You notice the signs. You have a clinical suspicion, maybe a strong one. And then comes the part nobody really trained you for: what do you actually say? How do you bring it up without alarming the patient, triggering defensiveness, or watching them nod politely and never follow through?
Why Referrals Fail (And Why It Matters)
The way a referral is made matters.
This makes sense when you think about what a patient with an eating disorder is usually carrying into that appointment. Shame about their eating behaviors. Fear of what treatment will require. Ambivalence about whether they actually want to change. Sometimes years of keeping this hidden. A vague directive to “see a specialist” doesn’t cut through any of that. It floats past the patient and lands nowhere.
A warm, specific, well-structured referral is something different. It meets the patient where they are and gives them something to hold onto after they leave your office.
Here’s how to make one.
Step 1: Name the Concern Clearly
The first thing a warm referral requires is honesty. A observation stated with care, but stated plainly.
Many providers soften their language to the point of ambiguity. “I just want to make sure you’re getting the right support” or “it might be worth talking to someone” doesn’t communicate clinical concern. It communicates uncertainty. And patients who are ambivalent about their eating disorder will find every reason to hear it as optional.
Naming the concern clearly sounds more like: “I’m worried about some of what you’ve described about your relationship with food. I think what you’re experiencing is an eating disorder, and I’d like to connect you with someone who specializes in this.”
Direct. Compassionate. Not alarmist, but not vague. The patient leaves knowing you saw something real.
Step 2: Explain What Specialized Care Can Offer
“Go see a specialist” tells a patient where to go. It doesn’t tell them why, and for someone who is ambivalent about treatment, the why is everything.
A patient who understands what specialized eating disorder care actually involves is far more likely to follow through than one who is imagining something abstract and probably frightening. So take a minute to explain it:
“An eating disorder specialist can help you understand what’s driving these patterns, work with you on building a healthier relationship with food, and coordinate with your medical care as needed. It’s not about being told what to eat, it’s about understanding why food has become so loaded, and what to do about it.”
This step also gives you the opportunity to normalize treatment. Many patients assume that eating disorder care is only for people who are “sick enough” or who look a certain way. Correcting that assumption directly removes one of the most common reasons patients talk themselves out of following through.
Step 3: Address the Ambivalence
Ambivalence is not a personality flaw or a sign of low motivation. It is a clinically expected feature of eating disorder presentations. Eating disorders serve functions. They provide control, comfort, predictability, identity, and part of the patient knows that treatment will disrupt those functions. Of course there’s hesitation.
If you don’t name that hesitation, it will follow your patient out the door and talk them out of making the call.
Naming it might sound like: “I want to acknowledge that this might feel like a big step. It’s normal to have mixed feelings about it and for part of you want support and part of you feel unsure. That’s really common. It doesn’t mean treatment isn’t worth it.”
You’re not trying to argue the patient into treatment. You’re just acknowledging that the door exists, and that the ambivalence they’re feeling doesn’t have to be the last word.
Step 4: Give a Specific Next Step
This is where many otherwise well-intentioned referrals fall apart: they end with a direction instead of a step.
“You can look into eating disorder treatment in your area” is a direction. It requires the patient ,who is already struggling, potentially ashamed, and almost certainly not excited about this process, to do significant work before anything happens. Many of them won’t.
A specific next step is a name, a number, or a concrete action: “I want to give you the name of a therapist I’d recommend. Here’s her contact information. If you’re not able to reach her, here are the resources in your area.”
The narrower the gap between “yes, I’ll do this” and the first concrete action, the more likely the patient is to cross it.
What This Looks Like All Together
Put these four steps together, and a warm eating disorder referral sounds something like this:
“I want to be honest with you about what I’m seeing. Based on what you’ve shared with me today, I’m concerned that you’re dealing with an eating disorder. I know that might be difficult to hear.
What I’d like to do is connect you with someone who specializes in this. Eating disorder treatment isn’t about being put on a strict diet or being told what’s wrong with you, it’s about understanding why food has become such a source of stress and building a healthier relationship with it, at your own pace.
I also know this might feel like a lot. It’s completely normal to feel uncertain or even resistant to the idea. That doesn’t mean it’s the wrong step. It just means you’re human.
Before you leave today, I’d like to give you the name of someone I’d recommend you contact. And if you want to talk through any of this before you make that call, my door is open.”
That’s a two-minute conversation. It names the concern, explains what treatment offers, acknowledges the ambivalence, and ends with a specific person to contact. It is not complicated. It just requires a little preparation and a willingness to say the hard thing clearly.
A Note on What You Don’t Need to Know
One of the reasons providers avoid making eating disorder referrals is that they feel underprepared. They’re not sure what they’re seeing. They don’t know the difference between diagnoses. They worry about saying the wrong thing.
Here’s what’s worth remembering: you don’t need a confirmed diagnosis to make a referral. You need a clinical concern and a willingness to name it.
What helps is having the skills to hold the conversation. Those are learnable. They’re also exactly what EDPEN’s trainings are designed to build.
EDPEN’s interdisciplinary training programs include specific, roleplay-based practice in eating disorder referral communication — for medical, mental health, and nutrition providers. Learn more at edpen.org →
EDPEN does not provide medical advice. This content is intended for educational purposes for healthcare providers.