Hassan Shariff explores the concept of diet culture and how teams can navigate conversations surrounding eating disorders within the practice environment.
A holistic approach in healthcare means Dental Care Professionals (DCP) often discuss health risk behaviours with patients. Consequently, the same knowledge is frequently relayed and discussed during work hours with team members.
Health information has become readily and easily accessible, particularly content regarding dietary requirements. We should consider if topics we freely discuss, could negatively impact fellow staff members.
This is crucial to the General Dental Council (GDC), who expect their registrants to treat each other fairly and with respect. This encompasses all interactions and all forms of communication, including brief lunchtime encounters.
Diet culture refers to the power of social media in dictating how or what we eat, to reach a specific of socially desirable body type. This phenomenon has become increasingly popular due to the rise of social media technology over the last decade. Subsequently, lunchtime conversations easily gravitate to the discussion of calories and portion sizes.
Whilst these conversations may seem nonchalant or even beneficial, they can have a detrimental effect on members of the population. Here, it is essential to consider that our proximity to team members does not necessarily dictate our knowledge of their personal lives/wellbeing.
Understated statistics
The National Institute for Health and Care Excellence (NICE) states that approximately 700,000 people within the UK suffer from an eating disorder. It is estimated that 90% of this population are women.
However, this is suggested to be an underestimation due to numerous cases failing to present at healthcare services. Research has described adolescents and young adults being most at risk of developing an eating disorder. Binge eating disorder, bulimia nervosa and anorexia nervosa are the three most common conditions in the UK.
NICE report that eating disorder statistics are already understated due to the lack of service user engagement. But this statement becomes further valid for data held on men. The National Eating Disorder Association released data which suggests one in three people struggling with an eating disorder is male.
The National Centre for Eating Disorders (NCED) estimated the gender distribution of these conditions to be as high as 50%. The NCED additionally reported that those who identify as men are less likely to seek assistance, due to existing stigmatisation of these disorders, which result in their categorisation as feminine ailments.
Eating disorder statistics are further likely to be unreliable when considering gender variations. For example, The Scottish Trans Alliance suggested those who are non-binary are less likely to engage with health care services due to a fear of discrimination.
Avoid certain topics
Members of the population who suffer with an eating disorder may not present as severely underweight. Additionally, due to internalised feelings of shame associated with the condition, sufferers often attempt to hide symptoms they are experiencing.
Thus, it is important to consider avoiding topics which exacerbate such conditions or encourage relapse. For example, active conversations regarding portion sizes, exercise, calorie intake, weight loss and weight gain can be detrimental. Particularly when we do not have an in-depth health history of our intended target audience.
In the dental environment, this is essential to consider. Whilst we are in a position to provide holistic advice, patients may not disclose a history of eating disorders, or they may not expect this to be relevant to our field.
It would be preferable to gain the patient’s consent before engaging in such conversations, rather than dictating what we believe is beneficial; this acts in accordance with the GDC’s standards for DCPs.
Safer environments
A similar approach should be considered when liaising with team members. A retrospective review in 2019 suggested that heath conversations can be re-directed towards body acceptance and increasing self-confidence to prevent exposure to unnecessary triggers.
In 2019, an article published for the Canadian Medical Association Journal reinforced this, by stating being exposed to anti-fat/weight bias resulted in physiological signs of stress including cortisol changes. This is due to a psychological internalisation following exposure to weight-bias.
Once again, it was emphasised that conversations should be directed to overall health rather than weight to address health risk behaviours without the risk of ‘fat shaming’.
Inevitably, approaching sensitive topics like these with staff members and patients can be difficult. However, by increasing awareness, environments can be made safer.
Practice managers should consider encouraging team members to engage with CPD programmes focusing on eating disorders. Staff should also have support made available to them, including practice policies which co-ordinate welfare.
Encourage tolerant environment
Patients, on the other hand, should have resources made available to them which are indicative of support/locally available services.
Care should be taken to ensure we are not mis-diagnosing patients with conditions. Leaflets could be placed in waiting rooms providing patients with choice as to whether they wish to engage with this information or not.
To summarise, our words can be influential in ways by which we may not intend. Being aware of this can prevent unnecessary harm and encourage a tolerant environment.
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