Garcia Moreno Natalia, Walker D Catherine, Gullo Nathalie, O'Dea Conor J
Union College, Schenectady, New York, USA.
Washington University in St. Louis, St Louis, Missouri, USA.
Int J Eat Disord. 2025 Apr;58(4):690-702. doi: 10.1002/eat.24374. Epub 2025 Jan 13.
There is limited research on weight bias in diagnosing eating disorders (EDs), particularly among healthcare professionals (HCPs). This is especially true for atypical anorexia nervosa, a diagnosis recently described in the DSM that includes people with anorexia nervosa symptoms who are not clinically underweight.
Using a within-subjects design, we assessed diagnosis, diagnostic confidence, and ED-related medical knowledge among a sample of lay people and medical professionals. Participants read three clinical vignettes (counterbalanced to avoid order effects) of a woman with anorexia nervosa or atypical anorexia nervosa (described as obese) and were assessed on weight stigma and prior ED medical knowledge.
Both lay people and HCPs were less likely to diagnose atypical anorexia nervosa and were less confident in that diagnosis than in the anorexia nervosa vignette condition. Lay participants' diagnostic bias, but not HCPs', was impacted by weight stigma; HCPs' confidence was impacted by weight stigma. In both cases, participants high in weight stigma were more accurate (lay sample) or more confident (HCPs) in diagnoses. Last, greater ED medical knowledge improved accuracy of diagnosis of vignette cases for the HCP sample that included snowball sample recruitment and CloudResearch participants and lay people, but not for the HCP sample recruited via snowball sampling only.
These findings highlight the urgency for more public awareness and training for HCPs emphasizing that people of all sizes can present with restrictive eating disorders.
关于饮食失调（EDs）诊断中体重偏见的研究有限，尤其是在医疗保健专业人员（HCPs）中。对于非典型神经性厌食症来说尤其如此，这是一种最近在《精神疾病诊断与统计手册》中描述的诊断，包括有神经性厌食症症状但临床上体重未减轻的人。
采用被试内设计，我们在非专业人士和医学专业人员样本中评估了诊断、诊断信心和与饮食失调相关的医学知识。参与者阅读了一名患有神经性厌食症或非典型神经性厌食症（描述为肥胖）女性的三个临床 vignette（进行了平衡以避免顺序效应），并在体重污名和先前的饮食失调医学知识方面接受评估。
非专业人士和医疗保健专业人员诊断非典型神经性厌食症的可能性都较小，并且对该诊断的信心低于神经性厌食症 vignette 情况。非专业参与者的诊断偏见受到体重污名的影响，但医疗保健专业人员不受影响；医疗保健专业人员的信心受到体重污名的影响。在这两种情况下，体重污名程度高的参与者在诊断中更准确（非专业样本）或更有信心（医疗保健专业人员）。最后，更多的饮食失调医学知识提高了包括雪球样本招募和 CloudResearch 参与者以及非专业人士的医疗保健专业人员样本对 vignette 病例诊断的准确性，但对于仅通过雪球抽样招募的医疗保健专业人员样本则没有提高。
这些发现凸显了提高公众意识以及对医疗保健专业人员进行培训的紧迫性，强调各种体型的人都可能出现限制性饮食失调。
