Warning Signs of an Eating Disorder

The earlier an eating disorder is detected, the better the chances of recovery are.  In fact, research shows that early identification and treatment result in a quicker recovery, greater reduction in symptoms/health complications and improve the likelihood of long-term recovery while avoiding relapse.  If left untreated, however, eating disorders can become less receptive to treatment and become much more severe (Becker, Franko, Nussbaum, & Herzog, 2004; Fichter, Quadflieg, & Hedlund, 2006).  While only a doctor or other treatment professional can diagnose an eating disorder, there are certain warning signs that you can be aware of in order to start treatment as soon as possible. In this blog post, we will talk about the most common warning signs we see and what to do if you/a loved one may need help. These warning signs vary depending on the type of eating disorder and are not always obvious.

Why Diet Culture Makes It Harder for Eating Disorders to Be Caught Early?

In a society that is obsessed with weight loss and dieting, the very behaviors that constitute disordered eating have not only been normalized, but horrifyingly promoted as well. Since disordered eating is a precursor for eating disorders, it therefore makes it a lot harder to identify eating disorder warning signs.

Diet culture teaches us that our body size is a direct reflection of our worth. That weight gain is bad while losing weight is good. That thinness equals health, wellness and worth, and therefore we should all pursue weight loss at all cost..  This ideology is maintained by the diet culture industry (a 72 billion dollars business!!) which continues to promote incredibly restrictive diets (e.g. Keto, Whole30, Paleo, Intermittent fasting, etc.) and perpetuate the thin ideal 

That said, with diet culture putting emphasis on weight loss and body size, individuals are more likely to turn to disordered eating in an attempt to fit the mold. According to the National Eating Disorders Association, 35% of “normal dieters” progress to pathological dieting and 20-25% of those individuals will go on to develop an eating disorder.  

While individuals with eating disorders exhibit disordered eating, not all disordered eaters have an eating disorder. The difference is in the frequency and severity of the behaviors, as well as the distress these behaviors cause. (to learn more about the difference, visit this post: https://thebalancedpractice.com/2020/02/28/eatingdisordersanddisorderedeating/.)

And no matter if you receive a diagnosis or not, your experience is valid and you deserve to seek support. 

Eating disorders are complex and go far beyond food and weight but they can begin with the diet culture lies that are embedded in our society. We’ve therefore listed some warning signs that can be a pretty good indication of an eating disorder. It is important to bear in mind however that a person does not necessarily need to have all these signs and symptoms at the same time and that this list is not intended as a checklist. 

If needed, please refer to the following blog post for a refresher on what eating disorders are: https://thebalancedpractice.com/2021/01/29/eatingdisorders/

Warning signs

Food

• Restriction of food intake or skipping meals
  • Refusal to eat certain foods/whole food groups (for e.g.  carbohydrates, dairy, sugar)
  • Lunchbox always coming back home untouched
  • Frequent and or chronic dieting
• Evidence of binge eating
  • Consuming large quantities of food in a short period of time (bingeing)
  • Disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food.
  • Stealing or hoarding food
  • Not being able to control when to stop eating, even when full
• Claiming to dislike previously liked foods or pursuing a plant-based diet** (while it is not always disordered eating, it can be a warning sign)
• Chaotic eating
• Not listening to hunger cues
• Preoccupation with food, eating, calories, carbohydrates, and fat grams
• Developing obsessive patterns around eating
• Inflexible eating behaviours and a short list of acceptable foods
• Extreme food pickiness and avoidance of certain foods based on color, texture, taste, smell, food groups, etc.

Mind

• Anxiety around mealtimes and general food anxiety
• Feeling uncomfortable eating around others
• Feeling of not being able to control behaviours around food
• Feelings of shame or disgust associated with eating  
• Low self-esteem
• Having trouble concentrating
• Often expressing strong dissatisfaction with body/appearance, complaining about feeling “fat” or overweight
• Intense fear of gaining weight
• Social withdrawal from friends, family and “normal” activities/routines, especially those involving food or meals
• Often checking oneself in the mirror for perceived flaws in appearanceà
• Obsession with losing or gaining weight quickly or at all
• Obsession with physical appearance and the need to change it

Body

• Menstrual irregularities — loss or disturbance of periods
• Dizziness or fainting spells
• Poor body image/body dissatisfaction
• Feeling cold all the time, even in warm weather
• Feeling tired and having sleep problems
• Low energy and lethargy
• Having an excessive exercise regime despite external factors such as illness, injury, fatigue, and weather
• Evidence of self-induced vomiting including dental problems, (e.g. enamel erosion, cavities, bad breath and tooth sensitivity) and calluses/swelling around knuckles
• Evidence of laxative abuse
• Dry skin and hair, and brittle nails
• Fine hair on body (lanugo) and hair loss
• Wearing layers of clothes to hide weight/weight loss or to stay warm
• Poor growth- drop in growth chart
• Noticeable and frequent weight fluctuations (weight  loss or weight gain) *however, we need to practice extreme caution when we use a person’s body weight to help guide our assessment of eating disorder behaviours
• Evidence of purging behaviours, including trips to the bathroom during or after meals, presence of laxatives/diuretics wrappers, rigid adherence to exercise regime, signs and/or smells of vomiting, etc.

It is important to note that weight is not the only nor the most important indicator when it comes to identifying eating disorders. In fact, as you can see with the warning signs listed above, eating disorders can be characterized by not only physical but psychological and behavioural/social attributes. Additionally, there are certain eating disorder stereotypes surrounding weight that need to be dispelled for e.g. individuals with eating disorders are underweight/thin. As you may or may not know, this is not necessarily true as eating disorders affect people of all body sizes and weights. Appearances are not everything, and solely focusing on weight can make you miss an underlying issue.  

Moreover, we wanted to do a quick section on these eating disorders as they tend to differ quite a bit from the main groups (anorexia nervosa, bulimia nervosa, binge eating disorder and OSFED). The following warning signs are categorized by eating disorders.

Avoidant Restrictive Food Intake Disorder (ARFID)

• Inflexible eating behaviours and a short list of acceptable foods
•  Extreme food pickiness and avoidance of certain foods based on color, texture, tase, smell, food groups, etc.
• Poor growth and weight gain
• Lack of appetite
• Anxiety when “fear” foods are present
• Having trouble chewing food

PICA

• Persistent eating of substances that are not food and do not provide nutritional value over a period of at least one month for example soap, metal, pebbles, paper, hair, ice, chalk, paint, soil, clay, ash, ice, cloth, pebbles, etc. 

Rumination Disorder

• Regular regurgitation of food (re-chewed, re-swallowed or spit out) occurring for a period of at least one month and is not due to a medical condition e.g. GI condition

Conclusion

Eating disorders can affect people of all shapes, sizes, body weights, genders, ages, and cultures. Warning signs are not always obvious and so it is important to not overlook someone who does not necessarily fit the stereotypical image of a person with an eating disorder. Oftentimes, individuals with an eating disorder will continue these behaviours despite severe personal and potentially life-threatening health consequences.

What to do next?

If you’ve identified eating disorder warning signs in yourself or in a loved one, we strongly urge you to seek professional help.  Eating disorder treatments typically involve a multidisciplinary approach which will address the medical, psychological, and nutritional aspects of the illness. To learn more about the Balanced Practice’s treatment approach, you can refer to this page: https://thebalancedpractice.com/2022/01/03/approach/

👉🏼 Another key component to eating disorder recovery and treatment is the involvement of family and support systems as these people know the patient best and play a pivotal role in helping them follow through with treatment recommendations at home.

That said, while eating disorders are complex, with the right approach, recovery is possible.

Written By Kristina Haddad, dietetic intern

Revised by Marie-Pier Pitre-D’Iorio, RD, B.Sc.Psychology
Founder of  The Balanced Practice

References

Becker, Anne & Franko, Debra & Nussbaum, Karin & Herzog, David. (2004). Secondary prevention for eating disorders: The impact of education, screening, and referral in a college-based screening program. The International Journal of Eating disorders. 36. 157-62. 10.1002/eat.20023. 

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National Eating Disorders Association. (2018, February 22). Pica. Retrieved from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/pica

National Eating Disorders Association. (2018, February 22). Rumination disorder. Retrieved from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/rumination-disorder

National Eating Disorders Association. (2019, May 2). Recognizing and resisting diet culture. Retrieved rom https://www.nationaleatingdisorders.org/blog/recognizing-and-resisting-diet-culture

National Eating Disorders Association. (2019, September 3). Why early intervention for eating disorders is essential. Retrieved from https://www.nationaleatingdisorders.org/blog/why-early-intervention-eating-disorders-essential

National Eating Disorders Association. (2021, July 14). Warning signs and symptoms. Retrieved from https://www.nationaleatingdisorders.org/warning-signs-and-symptoms

NEDC (National Eating Disorders Collaboration). (n.d.). Disordered Eating & Dieting. Retrieved from https://nedc.com.au/eating-disorders/eating-disorders-explained/disordered-eating-and-dieting/

Stice, E., Onipede, Z. A., & Marti, C. N. (2021, May 21). A meta-analytic review of trials that tested whether eating disorder prevention programs prevent eating disorder onset. Clinical Psychology Review. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S0272735821000891

WebMD. (n.d.). Anorexia nervosa symptoms: Warning signs to watch for. Retrieved from https://www.webmd.com/mental-health/eating-disorders/anorexia-nervosa/understanding-anorexia-symptoms