More doctors have unhealthy eating habits than thought, with the stress of the job – and more recently, Covid-19 – among the factors likely contributing to eating disorders (EDs) among healthcare professionals.
Data are limited on the prevalence of EDs among healthcare workers, but a 2019 global review and meta-analysis determined that “the summary prevalence of ED risk among medical students is 10.4%.”
A 2022 update of that review boosted the estimate to 17.35%.
That’s nearly double the 9% rate within the US general public, and while the following statistic isn’t an indicator of EDs per se, 19% of doctors admit to unhealthy eating habits, according to a recent Medscape Medical News physician survey.
Why are doctors at risk for EDs?
As with many mental health issues, EDs have no single cause. Researchers believe they stem from a complex interaction of genetic, biological, behavioural, psychological and social factors.
But some personality traits commonly associated with EDs are often shared by successful physicians.
“I think some of the overlap traits would be being highly driven, goal-oriented and self-critical,” said Lesley Williams, MD, a family medicine physician at the Mayo Clinic in Phoenix, Arizona.
“A lot of those traits can make you a very successful physician and physician-in-training but could also potentially spill over into body image and rigidity around food.”
Although all physicians strive for excellence, the majority of diligent, driven doctors will not develop an ED.
However, when pushed too far, those admirable qualities can easily become perfectionism – long recognised as a risk factor for EDs, and supported by decades of research.
Where eating disorders begin
“Medicine in general attracts people who often share similar characteristics to those struggling with eating disorders – high-achieving, hard-working perfectionists who put a lot of pressure on themselves,” said Elizabeth McNaught, MD, a general practitioner and medical director at Family Mental Wealth, who was diagnosed with an ED at 14.
Competitive, high-stress environments can also be a trigger, she said. “The pressure of medical school, for example, if you’re struggling, can perpetuate an eating disorder.”
Pressure to perform may not be the only problem. Medical students are taught to view weight as a key indicator of health.
Multiple studies suggest that not only does weight stigma exist in healthcare but has increased over time and negatively affects patients’ psychological well-being and physical health.
There is far less public discourse about how weight stigma can be harmful to medical students and physicians themselves, however.
In general, Williams and McNaught agree that medical training around EDs is lacking, producing doctors who are ill-equipped to diagnose, treat, or even discuss them with patients.
Williams recalled only one lecture on the topic in med school.
“And yet, anorexia carries the second highest death rate of all mental illnesses after opioid-use disorders,” she said, “so it’s astonishing that it just wasn’t included.”
MDs hiding mental health issues
Melissa Klein, PhD, a clinical psychologist specialising in EDs, has more than 25 years’ of experience working the in-patient ED unit at New York Presbyterian. Having treated medical professionals, she said they have legitimate concerns about revealing their struggles.
“Sometimes, they get reported to higher ups – the boards – and told they have to get help if they want to continue in their profession. I think people might be scared to ask for help because of that reason.”
Doctors often ignore ED
Some physicians who’ve experienced EDs first-hand are working to improve training on diagnosing and treating the conditions.
McNaught has developed and launched an eLearning programme for healthcare workers on how to recognise the early signs and symptoms of an ED and provide support.
“It's not only so they can recognise it in their patients but also if colleagues and family and friends are struggling,” she said.
In 2021, the American Psychiatric Association (APA) approved the APA Practice Guideline for the Treatment of Patients With Eating Disorders, which aims to improve patient care and treatment outcomes.
But Klein is concerned that increased stress since the Covid-19 pandemic may be putting healthcare workers at even greater risk.
Her message to healthcare workers is: don’t be ashamed. She described an ED as “a monster that takes over your brain”.
“Once it starts, it’s very hard to turn it around on your own. So I hope that anyone who is suffering, in whatever field they’re in, is able to ask for help.”
Psychiatry Online Eating Disorders PDF (Open access)
Medscape article – Why Do MDs Have Such a High Rate of Eating Disorders? (Open access)
Medscape article – Why Do MDs Have Such a High Rate of Eating Disorders? (Open access)
See more from MedicalBrief archives:
UK medical schools fail to provide adequate training on eating disorders
Eating disorders linked to exercise addiction
'Clear failings of care' resulted in UK anorexia death