Notes From an Eating Disorder Doctor

I recently attended a meeting of local eating disorder clinicians to hear some wisdom from a doctor practicing in this area (and others) for 30 years.

Wallace Hodges, MD, specializes in internal medicine at Minor and James Medical in Seattle, Washington. He provided a number of relevant thoughts that I'll share in bullet-point fashion. First, some advice for other doctors who see patients with eating disorders:

• Dr. Hodges suggests that doctors should try to resist the temptation to do something to patients with eating disorders, instead focusing on monitoring and maintenance (except in more extreme cases).
• Doctors should refer to therapists and dietitians as appropriate, stepping away from specific questions about nutrition and about emotional issues.
• If possible, a doctor should see an eating disorder patient at the end of the morning or the end of the day to avoid rushing the appointment. Taking time is critical.

Dr. Hodges also noted a couple of important diagnostic issues:

• In large enough quantities, stevia--a natural, no-calorie sweetener--can produce hypoglycemia (eating stevia in these quantities is rare, but persons with eating disorders are capable of using enormous amounts of sweeteners to generate flavor without the calories of sugar).
• Many times, patients with bulimia nervosa and depressive symptoms may get misdiagnosed as having a form of depression when the real emotional disturbance is some form of bipolar disorder. In general, antidepressants are not the treatment of choice for bipolar disorder.

Resources:

• Team Treatment for Eating Disorders: Doctor, Dietitian, Therapist
• Eating Disorder Risk Factors