Title: “You Don’t Look Anorexic:” A Mixed Methods Study of Weight Stigma and Healthcare Experiences in a Diverse Sample of Patients with Atypical Anorexia
Time: Thursday, August 20, 2020, 10:00 AM
Zoom link: https://washington.zoom.us/j/93236374747 Meeting ID: 932 3637 4747
Abstract:
“Atypical anorexia” (AAN) is an eating disorder (ED) describing those who meet all criteria for anorexia nervosa (AN) except being underweight. AAN individuals have higher weights and are more likely to experience weight stigma. The present study used multiple methodologies to explore the AAN experience, focusing on how weight and weight stigma affect healthcare experiences. Methods: Study 1 utilized a systematic review of 54 articles to determine the weight history and medical complications of AAN. Study 2 utilized in-depth semi-structured arts-based qualitative interviews with 38 AAN patients to describe their experiences of weight stigma in healthcare. Study 3 utilized correlation and linear regression to determine associations between weight-related variables, level of treatment received, and treatment delay. Results: The systematic review revealed that patients with AAN experienced lower rates of amenorrhea and bone density loss compared to AN. However, life-threatening symptoms (electrolyte imbalance, bradycardia, hypothermia, orthostasis) occurred at commensurate rates, though AAN weights were higher. Qualitative findings demonstrated that across the illness trajectory (risk development, pre-treatment, treatment, relapse prevention), patients reported that provider weight stigma contributed to initiation and persistence of ED behaviors, complicating illness trajectories. Quantitative results corroborated the impact of weight and weight stigma on treatment receipt and delay. Participants experienced a mean weight suppression of 24.6% (SD = 10.7) of their premorbid weight and a treatment delay of 11.7 years (SD = 11.1) from the time patients believed they had an ED until receiving treatment. Participant maximum Body Mass Index (BMI) was inversely correlated with level of care received such that heavier participants tended to receive lower levels of care (r = -.35, p = .03). Even after controlling for age, (b = .46, SE = .13, p =.001), minimum BMI (b = .76, SE = .31, p = .02) predicted treatment delay, indicating that participants reaching lower BMIs experienced less treatment delay. Discussion: These findings demonstrate that 1) AAN is a serious illness with similar medical comorbidities as AN, 2) higher weight patients were counseled to lose weight despite impairing ED cognitions and behaviors, 3) healthcare providers generally failed to recognize AAN in normal and higher weight patients, and 4) consequences of provider weight stigma included longer periods of living with undiagnosed, untreated EDs and instances of providers triggering (or re-triggering) ED behaviors, leading to increased risk for adverse medical complications. These findings suggest several needed steps. First, transitioning to a spectrum model for AN diagnosis (wherein weight is one severity indicator) may facilitate faster diagnosis and treatment. Second, training is needed for primary care providers to increase recognition and screening of EDs in normal and higher weight patients. Third, conversations are needed between obesity and ED professionals to ensure that universal health promotion efforts do not cause unintended harm. Addressing weight stigma in these ways could enhance treatment receipt, quality of care, and healthcare engagement for ED patients, particularly those at higher weights.
