Patient Perspectives on Nutrition Providers’ Phenotypes and Attitudes about Weight during Treatment for Atypical Anorexia Nervosa

Abstract

Introduction: To date, research on the experience of patients with higher weight who have restrictive eating disorders (EDs) is lacking. The patient's narrative provides meaning, context, and an understanding of the patient's experience of illness.

Methods: The Women’s Illness Narratives Through Eating Disorder and Remission (WINTER) longitudinal, mixed methods study explores treatment-related weight bias experiences in adult patients, ages 22–74 with BMI range from 25.6 kg/m²–61.1 kg/m² who have past or present diagnosis of Atypical Anorexia Nervosa. The present study is a partial sample (N = 20) from the WINTER study, which included three semi-structured interviews. Participants were asked to discuss: 1) their positive and negative experiences with healthcare providers and in ED treatment settings, 2) how these positive and negative experiences impacted their journey going forward, 3) how the visible identities of ED and healthcare providers impacted their experiences, and 4) how health professionals can improve their current practices. Dedoose software was used to analyze baseline and 6-month interviews for salient themes related specifically to nutrition providers. Nutrition providers were defined as any provider who prescribed a meal plan, offered nutrition advice, or discussed nutrition concepts as part of treatment, regardless of whether this provider was a known Registered Dietitian.

Results: Three main themes were identified. Two of these themes described ideologically opposed treatment approaches. One type of treatment centered weight and used it as a driving determinant of care, and a second type of treatment that was weight-inclusive, incorporated Health At Every Size^® (HAES^®) and Intuitive Eating principles, and acknowledged the harm of weight bias. The third and final theme identified participants’ ideas for improved future support.

Conclusion: Patient perspectives identified the need for greater awareness regarding the specific challenges individuals with restrictive eating disorders at high weights face. Further, these perspectives revealed the need to increase weight-inclusive nutrition treatment approaches (e.g. HAES^®) that target ED behaviors and cognitions and promote body acceptance at all sizes, and the importance of including diverse bodies in the ED treatment profession.