Managing adolescent eating disorders in primary care: a qualitative study of provider perspectives

Primary care providers (PCPs) serve a critical role in the identification and treatment of adolescent eating disorders (EDs); yet, few PCPs receive ED training. Without this training, PCPs are not well-equipped to deliver optimal care. Partnering with PCPs is essential to understanding and ameliorating the challenges they face in managing EDs within the primary care setting. This study seeks to explore PCP practices and priorities in the detection and treatment of adolescent EDs to ultimately inform a brief curriculum about EDs for PCPs.

PCPs in California (N = 10) participated in individual, semi-structured interviews focused on a needs assessment, including top priorities in their clinical care setting, current practices around screening and treating EDs, and areas of need around EDs. A multi-step, qualitative thematic analysis process was used to identify and name primary latent themes and subthemes that included both a priori interview content areas and themes uncovered in the data review.

PCPs described structural barriers and resource constraints to supporting ED patients in primary care. Regarding areas for further training, PCPs requested guidance on when to refer to a higher level of care, how to prevent EDs in vulnerable youth, and how to address psychological ED symptoms (e.g., negative body image). Providers reported directly encouraging adolescents with EDs to increase their nutrition, as opposed to utilizing a parent-led approach.

This study adds to the limited literature on the experiences of PCPs in identifying and managing EDs in adolescents. Future research can develop and evaluate strategies for integrating ED screening measures and interventions into PCP workflows, as well as targeted, asynchronous ED training programs for PCPs.