Eating Disorders: 5 Warning Signs

In the U.S., about 20 million women and 10 million men have eating disorders, so there’s a good chance someone you know is among them. They range from the more commonly known anorexia nervosa and bulimia to the lesser known binge-eating and restrictive food intake disorder. People who develop them often experience anxiety, low self-esteem and a level of perfectionism that makes them very hard on themselves.

Body dissatisfaction, especially concern about weight, is the strongest predictor of eating disorders. As the person attempts to achieve the perfect weight or shape—which is actually an effort to cope with intense emotions and stress—their relationships can become difficult.

Some people show subtle, early signs of eating disorders. These may include:

1. Withdrawing from family or friends—avoiding situations that cause stress or anxiety. They may isolate themselves by not participating in social functions or activities they typically enjoy.
2. A change in eating habits—eating alone, hiding food, eating slowly, or cutting/separating food into tiny pieces, for example. They might fixate on food and recipes and cook for others while restricting what they eat. There may be a pattern of eating when not hungry, eating to the point of discomfort, and experiencing depression, disgust or guilt after a meal.
3. Body insecurity—negative or obsessive thoughts about body size or shape. It’s also common to obsess over calories or fat content in food. Men may worry about their muscularity and feel the need to “bulk up” or lose weight.
4. Increased focus on body weight or shape—focusing more than usual on dieting or weight loss, possibly with a strict or excessive exercise routine performed even when they’re injured or fatigued. They may persistently worry or complain about being fat or feel they need to lose weight.
5. Changes in appearance—significant or unusual weight loss or fluctuations, which may be the most obvious warning sign. They may deny having a low body weight. Other physical signs include puffy cheeks, knuckle calluses from vomiting, hair loss, dry hair or skin, sensitivity to cold, absent or irregular menstruation, excessive facial or body hair, unusual sleep patterns, or feeling faint or tired. 

If someone you care about has changed their relationship with food, is skipping meals or making excuses for not eating, adopts an overly restrictive diet and/or exercise plan, or focuses obsessively on healthy eating, please consider whether it’s an eating disorder. Express your concerns in a forthright, caring manner. Find a safe, neutral, comforting place for both of you to talk and ask what would be most helpful. The person may deny problems, so it is important to keep the door open for future conversations.

Gently but firmly encourage them to seek professional help and offer to attend the evaluation appointment with them. If it’s your child, talk to your pediatrician or an eating disorder specialist.

Early intervention is critical for reducing the chance of chronic illness.

Mary Tantillo, PhD, PMHCNS-BC, FAED, is director of the Western New York Comprehensive Care Center for Eating Disorders, professor of clinical nursing at the University of Rochester School of Nursing, and founder/CEO of The Healing Connection.