Updated: Jul 28
What's your image of a person living with an eating disorder? Female, white, and very thin? Let me bust this stereotype about people diagnosed with eating disorders.
Here's what you need to know about eating disorders: Less than 6% of people diagnosed with eating disorders are clinically underweight. Eating disorders come in all shapes and sizes—and there is no one image of a person with an eating disorder. Anyone is at risk.
For cancer survivors, note that experiencing trauma (as in a breast cancer diagnosis), can put you at higher risk for an eating disorder. Additionally, weight stigma, often experienced at a medical visit, is a factor that can lead to an eating disorder.
Eating disorders exist on a spectrum
I'll address the most common ones in this article. Eating disorders often start from disordered eating. Understand that disordered eating patterns exist on a spectrum, from Normal Eating—Dieting—Subclinical Eating Disorder—Clinical Eating Disorder.
Sometimes eating disorders involve eating too much at one time. Other times they result in eating too little. One thing that all eating disorders have in common is the mental health aspect. Eating disorders involve thoughts about food, weight, and body shape, and these thoughts can translate into eating behaviors that can become concerning and detrimental.
Another myth about eating disorders is that it's a lifestyle choice. But eating disorders go beyond normal concerns about health, weight, and nutrition. Eating disorders involve problematic eating behaviors and distorted body image, and often result in serious malnutrition. They can lead to dangerous medical complications of the heart, kidney, liver, brain, lung, gastrointestinal, metabolic, skin, hormone, teeth, blood, and bone. Eating disorders, such as anorexia, has the highest death rate of any mental illness.
Anyone can develop an eating disorder. This means that they affect people of all ages, sizes, ethnicities, abilities, genders, and socioeconomic backgrounds. While disordered eating most often appears in women during the teen or early adult years, many eating disorders affect men and children, and may continue into midlife and beyond. The causes of eating disorders are not clear, but they seem to result from complex interactions between genetic, biological, behavioral, psychological, and social factors.
Dieting is a form of disordered eating. Although disordered eating have fewer physical risks than eating disorders, it significantly impacts your quality of life, body image, and self-worth. Guess what the highest predictor of developing an eating disorder is? It's dieting. In a large study conducted among 14-16 year olds, those who dieted were 5 times more likely to develop an eating disorder than those who did not diet.
If there is one takeaway about eating disorders it’s this: Eating disorders are treatable. There is hope and there is help. Many people recover completely from eating disorders—especially if they get the support they need. Early intervention and prevention is key.
Medical disclaimer: If you are in a crisis, reach a Crisis Counselor on the Crisis Text Line with free, 24/7 support for eating disorders. Text HOME to 741741 to connect with a volunteer Crisis Counselor.
Dieting is the highest predictor of disordered eating
Three most common types of an eating disorder
There are many different types of eating disorders. The three most common in the U.S. include binge-eating disorder, bulimia, and anorexia. Note that it’s possible for one person to experience multiple eating disorders.
Binge-eating disorder is the most common eating disorder in the U.S. It’s when eating feels out of control; like there is no ability to stop. Eating resembles gorging and continues well after the stomach is full. Binge-eating results in feelings of physical discomfort, often followed by guilt, shame, and distress. It can lead to weight gain and related medical conditions.
Bulimia nervosa (binging-purging)
Bulimia nervosa is the second most common eating disorder in the U.S. Bulimia occurs when episodes of binge-eating are followed by purging. Purging is trying to make the binged food leave the body to prevent weight gain (e.g., by making themselves throw up, using laxatives, etc.). People with bulimia may appear to be a larger size, normal weight, or underweight.
Anorexia nervosa is the third most common eating disorder in the U.S. It happens when people avoid or severely restrict food. This often occurs along with a relentless pursuit of thinness and feelings of overweight, even when the affected person is malnourished and underweight. People experiencing anorexia may feel the need to suppress the body’s cravings for food. They may feel a sense of pride or strength from their level of control, self-denial, and perfectionism. Anorexia can become very serious and can be fatal.
Signs and symptoms of an eating disorder
Many people are concerned about their health, weight, and nutrition. This in no way means that there is an eating disorder. One of the main differences is that people with eating disorders become fixated and obsessed with their weight and body shape. People with eating disorders may deny, minimize, rationalize, or hide their symptoms and the seriousness of the disorder.
These disorders may or may not be linked to a person’s current weight or body shape, although weight loss can trigger disordered eating. Simply put, there is more to diagnosing an eating disorder than a person’s appearance—especially due to the mental health component.
Eating disorders can be diagnosed by a healthcare provider using medical history, physical exams, and other tests (e.g., blood, urine, electrocardiogram, kidney function, etc.). Different eating disorders have different signs and symptoms.
Signs of binge-eating disorder include:
● Uncontrollably eating very large amounts of food in a short period of time
● Eating when not hungry or after feeling full
● Eating very quickly
● Continuing to eat until fullness becomes uncomfortable
● Eating alone or in secret
● Feeling distressed, ashamed, or guilty about eating
● Frequently going on diets
Symptoms of bulimia nervosa can include any of the binge-eating symptoms above, plus one or more of:
● Purging (making oneself throw up, or using laxatives, diuretics, diet pills, or enemas)—and the frequent bathroom trips and medications associated with this behavior
● Participating in intensive and excessive exercise
● Periods of fasting
Signs of anorexia nervosa include:
● Skipping meals or eating very small amounts of food during meals
● Repeatedly weighing themselves and a profound fear of gaining weight
● Participating in intensive and excessive exercise
● Extreme thinness and low body weight
● Denial of the seriousness of very low body weight
Eating disorders are often associated with mental health challenges such as mood disorders, depression, anxiety, obsessive-compulsive disorder, impulse control disorder, and/or substance use.
Other types of an eating disorder
It's important to note that other types of eating disorders can be diagnosed as well.
For example, an eating disorder that often appears in a pediatric or neurodivergent population is called Avoidant Restrictive Food Intake Disorder. This eating disorder leads to extremely limited food choices, but unlike other disorders, is not based on body image concerns.
In addition, although not considered a clinical eating disorder, Orthorexia, or an obsession with healthy eating, is associated with restrictive behaviors. The attempt to attain optimum health through attention to diet may lead to malnourishment, loss of relationships, and poor quality of life.
When and where to get help for an eating disorders
Make no mistake, there is help!
Remember that no one chooses to have an eating disorder. If at any point, it feels that thoughts and behaviors about food, weight, and body shape are taking over one’s life, it’s time to seek out help.
According to the National Institute of Mental Health, fewer than half of those affected by binge-eating disorder, bulimia, or anorexia seek help—and I want to help change that.
The goals of treating an eating disorder are to restore physical and mental wellness. This may include:
● Restoring optimal levels of vitamins, minerals, and other nutrients
● Gaining a healthful weight
● Ensuring exercise is at a level that promotes health
● Stopping binging and/or purging behaviors
How are these goals achieved? Eating disorders may be successfully treated in many different ways. They may involve one or more of: medical care, medicine, psychotherapy, and/or nutritional counseling.
Eating disorders may cause medical complications of the heart, kidneys, liver, etc. If medical symptoms or abnormal test results are found, those may be treated.
Depending on symptoms, people with eating disorders may be treated with medications that can also help with weight management, mood disorders, or other conditions related to the disordered eating.
Psychotherapy (talk therapy) may involve individual, group, or family counseling. This can help to identify and change negative thoughts and behaviors about food and weight. Psychotherapy can also help to build coping skills to manage situations that trigger disordered eating. This may involve cognitive behavioral therapy or other types of counseling.
If an eating disorder is diagnosed or suspected, it’s very important to get professional nutrition counseling. An effective nutrition strategy must be personalized to achieve optimal nutrient levels, and to promote healthy eating habits. This is why building a team that includes a registered dietitian skilled in eating disorders, is necessary for successful treatment.
Methods such as intuitive eating can help repair the relationship with food, and physical and mental health. Intuitive eating also lowers levels of disordered eating.
Eating disorders are treatable
Eating disorders are serious health concerns that can be successfully treated. Whether they involve binge-eating, bulimia, or anorexia, there is help.
The first step is to reach out to a healthcare professional who can help to confirm whether an eating disorder exists, and if so, which disorder it is. Once an informed diagnosis is obtained, then getting a personalized treatment plan is key. The goal is to restore nutrition, prevent or treat other related medical conditions, move toward a healthier weight, and provided coping skills and behavioral modification for long-term health.
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As a registered dietitian nutritionist who works with people experiencing cancer, I’d love to help. I offer clients support to plan, shop, and prepare more nutritious and healthy meals for yourself or your family. Here is my link to book a chat about making sure to meet your nutritional needs.
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Harvard Health Publishing. (2019, March 13). Anorexia nervosa. https://www.health.harvard.edu/a_to_z/anorexia-nervosa-a-to-z
Harvard Health Publishing. (2022, December 1). Eating disorders in midlife. https://www.health.harvard.edu/womens-health/eating-disorders-in-midlife
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MedlinePlus. (2022, April 30). Bulimia. https://medlineplus.gov/ency/article/000341.htm
National Institute of Mental Health. (2021). Eating disorders: About more than food. https://www.nimh.nih.gov/health/publications/eating-disorders
National Institute of Mental Health. (n.d.). Eating disorders. https://www.nimh.nih.gov/health/statistics/eating-disorders
National Institute of Mental Health. (n.d.). Let’s talk about eating disorders. https://www.nimh.nih.gov/health/publications/lets-talk-about-eating-disorders