Anorexic Patients Research Articles

Clinical study on anorexia in patients with terminal cancer.

Patients with terminal cancer tend to have an increased frequency of a variety of clinical symptoms, including anorexia, at 1 month of life expectancy. This study examined clinical symptoms affecting anorexia in patients with terminal cancer. Of 1068 patients with terminal cancer who died and were discharged from our hospital between April 2014 and March 2016, we included 471 patients whose clinical symptoms could be subjectively assessed within 4 weeks before death.Patients were evaluated subjectively on a scale of 0 to 10 (11-point scale) using the Numerical Rating Scale (NRS) once a week for nine major clinical symptoms: (1) pain, (2) general fatigue, (3) dyspnea, (4) depressed mood, (5) anorexia, (6) insomnia, (7) nausea, (8) constipation, and (9) dry mouth. Primary data within 4 weeks prior to death were used for analysis, and Spearman's rank correlation was used to examine clinical symptoms affecting anorexia. Spearman's rank correlation coefficients between anorexia and the following clinical symptoms were: pain, 0.186; general fatigue, 0.414; dyspnea, 0.15; depressed mood, 0.287; insomnia, 0.327; nausea, 0.297; constipation, 0.215; and dry mouth, 0.204. General fatigue was positively correlated with anorexia. General fatigue may influence anorexia in patients with terminal cancer.

DNA Methylation Signatures Characterize Gene Expression Modulation in Lung Cancer Patients Affected by Anorexia.

The pathophysiology of cancer anorexia is multifactorial and unclear. Transcriptomic analysis from PBMCs RNA showed diverse patterns of gene expression pathways in anorexic cancer patients. We assessed whether the different transcriptomic signatures are modulated by DNA methylation in lung cancer patients presenting with poor appetite. Lung cancer patients and controls were enrolled, and anorexia was assessed by the FAACT-score questionnaire. Genome-wide DNA methylation was determined by Human Infinium MethylationEPIC BeadChip Kit. Data from genome-wide methylation analysis were merged with those from gene expression analysis, previously obtained by RNA sequencing (NGS). Four groups of genes were identified for each comparison: hypermethylated repressed, hypermethylated induced, hypomethylated repressed, and hypomethylated induced. Cancer patients (n = 16) showed 382 differentially methylated genes when compared with controls (n = 8). Anorexic patients (n = 8) presented 586 hypomethylated and 174 hypermethylated genes compared with controls. In anorexic patients vs. non-anorexic (n = 8), 211 genes were identified as hypomethylated and 90 hypermethylated. When microarray methylation data were merged with transcriptomic data by RNA sequencing, we observed significant differences in anorexic patients vs. controls; a total of 42 genes resulted as hypomethylated and induced, 5 hypermethylated repressed, 10 hypermethylated induced, and 15 hypomethylated repressed. The CG sites analyzed by targeted bisulfite NGS in four genes of interest (FLNA, PGRMC1, GNL3L, and FHL1) resulting as hypomethylated in anorexic vs. controls allowed the validation of the data obtained from DNA methylation. Interestingly, the four genes resulted as hypomethylated in anorexic patients vs. non-anorexic patients and vs. controls (p < 0.0001). Our data support that methylation is implicated in cancer-associated anorexia and nutritional derangements among lung cancer patients.

"Terminal Anorexia", Treatment Refusal and Decision-Making Capacity.

Whether anorexic patients should be able to refuse treatment when this refusal potentially has a fatal outcome is a vexed topic. A recent proposal for a new category of "terminal anorexia" suggests criteria when a move to palliative care or even physician-assisted suicide might be justified. The author argues that this proposed diagnosis presents a false sense of certainty of the illness trajectory by conceptualizing anorexia in analogy with physical disorders and stressing the effects of starvation. Furthermore, this conceptualization is in conflict with the claim that individuals who meet the diagnostic criteria for terminal anorexia have decision-making capacity. It should therefore be rejected.

Rikkunshito improves anorexia through ghrelin- and orexin-dependent activation of the brain hypothalamus and mesolimbic dopaminergic pathway in rats.

Rikkunshito (RKT), a traditional Japanese medicine, can relieve epigastric discomfort and anorexia in patients with functional dyspepsia. RKT enhances the orexigenic hormone, ghrelin. Ghrelin regulates food motivation by stimulating the appetite control center in the hypothalamus and the brain mesolimbic dopaminergic pathway (MDPW). However, the effect of RKT on MDPW remains unclear. Here, we aimed to investigate the central neural mechanisms underlying the orexigenic effects of RKT, focusing on the MDPW. We examined the effects of RKT on food intake and neuronal c-Fos expression in restraint stress- and cholecystokinin octapeptide-induced anorexia in male rats. RKT treatment significantly restored stress- and cholecystokinin octapeptide-induced decreased food intake. RKT increased c-Fos expression in the ventral tegmental area (VTA), especially in tyrosine hydroxylase-immunoreactive neurons, and nucleus accumbens (NAc). The effects of RKT were suppressed by the ghrelin receptor antagonist [D-Lys3]-GHRP-6. RKT increased the number of c-Fos/orexin-double-positive neurons in the lateral hypothalamus (LH), which project to the VTA. The orexin receptor antagonist, SB334867, suppressed RKT-induced increase in food intake and c-Fos expression in the LH, VTA, and NAc. RKT increased c-Fos expression in the arcuate nucleus and nucleus of the solitary tract of the medulla, which was inhibited by [D-Lys3]-GHRP-6. RKT may restore appetite in subjects with anorexia through ghrelin- and orexin-dependent activation of neurons regulating the brain appetite control network, including the hypothalamus and MDPW.

Effects of Reflexology on Anorexia and Sleep Quality in Patients Undergoing Chemotherapy: A Randomized Clinical Trial.

Cancer and associated treatment methods present numerous complications, including anorexia and disturbances in sleep patterns. Consequently, the purpose of this study is to examine the impact of reflexology on the symptoms of anorexia and sleep quality among individuals afflicted with cancer. In this double-blinded randomized clinical trial, a total of 60 patients undergoing chemotherapy at Khansari Hospital, Arak, Iran, were selected using convenience sampling and then assigned to two groups of control and experimental using blocked randomization (30 patients in each group). The sample intervention group received reflexology in an exceedingly 4-week amount (two sessions a week), By contrast, the control group was administered a placebo treatment without exerting any pressure on the reflex points during the same time frame. Sleep quality and anorexia in patients were measured using a Pittsburgh questionnaire and visual analog scale before and right after the intervention. Eventually, the data were analyzed, and we used the tests of central tendency, dispersion, independent- and paired-samples t-tests, and Chi-square. The findings of the study revealed a significant improvement in sleep quality and reduction in anorexia symptoms among patients who received reflexology treatment scores (p < 0.001). Conversely, there was no significant difference in the control group before and after the intervention (without pressure effect on the foot points) (p > 0.05). According to the positive effects on sleep quality and the reduction of anorexia symptoms, it is recommended to incorporate this therapeutic modality along with conventional medication for the treatment of individuals with cancer.

A taste alteration-related scale assesses megestrol to improve chemotherapy-induced anorexia.

We evaluated the efficacy of megestrol in improving chemotherapy-related anorexia by analyzing the related scales of taste alteration. We conducted the current study on a group of advanced patients with cancer with two or more chemotherapy cycles. The chemotherapy-induced taste alteration scale (CiTAs) scale helped assess the megestrol effects on basic taste perception, aversive taste changes, unpleasant symptoms, and associated concerns. Furthermore, the Short Nutritional Assessment Questionnaire scale (SNAQ) helped measure the impact of megestrol on malnutrition likelihood in patients experiencing chemotherapy-induced anorexia. The World Health Organization Quality of Life (WHOQOL)-BREF Scale was used to evaluate the quality of life of participants, producing scores related to physical health, psychological well-being, environmental factors, and social relationships. The CiTAs scale assessment indicated that administering megestrol significantly enhanced taste perception among advanced patients with cancer undergoing chemotherapy. Notably, the megestrol group patients showed significantly higher Short Nutritional Assessment Questionnaire (SNAQ) scores than the control group. The megestrol group patients also exhibited higher physiological (PHYS) scores than their control group counterparts. However, this distinction was not statistically significant. The study findings indicate that patients who received megestrol demonstrated significantly higher scores in psychological (PSYCH) and environmental(ENVIR) domains than the control group. Furthermore, megestrol administration was associated with significantly elevated SOCIL and ENVIR levels in patients. The proficient efficacy evaluation of megestrol in enhancing appetite, mitigating malnutrition likelihood, and improving the quality of life of chemotherapy-induced anorexic patients can be achieved through taste-related scales.

Using Natural Language Processing for a Computer-Aided Rapid Assessment of the Human Condition in Terms of Anorexia Nervosa

This paper demonstrates how natural language processing methods can support the computer-aided rapid assessment of young adults suffering from anorexia nervosa. We applied natural language processing and machine learning techniques to develop methods that classified body image notes into four categories (sick/healthy, past tense, irony, and sentiment) and analyzed personal vocabulary. The datasets consisted of notes from 115 anorexic patients, 85 healthy participants, and 50 participants with head and neck cancer. To evaluate the usefulness of the proposed approach, we interviewed ten professional psychologists who were experts in eating disorders, eight direct (first contact) staff, and fourteen school counselors and school psychologists. The developed tools correctly differentiated the individuals suffering from anorexia nervosa, which was reflected in the linguistic profile and the results of the machine learning classification of the body image notes. The developed tool also received a positive evaluation from the psychologists specializing in treating eating disorders, school psychologists, and nurses. The obtained results indicate the potential of using natural language processing techniques for the computer-aided rapid assessment of a person’s condition in terms of anorexia nervosa. This method could be applied as both a screening tool and for the regular monitoring of people at risk of eating disorders.

Attachment, Mentalization, Emotion Dysregulation, and Empathy in Eating Disorders: Comparing Anorexic and Bulimic Patients.

Eating disorders (EDs) represent a wide range of clinical symptoms related to food intake, body image, and weight issues, and include anorexia nervosa-restricting type (AN-R), anorexia nervosa-binge-purge type (AN-BP), and bulimia nervosa (BN). The aim was to investigate the characteristics of attachment, mentalization, emotion dysregulation, and empathy in a sample of 102 patients with EDs. A sample of 102 patients and therapists completed a series of measures for the assessment of ED pathology, mentalization, empathy, and emotion dysregulation. Pearson correlations and analysis of variance were used to test the characteristics of the variables among the groups. In relation to attachment and emotion dysregulation, no significant differences were found. In relation to mentalization, significant difference in good mentalization was found in AN-R subtype compared with the BN subtype. In relation to empathy, results showed significantly lower scores in BN subtype on affective empathy compared with the AN-BP subtype, and in AN-R subtype on cognitive empathy. Finally, we used Z-scores for each item ranked by value (higher to lower) to develop different clinical prototypes for each group. Our results point toward the clinical need to address the assessed variables, specifically mentalization, emotion dysregulation, and empathy, in the diagnosis and treatment of EDs.

Network meta-analysis of the risk of dyspepsia and anorexia in patients with type 2 diabetes mellitus induced by glucagon-like peptide 1 receptor agonist hypoglycemic drugs.

The aim of this study was to investigate and evaluate the risk of dyspepsia and anorexia in patients with type 2 diabetes mellitus (T2DM) induced by glucagon-like peptide 1 receptor agonist (GLP-1 RA) hypoglycemic drugs. We searched papers in PubMed, Web of Science, Cochrane Library, Google Scholar, CNKI, Wanfang, Embase, and VIP databases, and the retrieval time limit was set from the establishment of the database to May 2023. Randomized Controlled Trials (RCTs) were collected in which the subjects were T2DM patients, the intervention was GLP-1RA compared with placebo or traditional hypoglycemic drugs, and the outcome indicators included dyspepsia and anorexia. A meta-analysis and a network meta-analysis were performed. The results of the traditional meta-analysis showed that the risk of dyspepsia and anorexia of total GLP-1 RA was 3.01 and 2.56 times that of placebo, respectively. All types of GLP-1RA were compared with placebo and the results also showed a trend towards increased risk of digestive system adverse events (DSAEs). Among all interventions included, liraglutide was the one with the highest risk of dyspepsia in patients with T2DM, and dulaglutide was the one with the highest risk of anorexia. The results of the two meta-analyses are consistent, and both clearly show that GLP-1RA can increase the risk of dyspepsia and anorexia in T2DM patients.

Thiamine deficiency as a cause of anorexia in terminally ill cancer patients: A case of possible gastrointestinal beriberi.

Anorexia in cancer patients has a variety of causes and impairs patients' quality of life. However, there have been few reports of thiamine deficiency (TD) playing a role in anorexia during palliative care. The objective of this report was to describe such a case. An 82-year-old woman with advanced cervical cancer was admitted for palliative care because of progressive disease. One month after admission, she developed myoclonus on the left side, difficulty speaking, slurred speech, and drooping of the left corner of the mouth, with no consciousness disturbance. She also developed nausea and complained of decreased dietary intake for more than 2 weeks. The patient's thiamine level, which had been measured 2 weeks earlier, was 27 ng/ml, which was below the normal range, and 100 mg of thiamine was administered intravenously. After 2 hours, the patient's neurological findings resolved, and her dietary intake improved from 30% to 40% of meals to 90% to 100%. Subsequently, the patient did not experience similar symptoms, and her clinical course was stable. Based on the patient's clinical course, gastrointestinal beriberi was diagnosed. This case shows that TD may cause anorexia. Many patients who receive palliative care have decreased dietary intake. Consequently, such patients may present with gastrointestinal beriberi, as in the present case. Appropriate diagnosis and treatment may contribute to increasing such patients' quality of life. It may be necessary to differentiate TD from other conditions as a cause of anorexia in patients receiving palliative care.

Mirtazapine versus megestrol acetate in treatment of anorexia-cachexia in advanced cancer patients: a randomized, double-blind trial.

Cancer-related anorexia-cachexia comprises one of the most common syndromes of advanced cancer patients. The management of cancer-related anorexia-cachexia is a great challenge in clinical practice. There are no definite practice guidelines yet for the prevention and treatment of cancer-related anorexia-cachexia. This study is considered to find out whether there is any role of mirtazapine in the improvement of anorexia in cancer patients. A total of 80 cancer-anorexia patients were enrolled. Patients in the trial arm received the standard chemotherapy medication plus one tablet of mirtazapine 15mg daily at night orally for 8weeks starting from the day of an initial assessment. The control arm received the standard chemotherapy medication plus one tablet of megestrol acetate 160mg daily orally for 8weeks starting from the day of an initial assessment. Each patient was assessed by validated versions of Functional Assessment of Anorexia/Cachexia Therapy Anorexia/Cachexia Sub Scale v 4 questionnaires. After 4 and 8weeks each patient was evaluated again using the Functional Assessment of Anorexia/Cachexia Therapy Anorexia/Cachexia Sub Scale tool. The quality of life of each patient was assessed by European Organization for Research and Treatment QLQ-C30 v 3.0. After 4 to 8weeks of treatment, the Functional Assessment of Anorexia/Cachexia Therapy Anorexia/Cachexia Sub Scale score in cancer anorexia patients in the mirtazapine improved anorexia significantly. However, the improvement after 4 to 8weeks was not statistically significant when it was compared with the megestrol acetate (P>0.05). Therefore, the findings of this study reveal that mirtazapine might be a potential alternative to megestrol acetate, as it has shown potential efficacy as like as megestrol acetate.

Analysis of current status and influencing factors of cancer-related anorexia in patients undergoing chemotherapy for gynecological malignancies

Analysis of current status and influencing factors of cancer-related anorexia in patients undergoing chemotherapy for gynecological malignancies

Should Cannabis be Used for Anorexia in Patients With Cancer?

Healthcare professionals are frequently asked about the benefits of cannabis for appetite or anorexia-cachexia syndrome. In popular culture, cannabis has a reputation of causing an increased hunger, slang termed “the munchies,” so many patients consume this with the hope that it may improve the loss of appetite associated with serious illness such as cancer. There have only been a few randomized, controlled trials studying the controversial question as to if cannabis improves appetite. These studies are small and show no statistically significant benefit for appetite and one small study showed improvement of taste for foods. Due to regulation barriers, the studies have use synthetic products, not the products that represent what is more commonly used in the population, often whole flower smoked, vaporized or oral products. Despite the popularity of cannabis in culture, often touted as a panacea for all maladies, the evidence and education for several adverse effects and potential drug interactions have has yet to catch up with the cultural craze. International cannabis experts in the United States and Australia do not routinely certify patients for medical cannabis off trial for anorexia-cachexia, but one expert in Canada would consider use in selected cancer patients.

Evaluation of Anorexia in Cancer and Its Association with Autonomic Nervous System Activity Assessed by Heart Rate Variability

Alterations in the central nervous system in cancer patients are pivotal in determining appetite dysregulation and body weight loss (BWL). Autonomic nervous system activity was tested by measuring heart rate variability (HRV) in cancer patients presenting with anorexia. We considered inpatients with different types of cancer and investigated anorexia using their FAACT scores. HRV was evaluated by a three-channel Holter ECG. The domains of low frequencies (LF, sympathetic activity) and high frequencies (HF, parasympathetic activity) were calculated. Also, SDNN (autonomic activity) and RMSSD (parasympathetic activity) were assessed. We enrolled 56 patients with cancer and 23 controls. In cancer patients, RMSSD and SDNN were lower than in controls (p &lt; 0.001 and p = 0.009). Sympathetic activity (LF nu) was lower in cancer patients than in controls (p = 0.023), including sympathovagal balance (LF/HF nu ratio) (p = 0.025). RMSSD was reduced in anorexic (p &lt; 0.001) and non-anorexic (p = 0.003) cancer patients compared to controls. The SDNN was lower in anorexic cancer patients than in non-anorexic cancer patients (p = 0.025), and it was lower in anorexic cancer patients than in controls (p = 0.001). LF nu was lower in anorexic cancer patients than in controls (p = 0.015), as was LF/HF (p = 0.031). SDNN was negatively correlated with BWL in the cancer group (rho = −0.40; p = 0.007). Our data support the hypothesis that autonomic nervous system dysregulation exists in patients with cancer presenting with anorexia, with implications for its diagnosis and treatment.

Feasibility and acceptability of comprehensive virtual treatment in eating disorders: perspectives from patients, parents and therapists during the COVID-19 pandemic

BackgroundLockdowns and social distancing as a result of the COVID-19 pandemic have brought about the need to continue treatment virtually in patients with Eating Disorders (ED). ObjectiveTo evaluate feasibility, acceptability and adherence to virtual treatment in patients, families and therapists. MethodsFourteen patients, 10 family members and eight therapists from an intensive outpatient program for ED answered online surveys and a SWOT analysis was performed with the responses. ResultsVirtual treatment during lockdown was considered feasible and useful by all respondents. Fear of contagion and the presence of parents in the home were identified as strengths. Parents reported problems with nutritional plan compliance, especially in anorexia patients. Therapists highlighted the importance of methodological adaptations in sessions to improve participation. Adherence to sessions was 100% for family members and 90% for patients. ConclusionsAdaptation to a virtual program is a valid and useful option during lockdowns. It improves family participation, but does not replace face-to-face treatment.

Anorexia assessment using the Simplified Nutritional Appetite Questionnaire and its association with activities of daily living in patients with stroke

ObjectiveThis study aimed to validate the assessment of anorexia in patients with acute stroke using the Simplified Nutritional Appetite Questionnaire. MethodsThis cross-sectional observational study assessed appetite using the Simplified Nutritional Appetite Questionnaire in patients with acute stroke at discharge from an acute care hospital. Additionally, the relationship between the Simplified Nutritional Appetite Questionnaire and Mini Nutritional Assessment, Mini Nutritional Assessment – Short Form scores, skeletal muscle mass, muscle strength, and activities of daily living measured using the Functional Independence Measures for the motor domain was investigated. A multiple regression analysis was conducted with the Functional Independence Measure for the motor domain as the dependent variable and the Simplified Nutritional Appetite Questionnaire and other confounding factors as explanatory variables to evaluate the association between the Simplified Nutritional Appetite Questionnaire and functional outcomes. ResultsAmong the 234 patients with stroke analyzed in this study, the median Simplified Nutritional Appetite Questionnaire score was 15 (IQR = 13–16) points. The Simplified Nutritional Appetite Questionnaire score significantly correlated with weight change, Functional Independence Measure for the motor domain, nutritional assessment index, and energy and protein intake. However, no significant differences in body mass index, muscle mass, or muscle strength were observed. In the multiple regression analysis adjusted for confounders, the Simplified Nutritional Appetite Questionnaire score (β = 0.106; P = 0.007) was independently associated with the Functional Independence Measure for the motor domain (adjusted R2 = 0.662). ConclusionsThis study's results found a significant correlation between Simplified Nutritional Appetite Questionnaire scores and nutritional status as well as an independent association with functional outcomes in patients with stroke. These findings suggest that the Simplified Nutritional Appetite Questionnaire can be a valuable tool for evaluating anorexia in this patient population.

An autopsy case of alpha-fetoprotein-producing large duodenal adenocarcinoma.

We report an autopsy case of a large duodenal adenocarcinoma that produced alpha-fetoprotein (AFP). The patient was a man in his 70s with diabetes mellitus. He presented with epigastralgia and was referred to our hospital. Upper gastrointestinal endoscopy and abdominal computed tomography revealed a large tumor of 11cm in diameter in the descending limb of the duodenum. A tumor biopsy showed poorly differentiated adenocarcinoma. Although his carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels were within the normal range, his AFP levels were significantly elevated (42,078.4ng/mL). Due to vascular invasion, curative resection was not feasible, and chemotherapy was chosen as the treatment option. After gastrojejunostomy was performed to enable oral intake, one cycle of modified leucovorin/5-fluorouracil/oxaliplatin (mFOLFOX6) therapy was administered. However, it proved ineffective, and the patient's anorexia gradually worsened. Ultimately, he succumbed to the progression of cancer cachexia. Autopsy findings revealed a 14-cm-long duodenal carcinoma primarily located in the duodenal bulb, with direct invasion into the stomach, pancreas, and liver. A pathological examination confirmed a diagnosis of poorly differentiated adenocarcinoma with AFP production. Duodenal cancer is rare, and AFP-producing duodenal cancer is even rarer, with only 21 reported cases, including our own. We present this autopsy case of AFP-producing duodenal adenocarcinoma and review the cases reported in the relevant literature.

Bodily self-recognition and body size overestimation in restrictive anorexia nervosa: implicit and explicit mechanisms.

It is widely known that among others, a pervasive symptom characterizing anorexia nervosa (AN) concerns body image overestimation, which largely contributes to the onset and maintenance of eating disorders. In the present study, we investigated the nature of the body image distortion by recording accuracy and reaction times in both a group of healthy controls and AN patients during two validated tasks requiring an implicit or explicit recognition of self/other hand stimuli, in which the perceived size of the stimuli was manipulated. Our results showed that (1) the perceived size of hand stimuli modulated both the implicit and explicit processing of body parts in both groups; (2) the implicit self-advantage emerged in both groups, but the bodily self, at an explicit level (perceptual, psycho-affective, cognitive) together with the integration and the distinction between self and other, was altered only in restrictive anorexia patients. Although further investigations will be necessary, these findings shed new light on the relationship between the different layers of self-experience and bodily self-disorders.

Clinical and psychodynamic aspects of the therapeutic work with the anorexic personality

A psychodynamic profile at the origin of anorexia was described. In order to provide reliability to the considerations presented, the work made use of a sample of anorexic and depressed patients compared with controls, to whom a series of statistically processed personality tests were administered. This methodology brought to light that anorexic profile originated in childhood (adverse attitudes enacted by the personality of parental figures), interpreted by the child as a refusal of her own (fat) corporeity and the tendency to process information, express emotions and affections, react and act accordingly. These traits characterize the nascent personality and become apparent in adolescence (disesteem, insecurity, immaturity, social isolation, and sexual issues). Therefore, clinical work on the personality and anorexic behavior should aim at understanding the meanings attributed to the food and the body to initiate a correction and change. Such an intervention would tend to facilitate a gradual change in the original feeling and thinking of these dimensions in anorexia.

“You Don’t Look Anorexic”: Atypical anorexia patient experiences of weight stigma in medical care

Eating disorders (ED) and weight stigma pose significant healthcare challenges. Patients at higher weights, like some with atypical anorexia (AAN), may face increased challenges due to weight stigma. This study analyzed patients’ lived experiences with weight stigma in healthcare. Thirty-eight adult patients with AAN completed in-depth, semi-structured interviews regarding healthcare experiences. Guided by narrative inquiry approaches, transcripts were thematically coded. Across the illness trajectory (ED development, pre-treatment, treatment, post-treatment), patients reported that weight stigma in healthcare contributed to initiation and persistence of ED behaviors. Themes included “providers pathologizing patient weight,” which patients reported triggered ED behaviors and relapse, “provider minimization and denial” of patients’ EDs, which contributed to delays in screening and care, and “overt forms of weight discrimination,” leading to healthcare avoidance. Participants reported that weight stigma prolonged ED behaviors, delayed care, created suboptimal treatment environments, deterred help-seeking, and lowered healthcare utilization. This suggests that many providers (pediatricians, primary care providers, ED treatment specialists, other healthcare specialists) may inadvertently reinforce patients’ EDs. Increasing training, screening for EDs across the weight spectrum, and targeting health behavior promotion rather than universal weight loss, could enhance quality of care and improve healthcare engagement for patients with EDs, particularly those at higher weights.