S1120 Provider-Prescribed Restrictive Diets in Patients With Eating Disorders Presenting for GI Care

Introduction: Despite increasing evidence and patient demand, restrictive diets for gastrointestinal (GI) disorders may be harmful in those with comorbid eating disorders (EDs). We sought to assess the rate of provider-recommended restrictive diets among those with ED diagnoses seeking GI care and compared the proportions of patients receiving restrictive diets with preexisting ED diagnoses to those with subsequent diagnoses. Methods: Using a preexisting cohort of 610 patents with GI consults and ED diagnoses, we selected patients with confirmed ED and GI diagnoses and diagnosis dates. We used systematic chart review to determine whether patients were prescribed a restrictive diet within 12 months of initial consult as well as diet type, provider subspecialty, and types of ED and GI diagnoses. Proportions of patients with an ED diagnosis before or after GI consults were compared with Chi-square tests. Results: From a cohort of 610 patients, we found 286 patients meeting our inclusion criteria. Of the 286, 53 (18.5%) were prescribed restrictive diets within 12 months of their GI consult, with 50 (94.3%) by a GI provider. Of these 50 patients, 60% were prescribed a restrictive diet despite a preexisting ED history (66.1% of the 286 had preexisting EDs) compared to 40% who had a subsequent ED diagnosis. Those with a preexisting ED were less likely to get a restrictive diet compared to the overall population (60% with preexisting ED vs 66.1% in the overall cohort, P < 0.0001). Twenty of the 50 had a primary structural GI diagnosis while 30 had a primary functional GI diagnosis. The most common primary GI diagnosis was gastroesophageal reflux disease (20%), followed by FD/Gastroparesis (18%) and IBS (18%). The most common ED diagnosis among these 50 patients was EDNOS (36%), followed by anorexia nervosa (30%) and bulimia nervosa (22%). The most prescribed diets were low lactose/dairy (22%) and low fat (22%), followed by gluten-free (20%) and low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (20%). Of the 50 diets prescribed by GI providers, most were prescribed by general GI (66%) and neurogastroenterology (24%), but also by hepatologists, IBD specialists and advanced endoscopists. Conclusion: We found that almost 20% of patients with EDs presenting for GI evaluation were prescribed a restrictive diet—the majority of whom had preexisting ED diagnoses—despite the potential risk of reactivating underlying harmful cognitions around eating in ED patients. While recent guidelines advise against this practice, further provider education on identifying those at risk for disordered eating is warranted.