Evaluation of Awareness and Attitudes Towards Eating Disorders and the Female Athlete Triad Among Orthopaedic Surgeons

Abstract

Background: Eating disorders (EDs) and the Female Athlete Triad are prevalent in female athletes and contribute to an increased injury risk. These patients are highly likely to present to orthopaedic surgeons. Therefore, it is important to evaluate surgeon awareness and attitudes towards these conditions. We hypothesized that awareness and attitudes would be poor overall, would improve with education and comfort recognizing symptoms, and would vary by surgeon demographic characteristics. Methods: An anonymous survey was sent via email to Maryland members of the American Academy of Orthopaedic Surgeons and circulated via social media. The survey assessed demographics, awareness, behaviors, and attitudes surrounding EDs and the Female Athlete Triad. Attitudes towards anorexia nervosa (AN) and binge eating disorder (BED) were assessed using a clinically validated scale, the Medical Condition Regard Scale (MCRS). Results: 52 surgeons completed the survey. 69% of surgeons reported being aware of or receiving didactic training on EDs, and 87% reported being aware of or receiving didactic training on the Female Athlete Triad. The mean levels of comfort with recognizing the symptoms of AN, bulimia nervosa (BN), and BED were 3.4 ± 1.1, 3.1 ± 1.1, and 2.9 ± 1.0 out of 5.0, respectively. Receiving didactic training was significantly associated with comfort recognizing the symptoms of AN, BN, and BED (p=0.01 for all), likelihood of screening for eating disorders (p=0.04), and number of components of the Female Athlete Triad identified (p<0.001). Comfort asking patients about behaviors increased with comfort recognizing the symptoms of AN, BN, and BED (p=0.001, p=0.01, and p=0.03, respectively). Likelihood of counseling on risks associated with EDs increased with comfort asking questions about eating behaviors (p=0.004). The average MCRS score for AN was 49.9 ± 10.6 and the average MCRS score for BED was 48.4 ± 10.9. Surgeons who were “extremely comfortable” discussing behaviors had significantly higher MCRS scores for AN and BED than those who were “extremely uncomfortable” (p=0.02 and p=0.01, respectively). Conclusion: The results of this study demonstrated moderate levels of awareness of and attitudes towards patients with EDs and the Female Athlete Triad. Effective management of these patients is grounded in thorough screening and formation of a therapeutic relationship, both of which are shown to relate to targeted didactic training. In order to improve care for patients with EDs and the Female Athlete Triad, didactic training that focuses on improving awareness, comfort, and attitudes should be implemented into orthopaedic surgery educational curricula.