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

Publication Number: 587.3674

Katherine E. Spanos, Pennsylvania State University College of Medicine, Hershey, PA, United States; Tonya Wright, Penn State Children's Hospital, mechanicsburg, PA, United States; Christina DeAngelis, Residency Program Director, Penn State Health Hershey Medical Center, Hershey, PA, United States; Jamal Essayli, Penn State College of Medicine, Hershey, PA, United States

Background: Anorexia nervosa (AN) and atypical anorexia nervosa (AAN) are eating disorders (EDs) characterized by extreme restriction of energy intake. In contrast to AN, those with AAN are not underweight, yet can still have dangerous symptoms resulting from malnutrition. Individuals with either AN or AAN can experience associated functional hypothalamic amenorrhea (FHA) that may prompt them to seek gynecologic care.

Objective: Little is known about OBGYNs’ knowledge of AN and AAN and their approach to patients of different body weights with secondary amenorrhea. This study sought to fill this gap through a survey of OBGYNs.

Design/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 eating disorders 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 thoughts 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(s): 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.

Figure 1a: Ranked Diagnoses for Low BMI Vignette
Legend indicates answer options presented to participants: FHA = Functional hypothalamic amenorrhea. Anovulatory = Normal anovulatory cycles. PCOS = Polycystic ovarian syndrome. Thyroid = Thyroid abnormalities. Pituitary = Pituitary tumor.

Figure 1b: Ranked Diagnoses for Normal BMI Vignette
Legend indicates options presented to participants: FHA = Functional hypothalamic amenorrhea. Anovulatory = Normal anovulatory cycles. PCOS = Polycystic ovarian syndrome. Thyroid = Thyroid abnormalities. Pituitary = Pituitary tumor.

Table 3: One-Way ANOVA with Contrast, Assessment of Amenorrhea by Weight, n (%), N=115
Answer responses on five-point frequency scale assigned numeric value: Never=1, Rarely=2, Sometimes=3, Very Often=4, Always=5.