Interview Contributed By: Jennifer L. Gaudiani, MD, CEDS
What drew you to the field of eating disorder treatment? Why?
I had family and friends with eating disorders growing up. Watching their struggles made a big impression on me. So did their joy when they found great treatment team members to connect with. I’m the oldest of three sisters, the mother of two young daughters, and a feminist who rejoices in the successes of women in my life, and growls fiercely at their societal barriers to happiness and wellness.
I went into internal medicine after medical school because I enjoy teaching people about their bodies and helping them find a way to understand what’s happening to them in the context of their own lives. During my internal medicine residency, I chose not to go on to subspecialize because I continued to like treating the whole person.
I took my love of general medicine to the field Hospital Medicine (taking care of adults while they are hospitalized) as I thought it would give me the best chance of having long, unrushed conversations with patients without keeping anyone waiting in a waiting room.
I joined the Hospital Medicine staff at Denver Health Medical Center in 2007 and had worked here for a year when I got an email from Dr. Philip Mehler (whom I knew at the time was the head of our hospital system, but didn’t know was also the world expert in the medical complications of eating disorders), asking if anyone wanted to help him open up the nation’s only medical stabilization program for patients with severe anorexia nervosa.
He envisioned bringing multidisciplinary expertise to the definitive stabilization of patients with anorexia nervosa, when they were too medically compromised to start treatment at even inpatient/residential eating disorder programs. I volunteered immediately, and my career changed forever.
What keep you in this work, day after day?
I adore my ACUTE patients (or ACUTies), men and women 17 and up who need our level of care prior to proceeding to IP/res. I get to have long conversations with them, getting to know them as a complete person, helping motivate them when times look dark, and I hope assisting in their motivation for treatment and recovery by using objective evidence of their body’s suffering to break through the distortion that they are “fine” and don’t need to recover.
This has been a theme that strongly permeates my message when I give talks to treatment professionals as well. My team is amazing, and it’s joyful to see them do their work every day. We support each other and lift each other up. I learn absolutely every day from my patients and my team.
It’s been joyful as well to form relationships with eating disorder programs around the country with whom I get to share patients on a regular basis, and who create the “national village” of eating disorder professionals.
Ultimately, seeing my ACUTE patients work so hard to achieve medical stability, then go on to work in depth on the emotional side of their disorder, and write me to tell me about how things are going…that’s what keeps me in this work.
What is your philosophy on eating disorder treatment?
Of course I can only comment on the medical stabilization side of eating disorders, as I leave the crucial mental health work in subsequent stages of treatment to the experts of those arenas.
My personal philosophy on the way I treat my own patients is to bring an authentically loving, enthusiastic, evidence-based, and straight-talking manner to the bedside. As I said above, I believe strongly as an internist in emphasizing the ways each patient’s body is responding poorly to starvation or purging, in order to motivate change.
The distortions that afflict my patients and make them believe they are “fine,” haven’t pushed the eating disorder far enough, aren’t worthy or “sick enough” for treatment, all are my enemy, and so I try to empower the patient’s own healthy voice with responses based on objective evidence.
I’m not afraid to provide structure and rigor in my treatment plans (any of my former patients reading this will probably laugh in agreement at that: when it’s time for a calorie increase, it’s time for a calorie increase and it’s not a democracy). I also learn about my patient as a complete person:
- What motivates her?
- What triggers her?
- What does she have to live for?
- What keeps her sick?
- What are her most wonderful positives?
- What knocks her off recovery?
- How can I best support her?
Ultimately, the medical side of eating disorder treatment has a long way to go. I’m super proud of the clinical, research, and outreach teaching work we do on ACUTE, but we’re still learning every day…and the primary care providers and emergency room clinicians have a lot of catching up to do to support and not accidentally hinder patients in their recovery.
I’d like to be a part of improving that whole medical system.
What tools would you like your participants to gain while working with you?
Medically, I want each patient to achieve our transparent criteria that define what we call “definitive medical stability,” which goes well beyond a bag of IV fluid and some potassium. A patient is considered ready to transfer to the IP/res level of care when he or she: is consuming between 2200-3000 kcal/day in meals and snacks (we don’t really do tubes on ACUTE unless we have to medically. We can, but it’s better for someone to eat than tube), sufficient to be slowly and steadily gaining lean body weight, has normal or nearly normal laboratory values, is having regular bowel movements, has little volume overload (edema, or water weight), and is physically strong enough to engage in IP/res treatment.
Emotionally, I hope every patient leaves ACUTE with a renewed sense of confidence that they actually can begin to recover, that they aren’t “beyond help” or with insurmountable medical issues that make recovery impossible.
I hope they carry a refreshed sense of themselves as a loveable person, emerging from the family/friend/co-worker fear and disappointment that surrounds a severe eating disorder initially or in relapse, and connecting with the glow of accomplishment. And I hope they have a stronger “healthy voice” grounded in medical awareness which can more ably talk back to the eating disorder voice when times get tough.
What do you envision the future of eating disorder treatment to be like?
For ACUTE, I hope we continue to grow and can serve even more of the many patients out there who have medical complications of their eating disorder that are getting in the way of recovery.
For eating disorder treatment particularly, I hope that medical professionals can get better at treating eating disorder patients at all stages of the disease. And broadly speaking, as a feminist, sister, mother, daughter, and friend, I hope we find ways to support (not undercut) each other’s successes, challenges, health, general wellness, and joy in life.