionals, a chronic pain advocate, and a complex medical patient. So, kind of a lot going on. And I also currently have a program that supports parents who have an adolescent or young adult with an eating disorder, called The Ultimate Eating Disorders Boot Camp for Parents.

Kevin Pho: So one thing caught my ear when you were mentioning medical gaslighting as it relates to health care professionals. What exactly is that?

Melissa Geraghty: Yes. So I know that there have been lots of articles on it and discussions, particularly in the past year or two, about medical gaslighting in our fields collectively. And so what I’ve started to do is help educate health care professionals, to open their minds, if they are indeed engaging in medical gaslighting, on how to address any biases they have, and to just be able to do trainings for facilities, medical facilities, about this really important topic that can highly impact patients.

Kevin Pho: So you’re also an eating disorder specialist, and you see a lot of cases as well. From your lens as a psychologist, how do clients or patients typically present to you?

Melissa Geraghty: Yes, so in many ways. In fact, one of the biases I talked about in my KevinMD article was that many people incorrectly assume that people look a certain way when they have an eating disorder. I think a stereotype a lot of the time is that eating disorders only occur in teenage, rich, white girls. So when patients present to me with an eating disorder, it doesn’t have a look. You can’t for sure tell if someone has an eating disorder or not.

My age range of people I see with eating disorders is from children up to the elderly. Over the past maybe five years or so, actually probably more than that, I’ve seen people being younger and younger with eating disorders who have come into inpatient facilities, residential facilities, and then to me in outpatient as well.

Kevin Pho: So let’s talk more about your KevinMD article. It’s titled “3 eating disorder myths that health care professionals should debunk.” Now, for those of you who get a chance to read that article, just walk my audience through it and share the story of why you decided to write it.

Melissa Geraghty: Yes. I decided to write it because what I’ve found is that there are so many myths that we as medical providers just follow, because that’s how it’s always been. And I really thought it was important just to discuss the three top myths. One I just discussed: that eating disorders look a certain way.

Another really rampant assumption that I see in the medical community is that people need to be at a certain BMI to be healthy. We know that insurance companies often use BMI as one of their criteria for hospital-based eating disorder treatment, but it’s such an outdated way to diagnose eating disorders. And it’s also really important to note that BMI was not designed to measure a person’s overall physical or mental health, and it absolutely does not consider factors such as age, gender, ethnicity, and body composition. So in the eating disorder community, we’re really trying to move away from BMI. It’s not helpful. And again, it goes back to fat bias: Many people incorrectly assume that people with thin bodies are healthy merely because they are thin, and obviously you can’t just assume that.

One place I recommend people go if they want more information on fat bias, and on eating disorders in general, is the Association for Size Diversity and Health. They’re committed to practicing Health at Every Size principles, so I think it’s a really great resource for health care professionals to have in their pocket.

Kevin Pho: So if BMI is an outdated tool to measure or look for eating disorders, what are some of the updated tools that we can use?

Melissa Geraghty: Yeah, so typically it is a history. It’s going through what is a quote-unquote normal for that person. Did they, for example, lose a lot of weight or gain a lot of weight? What kind of health problems? Are they purging? How often are they purging? What’s their food intake like? Are they eating one meal a day? Did they take out whole food groups?

So it’s often this very big intake process. I know my intake process alone, when I’m seeing someone who potentially has an eating disorder, can take two to three sessions, and my sessions are 50 minutes each, because it’s such a diverse background. As we know, too, when a person has an eating disorder, they likely have other things as well that they’re coming in with: depression, self-injury, trauma. A lot of people with eating disorders do have a traumatic past, not all of them. So again, it’s about the intake and doing a thorough intake of how the person is impacted.

Kevin Pho: Your third myth that you wrote was “My patient’s labs come back fine; they are not medically in danger.” Why is that a myth?

Melissa Geraghty: Yes. One of the most dangerous assumptions is this one. We know that any eating disorder can be deadly at any stage. And again, a person doesn’t necessarily have to look sick for the eating disorder to take their life, and that’s either medically or through suicide. It’s important for people to understand that a patient’s health can drastically and quickly change with an eating disorder, even if labs initially show up OK.

I’d like to give an example. Part of what I do is I send all my eating disorder patients to get a physical. If we need cardiology, we get them involved: EKG, blood work, all of that, to get a baseline of where they’re at. And it can be difficult, because when the labs initially show up OK, the patient and their parents can then say, “Oh, well, see, I told you it wasn’t that big of a deal.” But we know from research and from looking at the course of eating disorders that, again, that can change.

So, back to the story. I sent a patient to a cardiologist. She was having some concerning problems. Her heart rate was pretty low, but she was a really great athlete, and a lot of athletes have a lower heart rate. But the cardiologist completely dismissed that this was lower than her baseline, told the family she was completely fine, and dismissed this patient having anorexia. Then we, as the eating disorder professionals, have to come back and explain, “Actually, this is concerning. This is not the patient’s baseline,” and go from there. So that can be quite frustrating when people aren’t being collaborative with the eating disorder professionals.

Kevin Pho: So like many clinicians listening to the show, we don’t have the luxury sometimes of long intakes, and we only have sometimes 15 minutes with a patient. What kind of questions can you ask patients that may uncover a history that may be suggestive of an eating disorder?

Melissa Geraghty: Yeah, that’s a great question. I think it’s focusing on if there’s any purging, if there’s any laxative or diuretic abuse. And again, just, “What’s the typical day? Run me through a typical day of meals for you.” You can gather from that alone if they’re having enough intake. Also exercise: Are they overexercising? Do they almost have obsessive thoughts about exercising?

And because physicians have such a short amount of time, I always suggest that if you suspect anyone has disordered eating or an eating disorder, you find them a psychologist or counselor who specializes in eating disorders and go ahead and make that referral. Medical professionals can visit the eating disorder nonprofits ANAD and NEDA to find resources of trained professionals, so that your patient can go ahead and get the big intake and a confirmed diagnosis.

Kevin Pho: So take us into your office. If you’re talking to someone with an eating disorder, what are some of the treatment approaches that you typically use?

Melissa Geraghty: Yeah, so oftentimes, first we start out with just learning about the person’s history. After we do that, what I typically like to do before we dive in, particularly if there’s any trauma, is learn a baseline of coping skills, different types of grounding techniques. And then we start to elevate into doing a timeline of sorts: “OK, did you notice that the first time you had body image difficulties was around when you were eight years old, and your mom just happened to start dieting then?” And so we go through that.

The thing about eating disorders is that sometimes people don’t know why or how their eating disorder started. And the thing is, it’s OK that you don’t know, and sometimes we will never know. But the thing is, we can still treat it and still move forward. But it is nice to honor it if patients do know what started triggering, because it’s oftentimes many events and many things over the years that triggered it. So then we go into that.

And then we progress. We can have experiential activities, such as exposure therapy, where we eat certain fear foods in sessions. And also, we’re working on body image, because that’s usually a big component for people with eating disorders. And I’d like to say something that people don’t like to hear, but it is important: Body image, with eating disorder recovery, is the last thing to get better. And if you think about it, it makes sense, because it’s usually been around the longest. Our society is very body-focused. It has very much fat phobia. And so it takes a while for body image to start to not consume a person.

So it’s definitely a long list of base things that I adapt to the patient, because not everyone’s going to get the same treatment. Some people might have to then have additions of self-injury treatment and different sorts of things tailored to them. It just doesn’t fit in one box. But that’s kind of a basic overview.

Kevin Pho: We’re talking to Melissa Geraghty. She’s a psychologist, and she wrote the KevinMD article “3 eating disorder myths that health care professionals should debunk.” Melissa, what are some of your take-home messages that you want to leave with the KevinMD audience?

Melissa Geraghty: Yeah, the level of complexity of eating disorders definitely needs to be addressed by properly trained professionals, and patients should have a team in place that includes a medical professional, an eating disorder psychologist or counselor, and an eating disorder dietitian. It’s so important to be able to have that team so a patient can recover.

Kevin Pho: Melissa, thank you so much for coming back on the show and sharing your time and insight.

Melissa Geraghty: Thank you so much for having me.

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes