Wednesday 13 March 2013

Talking with a local GP about eating disorders

Last week I had a chat with a local GP about eating disorder awareness which was quite illuminating. Obviously this is just one GP from just one GPs' practice - a large, established practice in the leafy suburbs of a big northern UK city. Anyhow, this is what she said...

As a medical student at Cambridge, we probably had a couple of lectures on eating disorders, part of our psychiatry studies. As GPs we don't receive any further organised training. However if you have a specific interest in eating disorders you will look them up.

How would you identify a person with an eating disorder, say a parent brought their child in and were concerned about them? Maybe an a-typical presentation? Or they’re not emaciated or they’re in denial?

I'd speak to the parents. I'd also speak to the child, in fact I'd try to talk with the child alone if I could. In a case where the child insists there is nothing wrong and it's simply their parents being overly concerned, I'd talk with the parent. I'd ask why they are concerned. Is it because there are a lot of eating disorders around at the moment, for example at school? What evidence do they have that their child has got an eating disorder. Do they have evidence that they are taking laxatives, for example? Can they see their child not eating? I'd take it from there, really. If I felt it was just a paranoid parent then I'd probably just keep things under review, but if there was good hard evidence for me to go on then I would pursue it as much as I possibly could.

How much awareness do you have of males with eating disorders and children under 7? 

I referred a boy for treatment recently. I don't have any experience of eating disorders in the under 7s but I am aware that they happen.

What measures might you take on first presentation for example weight, height, bloods, etc? 

I'd definitely measure a young person's height and weight. Depending on age I'd talk to them about blood tests and explain why I felt they needed them. And if I were doing those investigations then I would definitely be referring to a specialist for advice. Knowing how long it can take to get someone seen, I would send off a referral at that point. GPs are just general practitioners; we're happy to help as much as we can but I’d be thinking that they would need to be seen by a specialist as well as seeing me.

I would refer a patient to CAMHS immediately, at that first appointment. If I thought there was some doubt about what was going on or what the family dynamic was then I would maybe see them again for another chat before referring but I’d definitely refer sooner rather than later.

While they were on the waiting list for CAMHS, I’d say "Come back, come back and see me whenever you need to". And if I felt the case was getting more urgent and they were really poorly, I'd see if I could expedite the appointment. I'd phone CAMHS. I have done this with eating disorders and self harming, so I can make sure CAMHS is aware of how serious I feel the situation is.

What, in your opinion, causes eating disorders? 

Oh my goodness! Society, the child’s personality, upbringing,... there are so many different causes. So definitely personality traits, anxious personalities, perfectionists, the way society projects the perfect female body in that you "have to be" thin, so peer pressure, bullying and comments from other girls. Also, competitive children, competition with other girls, parents... you know, parents with high expectations who put pressure on children so self harm is a release. Control, too. One thing they can control is food so they're using food as a control thing.

How much awareness do you have of the latest research showing that eating disorders are probably genetically based and heritable conditions?

Yes, I’d go with that. I’m sure it’s part of the spectrum of anxiety and depression and it can be – not all the time, but it can be – a manifestation of that spectrum. I know there is a genetic basis, so yes. Interesting how you try and winkle out nature and nurture, though. I mean, if you have a mother who is hyper-paranoid about her weight… but, anyway, yep, I’d go with that.

How many GPs in the practice have extensive experience of eating disorders?

I’d say there probably isn’t a GP here who has done psychiatry. As a GP you just see what crops up. I mean, we’re a middle class, educated GP practice so we might see more eating disorders in middle class well educated girls (and boys) than, say, somewhere with a different demographic.

But I don’t know how many eating disorder patients we see or if any GP particularly specialises in eating disorders. You might need to talk with one of our more senior partners. We don’t see eating disorders very often; GPs’ time is so pressured so, as a GP, you tend to find out more about what you see more of. But if ever I had anyone with an eating disorder and I felt out my depth then I would definitely find out more about the condition.


  1. The first few questions - great
    The "what causes eating disorders?" well at least she gave it a shot. When I had the chance to put previously approved questions to new members of staff the senior staff pointedly ignored the "what causes?" question, wouldn't even DISCUSS it let alone include it. Actually it's really making me annoyed all over again remembering that.
    "we’re a middle class, educated GP practice so we might see more eating disorders in middle class well educated girls (and boys) than, say, somewhere with a different demographic" O dear! Dangerous myth of the week

  2. But well done for asking the questions and also well done her for being willing to answer them - a useful snapshot I think.

  3. Why have you adopted this strange notion that ED's are genetically linked ? they are not !

    1. Dear Anon,

      Do please read Chapter 2 in "A collaborative approach to eating disorders" edited by Janet Treasure and June Alexander, a book which includes contributions from approx 62 of the world's leading ED experts.

      Please also read the Introduction for this book which says: "Research reveals that genetics comprise up to 86 per cent of the reason a person develops an eating disorder (Klump et al 2001; Lilenfield et al 1998).

      Also please do read Carrie Arnold's "Decoding Anorexia".

      Also, please Google "Genetic predisposition to eating disorders" and you will come across a whole range of studies.

    2. Please also check this out (The heritability of eating disorders: methods and current findings):

      This abstract says:


      Family, twin, and adoption studies of anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED), and the proposed purging disorder presentation (PD) have consistently demonstrated that genetic factors contribute to the variance in liability to eating disorders. In addition, endophenotypes and component phenotypes of eating disorders have been evaluated and provide further insight regarding genetic factors influencing eating disorders and eating disorder diagnostic criteria. Many of these phenotypes have demonstrated substantial heritability. This chapter reviews biometrical genetic methods and current findings from family and twin studies that investigate the role of genes and environment in the etiology of eating disorders. We review the methodology used to estimate heritability, the results of these studies, and discuss the implications of this research for the basic conceptualization of eating disorders and the future value of twin modeling in the molecular genetic era.

  4. But none of this is decisive, there is no general consensus among the world's leading ed experts, it's just a theory. Environmental factors are the cause of eating disorders, that is the conclusion I have come to.

    1. And what are your credentials? And can you produce the evidence?

  5. Yes; they do it for attention

  6. By attentention, I mean the ED clincians saying it's genetic, not the person with an ed !

    1. I'm not sure I get your drift? Why would the Ed clinicians do it to get attention?

  7. There's an interesting debate about this in the new Journal Advances in Eating Disorders Of course both sides want to get their work published and understood and thanks to the publishers it gets brought to our attention, and is free and well written so even the GP might get time to read it.

  8. Thank you Batty for providing this interesting GP perspective. You have provided a template we as parents could ask our own GP's to further understand from a broader range. The answer to "what causes ED" and so strikingly the GP's respond; Society, reinforces the need to produce an awareness campaign amongst GP's and point them to the evidence. Understandably, GP's are not generally inclined to be an expert or well informed in psychiatric disorders, however, dispelling the notion that society; parents etc are factors is evident.

    Equally, seems necessary to dispel that ED does not discriminate re demographics - white, middle class, well educated and pushy parents - hmm, this seems to be the wider perspective and I look forward to being part of the change in that perspective eventually.

    Excellent and thank you so very much for doing this and sharing with us.