Why health professional attitudes matter in eating disorder recovery—and how we can improve

For individuals with eating disorders, seeking help should be a path to healing, not another barrier.

However, as our systematic review, “Perceived clinician stigma and its impact on eating disorder treatment experiences (Lubieniecki et al., 2024),” suggests, stigma from healthcare professionals – whether intentional or not – can disrupt recovery, creating feelings of dismissal, misjudgement, and even shame.

Perceived stigma may be felt when individuals sense they are being unfairly judged or blamed for their eating disorder by healthcare providers. This can stem from subtle cues or even direct comments that make people feel misunderstood or responsible for their illness. Such experiences of perceived stigma can deepen the sense of isolation that individuals with eating disorders may already feel, adding yet another layer of emotional and psychological distress.

A key finding from our review was that perceived stigma can weaken the therapeutic alliance—one of the most essential, supportive relationships in a person’s recovery journey. When stigma is felt, people are far less likely to share important details about their symptoms, emotional state, or treatment needs, which are all crucial for healthcare professionals to know in order to guide effective care.

This lack of open communication and trust can hinder recovery. Research shows that dropout rates can be high in eating disorder treatment settings, reaching up to 73% in outpatient care and 51% in inpatient settings (Fassino et al., 2009), suggesting the need for supportive, non-judgmental therapeutic relationships. Although multiple factors likely contribute to these dropout rates, our findings highlight how crucial it is for individuals to feel safe and respected to encourage their treatment engagement and long-term recovery (Geller et al., 2021).

Weight stigma, or judging someone negatively because of their body size, in particular shifts the clinical focus and exacerbates biases. Many people, especially those in “normal” or “larger” bodies, report that healthcare providers fixate on weight loss instead of addressing the broader, complex psychological aspects of eating disorders (Bye et al., 2018; Harrop et al., 2023).

This narrow focus can reinforce harmful stereotypes and leaves many people feeling profoundly misunderstood and invalidated. It’s not uncommon for individuals with eating disorders to wait years for their condition to be properly acknowledged and addressed by healthcare professionals (Austin et al., 2021). These delays can worsen the mental and physical health impacts of untreated eating disorders and further entrench internalised stigma (Harrop et al., 2023; Phelan et al., 2015).

So, how can we improve?

Healthcare professionals are in a unique position to transform the recovery journey for those individuals experiencing eating disorders.  This requires actively engaging in reflection on their own biases from the earliest stages of their training.

Research demonstrates that when clinicians adopt a compassionate, person-centred approach, the therapeutic experience improves dramatically, creating a foundation of trust and collaboration that is essential for effective treatment (Ali et al., 2017; Geller et al., 2021).

This change starts with empathy. Clinicians who actively listen and validate each person’s individual experience contribute to a more inclusive, non-judgmental environment where individuals feel seen and valued.

Acknowledging the complexity of eating disorders, beyond weight or appearance alone, empowers people to open up about their struggles without fear of being misunderstood or dismissed (Doley et al., 2017). When individuals feel respected and that their experiences matter, they are more likely to engage fully in their treatment, building resilience and confidence in their recovery journey.

Healthcare professionals can also enhance their impact by making reflective practice a core part of their professional development. Regularly examining and challenging personal or societal biases should be an integral requirement in healthcare, helping providers approach each person with a fresh perspective and understanding that no two experiences with eating disorders are the same (Doley et al., 2017).

Engaging in ongoing training on stigma and inclusive care practices help clinicians stay attuned to the latest research, ensuring their approaches are not only compassionate but also evidence-based and effective (Thornicroft et al., 2022). By fostering a therapeutic space that supports both psychological and physical recovery, clinicians encourage individuals to see themselves beyond stigmatised labels and engage more meaningfully in their own healing process.

Empowering healthcare professionals to reduce stigma is not just beneficial for individual clients; it is essential for driving meaningful, systemic change across healthcare services. When policies and training frameworks prioritise respectful, stigma-free care, healthcare providers can work in environments that support and reinforce inclusive approaches to treatment.

Service-wide policies that require regular anti-stigma training, encourage reflective practice, and emphasise the importance of understanding diverse eating disorder experiences help shift the culture of care. These efforts not only improve patient outcomes but also create a ripple effect that dismantles harmful stereotypes and builds a more supportive, inclusive healthcare system for all.

Gabby Lubieniecki is a Credentialed Eating Disorder Clinician, a lived experience advocate and researcher. She is undertaking her PhD with the School of Psychology at the University of Queensland focussing on the impact of medical trauma in the severe and enduring eating disorder population.

Prof Gemma Sharp is a National Health and Medical Research Council Investigator Fellow and Senior Clinical Psychologist who leads the Body Image & Eating Disorder Research Program in the School of Psychology at the University of Queensland. She is also the lead of the international Consortium for Research in Eating Disorders.

About CoRe-ED

The Consortium for Research in Eating Disorders (CoRe-ED) brings together researchers, healthcare professionals, people with lived experience, advocates, not-for-profit and industry representatives globally to advance understanding and treatment of eating disorders. CoRe-ED hosts a range of freely accessible (online) resources and events to support collaboration across these communities. Free registration is available for those interested in connecting with this community.

 

References

Ali, K., Farrer, L., Fassnacht, D. B., Gulliver, A., Bauer, S., & Griffiths, K. M. (2017). Perceived barriers and facilitators towards help-seeking for eating disorders: A systematic review. International Journal of Eating Disorders, 50(1), 9-21. https://doi.org/https://dx.doi.org/10.1002/eat.22598

Austin, A., Flynn, M., Richards, K., Hodsoll, J., Duarte, T. A., Robinson, P., Kelly, J., & Schmidt, U. (2021). Duration of untreated eating disorder and relationship to outcomes: A systematic review of the literature. European Eating Disorders Review, 29(3), 329-345. https://doi.org/10.1002/erv.2745

Bye, A., Shawe, J., Bick, D., Easter, A., Kash-Macdonald, M., & Micali, N. (2018). Barriers to identifying eating disorders in pregnancy and in the postnatal period: a qualitative approach. BMC Pregnancy & Childbirth, 18(1), 114. https://doi.org/https://dx.doi.org/10.1186/s12884-018-1745-x

Doley, J. R., Hart, L. M., Stukas, A. A., Petrovic, K., Bouguettaya, A., & Paxton, S. J. (2017). Interventions to reduce the stigma of eating disorders: A systematic review and meta‐analysis. International Journal of Eating Disorders, 50(3), 210-230. https://doi.org/10.1002/eat.22691

Fassino, S., Pierò, A., Tomba, E., & Abbate-Daga, G. (2009). Factors associated with dropout from treatment for eating disorders: a comprehensive literature review. BMC Psychiatry, 9(1), 67. https://doi.org/10.1186/1471-244X-9-67

Geller, J., Fernandes, A., Srikameswaran, S., Pullmer, R., & Marshall, S. (2021). The power of feeling seen: Perspectives of individuals with eating disorders on receiving validation. Journal of Eating Disorders Vol 9, 2021, ArtID 149, 9. https://doi.org/https://dx.doi.org/10.1186/s40337-021-00500-x

Harrop, E. N., Hutcheson, R., Harner, V., Mensinger, J. L., & Lindhorst, T. (2023). “You Don’t Look Anorexic”: Atypical anorexia person experiences of weight stigma in medical care. Body Image, 46, 48-61. https://doi.org/https://dx.doi.org/10.1016/j.bodyim.2023.04.008

Lubieniecki, G., Fernando, A. N., Randhawa, A., Cowlishaw, S., & Sharp, G. (2024). Perceived clinician stigma and its impact on eating disorder treatment experiences: a systematic review of the lived experience literature. Journal of eating disorders, 12(1). https://doi.org/10.1186/s40337-024-01128-3

Phelan, S. M., Burgess, D. J., Yeazel, M. W., Hellerstedt, W. L., Griffin, J. M., & Van Ryn, M. (2015). Impact of weight bias and stigma on quality of care and outcomes for persons with obesity. Obesity Reviews, 16(4), 319-326. https://doi.org/10.1111/obr.12266

Thornicroft, G., Sunkel, C., Aliev, A. A., Baker, S., Brohan, E., Rabih el, C., Davies, K., Demissie, M., Duncan, J., Wubalem, F., Gronholm, P. C., Guerrero, Z., Gurung, D., Habtamu, K., Hanlon, C., Heim, E., Henderson, C., Hijazi, Z., Hoffman, C.,…Winkler, P. (2022). The Lancet Commission on ending stigma and discrimination in mental health. The Lancet, 400(10361), 1438-1480. https://doi.org/https://doi.org/10.1016/S0140-6736(22)01470-2