Eating disorders among doctors: How to protect against them?

Shoemakers are often the worst shod, the saying goes, and it seems that this adage applies to health professionals. Although the literature is still thin on the subject of doctors' diets, the few available data are striking, suggesting health professionals are “at high risk of developing eating disorders." The report comes from the Hédi Chaker University Hospital in Sfax, Tunisia, published in October 2023 in Annales d'Endocrinologie. It establishes that 24.6% of the health professionals observed were “at high risk of developing eating disorders." A history of chronic illness was a main risk factor, as well as abnormal perception of body image and disordered eating behaviour, such as exercising more than an hour a day to lose weight or control one's figure.The findings do not surprise Sandrine Geoffrion, nutritionist, member of the Order of Dietitians-Nutritionists of Quebec. “Certain psychological traits that are fairly widespread among health professions may be linked to the appearance of eating disorders: perfectionism, anxiety disorder and performance anxiety, all linked to a stressful work environment, heavy schedules and a great emotional charge.”Diet culture deeply rooted, even among doctors“Stereotypes linked to the credibility of a health professional based on their physical appearance are well-documented,” said Geoffrion. Being thin and sporty will be well-regarded, especially among women.” The nutritionist reminds us that a person who does not meet the weight standards can also suffer from disordered eating. “Fatphobia and clichés lead to many false beliefs, including among doctors, who can associate good health with weight and BMI.” Beyond the diagnosis of an eating disorder, some introspection seems necessary: What is your relationship with food? Do you take the time to eat, if possible? What foods do you favour during your shifts? “The most important thing is to adopt a caring, guilt-free approach that allows us to not be perfect. It’s even more important among doctors, who don’t really have the right to make mistakes," said Geoffrion. "Otherwise, food will take up too much space and will have an impact on our mental and social health, and possibly on the way we treat our patients.”Here are some tips for approaching your shifts, and especially the meals or snacks that accompany them.The risks of night hours“Changes in schedules can be difficult, going from a night shift to a day shift or doing double shifts,” the nutritionist said. "The state of knowledge on eating behaviours among hospital workers is surprisingly limited, even though many of them are affected by night shifts.” Indeed at night, our body is out of sync with our circadian rhythm, which can in the long term, be harmful to its functioning—cardiovascular disease, type 2 diabetes, weight gain, etc. “Weight gain can affect our relationship with food and can make us fall into diet culture, into orthorexia, an obsession with healthy eating.”Read: What is body dysmorphic disorder?In addition to the general recommendations for a healthy diet—more fruits and vegetables, fewer processed foods, whole grain foods and more plant proteins—it is important to adapt your pace to these difficult schedules. “Have a more substantial lunch before leaving home, for example, rich in good fat, then during the night eat slightly lighter but protein-rich meals, supplemented with snacks, because it is possible to have more difficulty digesting fat during at night,” said Geoffrion.“When you come home from work, if you are hungry, it is important to eat before going to bed, because sleep is essential. If you go to bed on an empty stomach or if you eat too much fat, it could disturb it. You can also plan a snack to eat on the way home, to avoid being hungry when you get home.” Eating meals with othersIn addition to giving pride of place to plants to supprt digestion and thereby one's general functioning, don't forget to hydrate. “Often, we have less time to hydrate during a shift, or do not feel thirsty, but we must maintain the habit of drinking. Favour water, herbal teas, low-caffeine drinks. Avoid juices and sugary drinks as much as possible,” Geoffrion recommended. What about coffee? It often seems impossible to function without it, especially on night shifts. The recommendation is to not exceed two or three cups per day and to avoid it at least four hours before bedtime. Working conditions at night are also difficult in that staff numbers are small and restauranta are often closed. But it is always essential, as much as possible, to eat meals with others, even if you only have five minutes. “The social aspect of food is very important. It's essential to stop to eat and to do so in good company: Try to find colleagues with whom you can sit, when possible. It could also be a way to encourage each other to get out of the ambient stress—unless the conversation is toxic and concerns weight loss or diets,” cautioned Geoffrion. “The community is a positive factor in encouraging each other to cook, bringing food for the whole team and sharing our favourite recipes."Stressful times can lead us towards sweet or fatty comfort foods. From time to time, these can be part of a healthy diet, but it should be far from the only stress management technique healthcare workers use. Eating well at work, a political questionBut (fortunately) everything doesn’t depend on you! Your establishment and your employers also have their role to play in providing you with a caring working environment, even at night. “We must move away from the discourse of individual responsibility,” said the nutritionist. "Obviously, we are responsible for our choices, but we also need to rethink working conditions. Long shifts without breaks, lack of access to meal places at night or early in the morning—in general the cafeterias are closed and we will turn to fast food or delivery services. We need fridges to store our lunches, vending machines that offer something other than sandwiches, chips and chocolate.”Read: Sleepy residents: Embrace fatigue-proofing strategies for safer careGeoffrion gives the example of the CHU Sainte-Justine in Montreal, which offers refrigerated meals approved by the union to all employees. She is convinced, “political actions can be taken. The (Quebec) Commission for Standards, Equity, Health and Safety at Work (CNESST) does not talk about risks or food availability at work. We need a real cultural change to protect night workers.”Raising awareness among future health professionals at school is also an important lever for action. “Nutrition is a complex subject, that’s why we exist,” said Geoffrion. A student from the Faculty of Medicine at the University of Alberta, for example, launched culinary medicine courses which are now very successful. Know how to call for helpBut beyond nutrition, it is essential to train students on eating disorders and their triggers, weight perception, BMI limits and the consequences of fatphobia. “Many factors influence eating behaviours and weight, starting with the socio-economic environment. We must not stigmatize our population. Everyone knows that you need to eat more fruits and vegetables to be healthy, but the real question is why don't people do it? This requires more than simple advice, which can sometimes do a lot of harm.” Finally, even as a health professional, never hesitate to ask for help: “You should not be ashamed to go and consult a colleague. We are faced with patients with eating disorders, but we are also at risk of developing them. We must not trivialize them, but rather try to be as empathetic with ourselves as with our patients.”

Eating disorders among doctors: How to protect against them?

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