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 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 gynecological care, little is known about 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. OBGYNs then responded to items assessing their approaches, knowledge, and attitudes towards amenorrheic patients and EDs more broadly.

Results: Participants ranked FHA as significantly more likely in the underweight vignette than in the normal weight vignette. Participants reported that they more frequently ask about weight, eating, exercise, and body image in the underweight amenorrheic patient relative to normal or overweight patients. Overall, 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, AAN patients with 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 ED patients of varying weights.