Eating Disorders and Opportunity: Thoughts from a Medical Trainee
By Nicole Cifra, MD, MPH
I didn’t start medical school expecting to become so interested in eating disorders. While I always had the feeling I would like working with younger patients, I would have initially guessed that I’d end up doing something along the lines of pediatric oncology. It wasn’t until the end of my second year of medical school, when I was studying for my first set of boards (otherwise known as “Step 1”) that I became aware of the need for professionals in the eating disorders field.
As a part of my tightly adhered to study schedule, I was studiously listening to a friendly psychiatrist give the online behavioral science lectures my school had purchased for us. I received two lectures on eating disorders during my first two years of medical school, so I realized I had quite a bit to learn about this topic. However, the first words out of the lecturer’s mouth weren’t about the epidemiology or the diagnostic criteria of these diseases, as was the norm for this lecture series. Instead, he began by saying that this was an area of great need, both in terms of treatment and research.
This got my attention. As a then 23-year-old female, I knew eating disorders weren’t exceedingly rare. As the National Eating Disorders Association says, “everybody knows somebody,” or in most cases, at least a few people. I also knew from the lectures I had already received that eating disorders were highly fatal. I found the combination of seriousness and simultaneous lack for resources and expertise very intriguing.
After I took my exam, I became otherwise engaged in a year of public health study following my second year of medical school. But the curiosity lingered, and led me to a yearlong clinical experience in adolescent medicine, a board of directors position with an eating disorders related non-profit, and the Society of Adolescent Health and Medicine annual meeting. The complexity of eating disorders as being both psychiatric and medical, coupled with the influence of environmental and developmental factors, continued to interest me. As my public health classmates discussed interventions on childhood obesity, I found myself concerned about the opposite end of the spectrum. I played the devil’s advocate in class when we discussed programs, policies, and beliefs related to obesity, and jokingly referred to myself as the “public health heretic.”
The next year, I brought this newfound knowledge and passion with me to my third year of medical school, where I was surprised by the opportunities available to me because I had this unique interest. As a medical student, it’s hard to feel like you’re contributing to your team, but on many rotations I was able to offer knowledge that directly benefited the care of patients exhibiting eating disordered behaviors.
From my perspective, the field of eating disorders represented an opportunity. I gave in-service presentations on the new DSM-5 criteria, educated our hospitalist teams about the use of blind weights, and provided information regarding different levels of care when it came time to discharge patients. One of my mentors says “the expert is the person in the room who knows the most on a subject,” but I never would have guessed this person would ever be the medical student, or at least not me.
When I look back at my medical school experience, I’m grateful that my interest in eating disorders was sparked during that time. As trainees, it’s easy to get into the habit of thinking that our time to contribute is in the distant future, when we have acquired a certain amount of knowledge or proficiency. Through my experience, I’ve learned that everyone has something to offer, even those with the most to learn.
I’ve also learned to view eating disorders as not an area where medicine has fallen short, but an area where there is exciting opportunity to move forward. We, as a medical community, are learning more about how to better prevent and treat these diseases, and in turn improve the lives of our patients. There are few things I can imagine that would be more exciting to be a part of as a trainee.
Visit the NEDA website, attend the organization’s annual conference or participate in a fundraising walksponsored by the National Eating Disorders Association (NEDA), and you will immediately perceive that the focus of this organization is to embrace and support the experiences of both eating disorder sufferers AND their loved ones. NEDA knows that loved ones play a critical role in recovery, and that they need information, a compassionate ear and informed encouragement to help them overcome the sometimes isolating and overwhelming experience of supporting a loved one with an eating disorder.
The Steering Committee of the Parent, Family and Friends Network (PFN) has been comprised of parents and siblings of eating disorders sufferers and has been critical in identifying and creating the resources and programs that support families and loved ones. These include publications like the online Parent Toolkit, the peer-to-peer support of the NEDA Navigators program, the NEDA Conference buddy system and a library of videos (http://www.nationaleatingdisorders.org/webinars) featuring experts discussing topics of relevance to parents and loved ones, such as the levels of care in eating disorders treatment, the role of nutrition therapy in eating disorders treatment and tips on obtaining insurance authorization for eating disorder treatment. NEDA estimates that PFN sponsored videos and publications have reached over 20,000 people. In addition, 288 people have been trained as NEDA Navigators.
The Navigators program is the most hands-on effort of the PFN. Through the NEDA Helpline (800-931-2237), those caring for a loved one struggling with an eating disorder can be connected with a trained Navigator for peer-to-peer online support geared towards offering short-term, goal-oriented assistance. Navigators can help identify treatment options, support groups, websites, books, and next steps on the road to recovery. They offer the wisdom of experience and encouragement, sharing personal stories and listening to the concerns of those who request a Navigator relationship.