A GP’s guide to navigating eating disorders with compassion and care

00:00:00 Yvie
This podcast is recorded and produced on the land of the Wurundjeri people of the Kulin nation. We pay our respects to their elders, past and present, and extend that respect to all aboriginal and torres Strait islander people who may be listening. The producers of let’s talk would like to also acknowledge our listeners with lived experience of an eating disorder or body image issue. You are at the heart of all we do and this podcast and the work we do daily at the Butterfly foundation is is for you. Hello and welcome to let’s talk. I’m your brand new host, Yvie Jones. I’m absolutely honoured to be the new host of this podcast. Eating disorders and body image issues are something that are very close to my heart. I have binge eating disorder or BED. Five years ago, I took a stand on I’m a celebrity, get me out of here where I refused to do the weigh in, which was mandatory every season. Little did I know what an impact that that was going to have as every season after that, the weigh in was missing. It just wasn’t there anymore. Like most things, it’s small steps. It’s the little ripples that we can make. I love education and information, both just so powerful and having both, they help me get a better understanding of who I am, what my eating disorder is and how to deal with it. The Butterfly foundation is one of the best resources we have, so I’m just really proud to bring you episodes filled with knowledge, education, relatable content and emotional wisdom. With that said, let’s get on with the first show. Today we are joined by Priya Patel, a GP based in Richmond, Victoria, with a special interest in body image and eating disorders. In this conversation, Doctor Priya will share her insights on how gps can better support their patients by building trust and rapport, collaborating with the right team of specialists, and how unconscious bias can sometimes play a part in the way patients are treated. Tell us about yourself and how you got into medicine.

00:02:27 Dr Preeya
So I am a GP, I’m a practising GP in Melbourne. I work in Richmond in the consulting room two days a week, and I’m a mum of two kids. I think that’s a big part of my defining feature and I’m very passionate about lots of things, like things that you can do to, you know, change your child’s health trajectory. So eating rainbows and moving the body, looking after the brain, all these things. And so that probably brings me to my next passion, which is I do love cooking and I do love being in the veggie patch. But at the crux of it, I am a passionate human when it comes to health literacy and helping people with really solid health information, because I think it’s really, really muddy for people. Now.

00:03:11 Yvie
If you’ve spent any time on social media, you’ll know it can be filled with misinformation, in particular when it comes to our health and wellbeing. Doctor Priya shares her experience when it comes to the role social media plays and how this was a driving factor in her decision to do this work in 2016.

00:03:31 Dr Preeya
I was kind of looking at social, I was new to Insta, I was looking at what was on there, and I was seeing a lot of health misinformation.

00:03:39 Yvie
Yes.

00:03:39 Dr Preeya
Yeah. Particularly in the vaccination space at that time. And so I was seeing a lot of stuff like people saying, you know, if you increase your avocado consumption, you can cure cancer, so you can therefore not pursue chemotherapy or radiotherapy or surgery. So, really deeply concerning stuff. And it was just. It is still rampant. It’s probably worse now, but that’s what kind of got the passion burning. I was like, wait a minute, we need more qualified voices. I can talk. I like talking. And so I’ve just tried to make health information digestible. That’s the kind of mission.

00:04:15 Yvie
I love doctors like you because I really believe in science and, you know, that’s. And I’m really glad you’re in that space in the public eye.

00:04:26 Dr Preeya
Thank you. It’s a difficult space. Like, if we’re being honest, it is a difficult space to be in because you are competing with very loud, unqualified voices, often with huge platforms. Yes. And we’re regulated very differently where I’m bound by, you know, opera and my college and all sorts of things, and unqualified people aren’t. So it’s a tricky space to be in, but it’s worthwhile. Yeah. Good. Yeah.

00:04:52 Yvie
Gps often serve as the initial touchpoint for individuals grappling with body image issues and eating disorders. Their role is pivotal in identifying early signs, offering initial support, coordinating care, and monitoring progress. But doctors are human. An unconscious bias can and sometimes does influence the way they treat patients.

00:05:19 Dr Preeya
So I think if you talk to gps across the country, I think a lot of people would say that we are seeing this stuff in this space more and more. So you really do. If you want to be a knowledgeable, practical GP for your patients, you got to upskill. And so I upskilled out of necessity, but also because I think with time and growth, I have been forced to address my own unconscious biases. With lots of things. But weight stigma within the healthcare profession was one of them.

00:05:58 Yvie
It’s a big one, isn’t it?

00:05:59 Dr Preeya
It’s a big one, yeah.

00:06:00 Yvie
I personally experience it constantly as a woman living in a larger body. I call myself fat, and I’m fine with that. And the amount of doctors who have dismissed me, not treated me, the amount of time it’s taken for me to find a really great GP is really frustrating that that can even happen.

00:06:22 Dr Preeya
When I talk about. I think it’s. I need to be really transparent here that as a doctor in the healthcare profession, it’s sometimes tricky to talk about the fact that, you know, we’ve got problems like everybody else. Medical misogyny. There are racial prejudices within healthcare. We know that first nations women can have poorer outcomes for some health things, weight stigma. So it often. But I think we need to talk about it and to acknowledge it. It’s a problem.

00:06:48 Yvie
Yes.

00:06:50 Dr Preeya
We at medical school are not taught to kind of address unconscious biases that we might have. As you’re alluding to, people who are living with overweight or obesity can tend to feel dismissed by the healthcare system, neglected. You know, you walk in for, say, ankle pain and you’re told immediately that it’s due to your weight, when in fact, gosh, has anyone even examined the ankle, taken the history? This is all stuff that is still a huge problem. But I myself, over time, and I think, you know, it’s my own life experiences as well, I’ve had. I’ve gone, okay, I’ve got some work to do if I want to be part of change in the profession. And this was certainly an area where I went, okay, you know, am I having any kind of fatphobic tendencies in my consulting room? Are there weight stigma, things that I need to address in my own clinical practice? And it’s been a journey. Cause no one wants to go, ugh.

00:07:55 Yvie
Yeah, I may be a part of the problem.

00:07:57 Dr Preeya
Yeah.

00:07:58 Yvie
No one does, of course.

00:07:59 Dr Preeya
No. But we are all. If you really look at it and do some really deep, hard thinking, we all have some ugly unconscious biases.

00:08:09 Yvie
Absolutely.

00:08:09 Dr Preeya
And it’s yucky to confront them, but it’s worthwhile.

00:08:12 Yvie
It is, it is. And I always say it’s calling each other in, rather than calling each other out of, because that just, you bristle and get defensive when you’re being called out on something. Whereas if, especially from a medical professional to another medical professional, calling each other in is a really lovely way of saying, I did it. I do it, too.

00:08:33 Dr Preeya
Yeah.

00:08:34 Yvie
And do you want to continue being that person, or do you want to live and grow, learn and grow? Risk factors and symptoms of eating disorders can manifest in various ways. I asked Doctor Priya, what are some of the risk factors and symptoms associated with body image and eating disorders that she might encounter in her practice?

00:08:58 Dr Preeya
So this is a big question. Risk factors, when it comes to risk, you know, we know there are so many things that can increase one’s risk of eating disorders, body image disorders. And I tend to think of them in the consulting room as things that are kind of, you know, social factors. Like, have we grown up in a household where praise is constantly appearance based, where someone’s constantly dieting, talking about weight loss, assigning labels to food like good and bad, healthy and unhealthy? And we might get into that, but those are certainly things that can increase risk. There’s also other brands, things like a family history of eating disorders, like a history in an individual of things like a mood disorder, like depression, anxiety. So there are things that can increase risk, you know, social, brain, genetic. There’s lots of things. But in terms of symptoms, I mean, that’s a huge question. And I think, you know, I see lots in my consulting room, and sometimes people come in knowing that there’s something there. Prayer. I’m constantly thinking about food and scared of gaining weight and restricting intake. Sometimes people know, but often I have to build rapport over several consults and I do a bit of investigative work. And I have to have the difficult discussion of, do you think there could be something around food or body going on here? And I’ve just had some very interesting chats in that space with some patients. And, you know, often people go, oh, my gosh. Upon reflection, yes. I didn’t know that it’s not normal to run five ks after I’ve eaten a bar of chocolate, chocolate to compensate. I didn’t know that losing control with food and consuming excessive quantities in a short period of time and then having guilt and shame was not normal.

00:11:10 Yvie
Yeah. The 1980s were a transformative decade for diet culture, marked by the rise of fad diets, fitness crazes, and a growing obsession with thinness as the ideal body type. This era laid the groundwork for many of the diet trends and body image issues that persist today.

00:11:34 Dr Preeya
When we talk about risk of eating disorders, body image disorders, I think we need to be really open that diet culture is a huge factor. And I’m a person, I’m 37. I grew up in the eighties when on the COVID of Dolly, it said stuff like, you know, losing weight for summer or how to get your summer body or how to get your.

00:12:00 Yvie
How to lose weight in three days.

00:12:02 Dr Preeya
Yes.

00:12:03 Yvie
Oh, yeah.

00:12:04 Dr Preeya
That was the world I grew up in. And diet culture, this notion that, you know, what is diet culture? Diet culture is everywhere. It is pervasive. It’s this notion that we should all buy into this body ideal, that being thin equals success and amazingness and good. And, you know, anything that’s not in that ideal is unhealthy or bad. And really, that the way we look should define our worth. It’s really deep seated, pervasive stuff that even now, as a 37 year old mum of two, every day I’m like, prayer. You know, that that’s, you know, things will pop over my feet where I have to go, wait a minute. I don’t need a summer body. There’s no such thing as a summer body. My body’s. My body.

00:12:54 Yvie
Yeah, yeah.

00:12:55 Dr Preeya
It can look the same the whole bloody year round. It doesn’t matter. But that kind of diet culture stuff that is everywhere on our feeds, on our tv screen, on magazines, is also a contributing factor. And I think sometimes I have to say to myself, you know, a reminder that just really simple mantras like Priya, there is no body ideal. There’s no perfect body. Not all weight loss is good. Being thin doesn’t equal success. Just really simple stuff to ensure that.

00:13:27 Yvie
Deprogramming. Yes, because we are so programmed from birth, it’s there. It’s in our mother’s ears while we’re still here in utero. Like, it’s just, just.

00:13:37 Dr Preeya
And that’s why what we do in childhood, though, as well. So this is why. And we’re getting into prevention now, but also risk. But, you know, I talk about this all the time on social media or on media, wherever we are, that what we do around little people as parents, as caregivers, whoever you are, the way you talk about food, the way you talk about your own body, their body, it can impact your child’s or a child’s relationship with food and body. You can positively shape that by not labeling foods, by not doing the. You look so pretty, you look so wonderful in that. Not making all compliments appearance based. You’ve got some power.

00:14:22 Yvie
Cause a lot of people feel that powerlessness of what can I do? It’s huge. It’s so big, and I’m so programmed. And that, again, comes back to having an open mind, being open to reprogramming, relearning, learning new things.

00:14:38 Dr Preeya
Yeah. And I think a lot of kind of subtle comments that are really deeply seen. Yeah. So, you know, this comment sometimes, and look, you might have a different experience with this, but you’ve alluded to the fact that you’ve experienced weight stigma within the healthcare profession. But, you know, this notion that, you know, someone older in your life might go, oh, have you lost some weight? You look great. This notion that any weight loss is good is favourable when in fact, the times when I’m personally, you know, shifting weight in that manner, I’ve, you know, it has been when I’ve had uncontrolled anxiety during medical school, it’s when my patients got hypothyroidism or a new cancer diagnosis or. And so, yeah, it is kind of, and it’s hard, I think, for older people. But, you know, for instance, for my mum, who’s a caregiver to our kids, often I’ve had to explain mum and she doesn’t, to be fair, and it’s taken a while, I’m like, mum, we don’t have scales, we don’t talk about weight, we don’t, you know, talk about, oh, you look a bit chubby or anything, and she’s really taken, you know, okay, that’s wonderful. Yeah. But she’s open to that and that takes, you know, courage and effort. But, you know, when I explained to her, this is the impact that you can have as well, both positive and negative, she was on board.

00:15:58 Yvie
General practitioners are tasked with identifying early warning signs and preventing eating disorders from becoming chronic. But patients can often be elusive. I asked Doctor Praya, how should a GP approach a situation where they suspect someone is experiencing symptoms but the individual has an identity, the problem themselves?

00:16:20 Dr Preeya
So sometimes it’s my job as the GP and it’s not my personality. I’ve had to learn this skill and I’ve got mentors, older gps who help me with this because I like to fix things and you can’t fix everything in general practice. That is the reality. But sometimes I just have to sit and wait and support and it’s like that with lots of different things in my consulting room. So that can be the same with things like alcohol dependence. When someone goes, I know, but I, you know, I’m not there and that’s okay. It’s my job to go, okay, you know, in the case of, let’s say, something like a binge eating disorder or restriction, it’s my job to say, okay, can we do some bloods to make sure that we’re safe, that there’s no nutritional deficiencies that we can, you can’t optimize anything. Can we make sure your bones are healthy? You know, I’m going to do the medical optimisation and if I generate the right environment and the patient rebooks to see me, that in itself is a win. In general practice, the patients come back, they trust me. I’ve got enough rapport there then with time. What I’ve learned is that eventually people, we’ll get there. And sometimes, you know, it’s my job to point out, you know, some of the stuff that’s going on at home could be a risk, could be increasing risk for your kids. That’s a big carrot for a lot of people. Oh, I hadn’t, okay, because I’m not eating during the day or eating any of the meals or I’m compensating or I’m talking about food like this, okay? And that can often be a draw card or hey, you, you know, your nutritional markers are down due to restriction and that might be the carrot to then for me that triggers me to go, okay, when the patient consents and we’re ready to take the next step, because I can’t force that unless there’s, you know, some imminent risk. It’s my job to then go, okay, let’s do all the amazing paperwork that needs to be done to facilitate psychology, input, dietitian, whatever else we need.

00:18:30 Yvie
We know that using compassionate, empathetic and culturally sensitive language is the first step to a positive experience with a GP. What are some of the things that gps can say or not say to people at risk to build the trust with their treatment team?

00:18:48 Dr Preeya
Look, I think that’s interesting. I think that’s such a nuanced thing between a GP and their patient. And it depends on their consulting style and the therapeutic relationship, the type of GP you’ve got, the patient. I think if people sat in my consulting room, they’d be like, whoa, you do that with your patients and you’re high fiving and you give them a hug, you know, like, yeah, sometimes I do. It’s clinically appropriate. And I’ve known these people for many years. So I think the key thing to not do is to not stigmatise based on weight. And I also mean when I say that not to dismiss someone’s concerns about food body image, if to you they look like they’re in a larger body. Yeah, just don’t. Because there are people with binge eating disorders, with restrictive eating disorders, with compensation with exercise, all sorts of things who, you know, people on the street go, oh, you know, I also have a real issue with that, as we all should, with people looking at someone and going, they’re unhealthy or healthy. You cannot tell that by looking at somebody.

00:20:06 Yvie
That’s right.

00:20:08 Dr Preeya
It’s it. I’m a GP, you can’t do it.

00:20:10 Yvie
That’s right.

00:20:11 Dr Preeya
Because it’s not based on numbers or appearance or weight. It’s like, what’s their blood pressure? What’s their sleep quality? Have they had a cervical screening test, a mammogram, if they’re eligible? Bowel count? It’s like. It’s a huge, loaded question.

00:20:23 Yvie
And it’s this opposite as well. You may have an emaciated patient who you think you would naturally think has an eating disorder, and they may not.

00:20:33 Dr Preeya
They may have a medical issue.

00:20:35 Yvie
A medical issue, yes. And that’s what really frustrates me in a larger body with the medical stigma. For me, it works the opposite way. Just don’t assume someone is healthy because they’re thin.

00:20:48 Dr Preeya
Correct.

00:20:52 Yvie
If you’re experiencing body image issues or suspect you might have an eating disorder, reaching out to a trusted GP can greatly improve your chances of recovery and long term well being. Remember, you deserve respect, respectful, non judgmental care. If you feel misunderstood, it’s okay to seek another opinion.

00:21:15 Dr Preeya
So, look, I think if you’re listening and you think, hey, I think there’s something here. Like, I think maybe I do have loss of control with food. Food does dominate my thinking constantly. I’m scared of gaining weight. I do compensate with exercise or response. If you have, you know, people will say to me, oh, Priya, I hadn’t realised. But often, if I’m going out for dinner that night, I don’t eat for the entire day, people have kind of normalized it.

00:21:42 Yvie
I was just going to say exactly that. There’s just all of these things you’ve just said. You’ve listed them, they were so normal to me once upon a time, and all of my friends.

00:21:50 Dr Preeya
And so I do think people are more and more realizing, hey, this might not be normal because of things like, you know, some videos that I might do on social media or what the butterfly foundation puts out or what a celebrity might share. I think there’s more awareness that people are going, okay, maybe that is not necessarily good for my body and brain to be doing that, to be compensating with exercise, to be binging and then purging, which, you know, yeah, you’re right, a lot of things have been normalized. But I think if anyone’s listening and goes, oh, I think there could be something here for me. You need to go to a GP that you trust, and if you’re thinking, I don’t have that person yet, you need to go and find them. And that can be a journey in itself. Go and try a few. Ask your mates. Go and fill the juju. Is it right? Try them out for a couple of simple things. We know that patients do this. There’s research and studies that tell us that patients will kind of come and see you for the sore finger and then the mole on the back, and then I’ve got rectal bleeding or whatever it is, the serious thing they’ve been holding back. And so go and try find someone who’s safe, who you can talk to. And I think you need to know what to expect. And so if you come and see me for anything in that space, I’m going to take a history. I want to know what your relationship with food and exercise and laxative use. I want to know all of that stuff. So it can be slightly confronting, but it’s my job to kind of warn you and to say that this is all really important information gathering. We need to examine you often. It might not be all in one consult. This can take several consults, but at some point I need to know that your blood pressure is okay. I might, with your consent, need to do a wait in my consulting room if you feel safe. And I say to patients, you might not want to look down and see the number, and that’s okay. But the weight, this BMI measurement, it’s not the be all and end all. No, there’s much more to it. And we might need blood tests. But then I’m talking about. We need a team. It’s about a team. I sing when I get passionate, but, you know, I then need to go. Okay, we need a psychologist who is an expert in this area. I know you know, five amazing ones near me. I think you’d be a good fit with this one. We need a dietitian. We might need an eating disorder plan. If you qualify, we need to do bloods at regular intervals. I need to see you three, six monthly, maybe four weekly, whatever it is. But it’s about having this multidisciplinary team trying to cut costs where we can, because this can get expensive, which is where the eating disorder plan can be really useful. People are eligible, but about kind of this multi pronged, multifaceted approach to a really complex problem that’s often been seeded for years with diet, culture, with stuff that’s happened in childhood, genetic factors, maybe personal factors, there’s a lot.

00:24:51 Yvie
The Butterfly referral database provides a valuable resource for gps and other healthcare professionals, offering access to experts screened for their understanding and knowledge of appropriate care. When it comes to treating eating disorders, gps face a unique set of challenges that require both medical expertise and deep sensitivity. I asked Doctor Priya if she had any advice for other gps to help navigate these complexities with greater confidence and effectiveness.

00:25:23 Dr Preeya
It’s. Look, I think upskill as much as you can. So I.

00:25:27 Yvie
Can I ask you what you’re upskilling?

00:25:28 Dr Preeya
Yeah. So I’m actually currently doing the additional modules. So if you’re a GP, you can go on and have a look at RACGP or inside out, I think it’s called. There’s modules that can do, then you can do additional training and gain an additional certificate. So I’m on the path there. I’ve up skilled anyway, just from reading journal articles, stuff from Butterfly foundation. They’ve got so many things for health professionals, but I’ve had to, you know, talk to the psychologists that I work with in this space. The dietitians get to know them and I’ve upskilled that way. But I’m doing more formal stuff now. But I do think if you’re going to have these discussions, rapport and rapport building is critical.

00:26:15 Yvie
Yeah.

00:26:16 Dr Preeya
And I think you actually need to, you know, perhaps address some of your own unconscious biases as well, because I think we often assume that in order to qualify for the diagnosis of an eating disorder, be that anorexia or bulimia or a binge eating disorder, that you may need to look a certain way or fit a certain body type, and that’s not the case. And people can have, you know, serious brain and body complications from their eating or food behaviors. And in your consulting room, you know, you might go, no, that’s not possible. But it 100% is. And that’s our own unconscious biases and the need to upskill and learn that actually binging, purging, restriction, compensation with exercise, all of this stuff can happen in lots of different body types.

00:27:12 Yvie
Yeah.

00:27:12 Dr Preeya
No one’s immune.

00:27:13 Yvie
No.

00:27:14 Dr Preeya
Yep.

00:27:18 Yvie
An eating disorder plan is a structured approach designed to support individuals struggling with eating disorders in their journey toward recovery. I asked Doctor Priya to tell us a little bit more about these plans and what a patient might expect.

00:27:32 Dr Preeya
So an eating disorder plan is essentially something your GP can do. It’s a whole pile of paperwork we need to deem whether or not you’re eligible. So you need to meet certain criteria. And that’s my job to know that criteria. But you might get asked to do a questionnaire by your GP, the EdeQ. We might get you to do that at home or in the consulting room. And if you meet the criteria, then we fill out loads of paperwork and it enables you to access subsidised psychology and dietitian sessions. 40 psychology 20 dietician depending on. Yeah, there are lots of other things to take into account. Have you had a mental health care plan for something else? All sorts of things, but subsidised allied health input. And it really should be, I call it to my patients, the scaffolding. It’s that you’ve got the dietitian, the psychologist who normally, when I do this in the community, it’s normally that they work together in a similar place and the patient comes and sees me. We’re all in regular communication and we involve other people as required.

00:28:40 Yvie
Recovery from eating disorders is possible and your GP can help your chances for a full recovery by collaborating with dietitians, psychologists and other specialists trained in eating disorders and body image issues. I think that’s GPS, a foundation.

00:28:56 Dr Preeya
It’s a big role, it’s your step. It’s the big. I say to patients, I’m there in the passenger seat. Yeah, you’re the driver. But, you know, it is a big role to kind of be the advocate, the supporter, give people the resources and sometimes just the time, the space to be ready for change.

00:29:16 Yvie
Oh, thank you so much for your time, your patience, being ready, all about your expertise and more than anything, your passion and the fact that you sing when you get a little bit passionate about something. Thank you. I’m just delighted to have spoken to you today. So thank you so much for being here.

00:29:35 Dr Preeya
Thank you.

00:29:41 Yvie
Huge thank you to doctor Priya Patel for sharing her invaluable insights and compassionate approach to body image and eating disorders. If you’re concerned about an eating disorder for yourself or someone you care about, please reach out to the Butterfly national helpline at 1833 4673. That’s 1800 Ed hope for a free confidential conversation with one of our specialist counsellors. Alternatively, you can chat online by visiting butterfly.org dot au and following the prompts at the top of the page, you can also download your own support script to take to your GP or other healthcare professional, personalised with your needs and requirements for a better experience. To find out more about today’s episode and to follow Doctor Priya Patel on Instagram, check out the helpful links in in the show notes and on the Butterfly website. Just head to butterfly.org dot au podcast and click through to this episode. Let’s Talk is produced for the Butterfly foundation by Yvie Jones and Annette Stalliano from classic Me Productions with the support of the Waratah Education foundation. Our executive producer is Camilla Becket with support from Melissa Wilton and Kate Mulray. Please give us a follow on your preferred podcast app, and you can also rate and review us if you have the time.