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

TL;DR

This study explores how primary care providers in California manage adolescent eating disorders and identifies training needs to improve their care.

Contribution

The study provides new insights into the challenges and training needs of primary care providers in managing adolescent eating disorders.

Findings

PCPs face structural barriers like limited mental health resources and time constraints in treating eating disorders.

PCPs requested training on prevention, ongoing management, and addressing psychological symptoms like negative body image.

Providers prefer self-paced, asynchronous training to better accommodate their schedules.

Abstract

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.

The online version contains supplementary material available at 10.1186/s40337-025-01412-w.

Primary care physicians (PCPs) often serve as a first point of contact in identifying eating disorders in adolescents, and frequently remain involved in an adolescent’s eating disorder treatment. Despite their central role, PCPs typically receive very little eating disorder training. This study interviewed PCPs in California about their perspectives and experiences providing care to adolescents with eating disorders, to ultimately inform a larger goal of developing training materials about eating disorders for PCPs. In their interview responses, PCPs described several challenges to caring for adolescents with eating disorders, including limited mental health referral resources and time constraints. They requested training on preventing eating disorders in youth, managing eating disorders on an ongoing basis, and addressing psychological eating disorder symptoms, such as negative body image. They also indicated that a self-paced eating disorder training would be most accessible for them.

The online version contains supplementary material available at 10.1186/s40337-025-01412-w.