Better training could help health professionals identify and support pregnant women with eating disorders

Physical and emotional changes a woman experiences during and after pregnancy can cause distress, and this is especially true of women with eating disorders. Despite the risks, however, many women's eating disorders go untreated during pregnancy. A new study in BMC Pregnancy and Childbirth explores the barriers faced by both women and health professionals in provision of care of eating disorders during pregnancy.

Eating disorders are mental illnesses characterized by severely disturbed eating behaviors and cognitions that impact on an individual’s health and wellbeing. Research suggests around 7.5% of women are affected with eating disorders during pregnancy and there is an increased risk of pregnancy complications (1, 2, 3). Furthermore, pregnancy can be a difficult time emotionally for some women with eating disorders as they encounter changes to their appetite and body weight and shape that are beyond their control.

Given the increased risks, health professionals need to be able to identify women with eating disorders during and after pregnancy so that they can effectively monitor and support these women in accordance with the clinical guidance.

The stigma of having an eating disorder, as is common with other mental health problems, means women are unlikely to say that they have an eating disorder without being directly asked by a health professional.

We carried out a qualitative study to understand the potential barriers to identifying eating disorders from the perspectives of both women and midwives and health visitors. These health professionals are important as they often have the most contact with women during antenatal and early years’ care.

To identify an eating disorder, health professionals need to be able to enquire effectively with women and likewise women need to openly disclose their difficulties. Health professionals receive little to no training on eating disorders so they may lack the knowledge and understanding to confidently ask women about these difficulties. The stigma of having an eating disorder, as is common with other mental health problems, means women are unlikely to say that they have an eating disorder without being directly asked by a health professional. Thus, eating disorders can go undetected during this time and women will not receive the care and support they may need.

There are two foreseeable approaches that could address these barriers to improve the identification of women experiencing eating disorders during and after pregnancy. Firstly, our research highlights the lack of training resources on eating disorders available for health professionals. This finding has led on to work with King’s College London, funded by The Health Foundation, to translate the research and clinical guidance into practical and engaging training resources for health professionals.

The resources include a short animation film that has been co-designed by women with eating disorders, health professionals and key organisations, such as Tommy’s, Beat and the Institute of Health Visiting. We launched the resources during Eating Disorders Awareness Week 2018 and they are available for free at www.eatingdisordersandpregnancy.co.uk.

Secondly, many public health campaigns have been launched in the UK to raise awareness and reduce stigma about mental health, but eating disorders, and particularly highlighting the experience of pregnant women and mothers, have been missing in these campaigns. Campaigns are needed to specifically target eating disorders during and after pregnancy. Awareness raising activities may empower pregnant women and mothers with eating disorders to be able to talk openly and access support without worrying about negative judgements.

These types of activities that raise both professional and public awareness about eating disorders can help facilitate open and informed discussions between a woman and a health professional, and enables that health professional to be able to plan and deliver tailored care that is responsive to the specific needs of that woman. This type of tailored care could not only improve pregnancy outcomes but also patient experience, which is often as important.

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