Every 52 minutes, a person dies as a direct result of an eating disorder in the United States (1).
Think about that. Eating disorders account for over 10,000 deaths per year and yet still remain largely in the shadows of public health discourse and are often stigmatized, if not glamorized, in popular culture. Our society’s obsession with diet & wellness culture has normalized disordered eating behavior, blurred the line of what is considered “healthy,” and created a confusing and potentially perilous environment for many.
It’s no wonder a significant segment of the population struggles with some form of disordered eating, we’ve cultivated a potentially fertile breeding ground for full-blown eating disorders.
As with so many other issues today, misunderstanding and misinformation complicate one’s ability to identify a potential eating disorder. For one thing, eating disorders do not always appear as one would imagine and, because of this, they can often go undetected for weeks, months, years, and even decades. Also,
anyone can have an eating disorder. Eating disorders affect people of all races, abilities, genders, ages, socioeconomic statuses, sexual orientations, and ethnicities. Despite popular misconceptions, a person’s body shape or size cannot tell us if they have an eating disorder.
In fact, many people with eating disorders look healthy despite being very ill. Unfortunately, people in larger bodies are half as likely as those at a “normal weight” or “underweight” to be diagnosed with an eating disorder (2). Additionally, people of color are half as likely to be diagnosed with and receive treatment for an eating disorder (3).
While eating disorders can and do affect people across all segments of society…
it is also important to recognize there are biological, psychological, and social risk factors that may contribute to one’s susceptibility of developing an eating disorder. For instance, having a relative with an eating disorder or mental health diagnosis place one at higher risk. Perfectionism, anxiety, and poor body image can also contribute to the development of eating disorders. Additionally, weight stigma, trauma, and participation in athletic activities that place a high emphasis on appearance all can potentially increase the risk of an eating disorder developing.
Raising awareness about eating disorders is an essential first step but recognizing when there is truly an issue can be difficult.
Eating disorders can start out very innocently but very quickly spiral out of control. While there is no clear indicator that can be applied to all, when “healthy” eating behaviors begin to interfere with relationships, socialization, education, work, mood, medical stability, and for children and adolescents, growth and development, that is a sign that there is an issue. Knowing if or when to intervene is definitely key.
Let me outline a few “red flags” that might warrant further attention. It is important to note that none of these signs or symptoms alone indicate an eating disorder. A comprehensive assessment by a trained eating disorder specialist must be done to diagnose this illness.
● elimination of an entire food group or of foods you/your loved one used to enjoy (in the absence of a food allergy confirmed by a physician)
● food rituals (Ex. cutting or tearing food into tiny pieces, using condiments in excess)
● preoccupation with food, weight (ex. eating “clean”, counting calories, weighing/measuring food)
● secretive eating
● excessive exercise
● negative comments about body shape or size
● distorted body image
● isolating oneself at social events and/or with family around meal times
● noticeable changes in weight (up or down)*
● fatigue, dizziness, fainting
● lanugo (fine, soft hair covering the body)
● low heart rate
● cold intolerance
● menstrual irregularities (females)
*This is not always the case and anyone of any size can have an eating disorder. If weight loss occurs in a child or adolescent, growth and development will be impacted and this necessitates immediate intervention.
Because of the potentially life-threatening nature of eating disorders, early detection is crucial.
To find an eating disorder specialist, you can search here to access a directory from the International Association of Eating Disorder Professionals. You can also check the credentials and training of the clinician you’re seeing and be sure that the clinician is health at every size® (HAES®) aligned. A multidisciplinary treatment team including a Registered Dietitian, Mental Health Professional, Medical Doctor, and in some cases, a Psychiatrist is necessary for the most comprehensive treatment. If cost is a factor in seeking treatment, organizations like Project Heal can offer financial assistance to those in need.
It can be extremely difficult to acknowledge a potential eating disorder, whether in yourself or a loved one.
It can be equally difficult to ask for help or know how to help someone in need. Fortunately, it is important to know that eating disorders ARE TREATABLE and HELP IS AVAILABLE. Even though the stigma surrounding the illness still exists, awareness and the treatment of eating disorders have improved substantially over the last few decades.
Unfortunately, some estimates indicate that 70% of those who have eating disorders, still do not get the help they need.
We must continue to raise awareness, not just of eating disorders, but of the potential dangers of the diet and wellness culture that contribute to their prevalence. Additionally, we must finally address the other issues at play including cost, access to specialists, and general knowledge of eating disorders either by the individual experiencing signs & symptoms or someone in their family or friend network. As an eating disorder specialist and Registered Dietitian, I work with adults and adolescents to fully recover and improve their relationship with food and their body. Help is available. Here is a Screening Tool to use if you suspect you or a loved one might have an eating disorder. Getting treatment early, even if an eating disorder has not yet been diagnosed, is possible and will be a life-changing decision.
1. Deloitte Access Economics. The Social and Economic Cost of Eating Disorders in the United States of America: A Report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders. June 2020. Available at: https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/.
2. Nagata, J. M., Garber, A. K., Tabler, J. L., Murray, S. B., & Bibbins-Domingo, K. (2018). Prevalence and Correlates of Disordered Eating Behaviors Among Young adults with Overweight or Obesity. Journal of General Internal Medicine, 33(8), 1337-1343. https://doi.org/10.1007/s11606-018-4465-z
3. Sonneville KR, & Lipson SK (2018). Disparities in eating disorder diagnosis and treatment according to weight status, race/ethnicity, socioeconomic background, and sex among college students. International Journal of Eating Disorders, 51(6), 518–526; https://onlinelibrary.wiley.com/doi/10.1002/eat.22846
About the Author:
Laurie Durham, MS, RD, LD, CEDS-S, is a Master’s Level Registered Dietitian and Certified Eating Disorders Specialist with over 2 decades of experience and has a passion for helping people leave diet culture behind and re-learn how to enjoy food, eating, and life again. She empowers individuals to move beyond maladaptive eating thoughts and behaviors and regain the ability to trust internal appetite cues, without guilt. Laurie seeks to meet you where you’re at in the process of learning and making a change.
Education: MS in Medical Dietetics, The Ohio State University, Dietetic Internship, The Ohio State University, BS in Health and Sport Studies, Miami University
Licensure/Certifications: Registered Dietitian #863229, Licensed Dietitian, Ohio, #4801, Certified Eating Disorder Specialist, iaedp™ Approved Supervisor, Be Body Positive Licensed Facilitator