Assessing Obstetrics and Gynecology (OBGYN) Clinicians’ Knowledge, Practice, and Attitudes toward Anorexia Nervosa, Atypical Anorexia Nervosa, and Amenorrhea

Study Objective: Anorexia nervosa (AN) and atypical anorexia nervosa (AAN) are eating disorders (EDs) characterized by extreme restriction of energy intake. However, in contrast to individuals with AN, those with AAN are not underweight. Although individuals with either AN or AAN can experience associated functional hypothalamic amenorrhea (FHA) that may prompt them to seek gynecologic care, little is known about obstetricians’ and gynecologists’ (OBGYNs’) knowledge and approach to these patients; this study sought to fill this gap. Methods: A total of 119 OBGYNs read vignettes describing an underweight patient with AN and a normal-weight patient with AAN presenting with FHA. The OBGYNs then responded to items assessing their approaches, knowledge, and attitudes toward patients with amenorrhea and EDs more broadly. Results: The participants ranked FHA as significantly more likely in the underweight vignette than in the normal-weight vignette. The participants reported that they more frequently ask about weight, eating, exercise, and body image in underweight patients with amenorrhea relative to patients who are normal weight or overweight. Overall, the participants demonstrated low knowledge of AN and AAN and reported less familiarity with AAN. Conclusion: OBGYNs may be less likely to identify FHA and assess for an ED in non-underweight patients with secondary amenorrhea. Therefore, patients with AAN having complications of malnutrition may be less likely to be properly evaluated and treated. Future research should investigate educational interventions that aim to improve OBGYN assessment and management of patients of varying weights who have EDs.