Beyond the Stereotypes: Identifying and Treating Eating Disorders in Adults

In this episode of Medicine 3.0, Dr. Catherine Isaac sits down with Dr. Rebecca Berens, a board-certified family medicine physician and founder of Vita Family Medicine in Houston, Texas, to explore a topic that is often misunderstood and underdiagnosed in clinical practice: adult eating disorders.

While eating disorders are typically associated with adolescence, they are increasingly present‚ and frequently missed‚ among adults. Dr. Berens brings a unique perspective to this discussion, blending her clinical expertise with personal lived experience and a deeply weight-inclusive approach to care.

Reframing What We Think We Know

As Dr. Berens explains, most clinicians and patients still carry outdated stereotypes of what an eating disorder "looks like." These misconceptions often lead to missed diagnoses, delayed treatment, and harm caused by well-intentioned but misinformed care.

Among the key takeaways:

• Many individuals with anorexia are not underweight
• Binge eating disorder is the most common eating disorder in the U.S.
• Disordered eating is widespread, normalized, and often undetected in primary care settings

Disordered Eating vs. Eating Disorders

One of the central themes in this episode is the distinction between disordered eating and diagnosable eating disorders. Disordered eating often exists on a spectrum and may not meet strict DSM-5 criteria, but still carries serious physical and psychological consequences. This includes chronic dieting, food avoidance, excessive, clean eating, or rigid fasting practices that disrupt daily life.

Dr. Berens shares simple screening tools like the SCOFF questionnaire to help clinicians identify high-risk behaviors and initiate conversations that are compassionate, non-judgmental, and clinically useful.

Medical Complications and Misdiagnosis

Eating disorders don't just affect mental health‚ they can compromise multiple body systems. Dr. Berens details how restrictive eating patterns, binge cycles, and purging behaviors can lead to:

• Osteopenia and osteoporosis
• Sarcopenia (muscle loss)
• Amenorrhea and hormone disruption
• Bradycardia and orthostatic hypotension
• GI symptoms frequently misdiagnosed as IBS

She also emphasizes how many common conditions, including ADHD and PCOS, intersect with eating disorders in ways that are frequently overlooked.

Creating Safe, Weight-Inclusive Care

The episode challenges providers to move away from weight-centric care and toward a more individualized, evidence-based model. Dr. Berens outlines how to:

• Avoid re-traumatizing patients through weight-based messaging
• Shift clinical conversations toward health behaviors, not body size
• Build trust with patients who may have avoided care due to weight stigma

Recommended Resources

Dr. Berens shares helpful tools for clinicians and patients alike, including:

• National Alliance for Eating Disorders: allianceforeatingdisorders.com
• Association for Size and Weight Inclusive Health: aswimh.org
• Christy Harrison‚Äôs Podcast & Books: Food Psych and The Wellness Trap
• Harvard Implicit Bias Tests (Weight IAT): implicit.harvard.edu

For providers interested in CME, Dr. Berens recommends offerings from Eating Recovery Center and the Academy of Eating Disorders.