Does My Loved One Need Help?: How to Tell If Someone Has an Eating Disorder

Have you noticed your loved one acting differently around food or their body image? Are they skipping family meals, or avoiding foods that they used to love? Is food going missing from the pantry or have you found them eating in secret? Maybe they’ve made comments about how they “feel fat,” or that they need to go on a diet or start a new exercise regime, even if they appear to have lost weight?

Even if you think it would be obvious, you may not know how to tell if someone has an eating disorder. If you’re concerned for your loved one’s wellbeing, get to know the warning signs of disordered eating so you can find support for them right away. Early intervention is crucial for positive eating disorder treatment outcomes. 

Understanding eating disorder risk

Eating disorders are complex mental health illnesses with very serious physical side effects. Some people are at a greater risk of developing an eating disorder than others. Those at a great risk of developing an eating disorder are those who:

• Struggle with perfectionism and black-and-white thinking
• Have poor body image, low self-esteem, or low self-worth
• Have been teased or bullied about their size
• Engage in sports that emphasize body size (like track, gymnastics, ballet, or wrestling)
• Engage in dieting or intentional weight loss
• Grew up in homes where parents engaged in dieting or had an eating disorder
• Have experienced physical or emotional trauma or abuse
• Have another mental health condition like anxiety, depression, bipolar, OCD, or ADHD 

How to tell if someone has an eating disorder

Changes in food thoughts and behaviors

One indicator that your loved one may be struggling with disordered eating is a drastic change in their eating habits. Ask yourself the following about your loved one’s eating habits:

• Are they suddenly skipping meals? Maybe they say they already ate or that they will be eating at a friend’s house. Or maybe they simply claim they aren’t hungry?
• Do they spend lots of time cutting their food up or moving it around their plate at the dinner table?
• Do they seem to get anxious when you suggest eating out at a restaurant?
• Have they suddenly become a vegetarian or vegan?
• Have they developed strict rules or rituals around eating like only being able to eat at specific times or only if they have exercised that day?
• Do you see them reading food labels more often and choosing foods with lower calories or fat content?
• Have they cut out foods that they used to love?
• Have they stopped eating dinner with the family?
• Have they started eating in secret or hoarding foods?
• Have they started cooking or baking for others without taking part in enjoying what they have made?
• Do they chew their food and then spit it out without swallowing?
• Do they spend a lot of time in the bathroom after meals?
• Are they expressing guilt, anger, or fear in response to eating certain foods?

Changes in exercise thoughts and behaviors

You may think that the changes your loved one has made in terms of physical activity are healthy ones. Yet, while these changes may not be an indication that anything is wrong, it is possible they may be signs of something deeper.

Here are some questions to ask yourself about your loved one’s exercise habits:

• Do they compulsively exercise after eating (meaning do they feel compelled to exercise regardless of time, fullness, energy levels, etc.)?
• Do they get emotional or agitated when they are unable to exercise after a meal or that day?
• Do they spend hours at the gym, when before they disliked sports/physical activity?
• Do they have a rigid workout schedule that is maintained regardless of injury or fatigue?
• Have they made comments about exercising (like needing to “burn off calories,” “earn a meal,” or proclaiming “no days off”)?
• Do they express feeling guilty or ashamed for missing a workout?
• Are they regularly forgoing normal social engagements in favor of going to the gym?

Changes in physical appearance or body image

• Has your loved one lost a significant amount of weight? Regardless of if they started a “normal” or higher weight, has there been a significant or rapid change?
• Do you notice that their hair seems dry, brittle, thinning, or breaking off? Has their skin broken out?
• Do they complain of being cold all the time?
• Have their clothing choices changed to wearing baggy clothes or clothing considered inappropriate for the weather?
• Do they seem preoccupied by their appearance in mirrors or other reflective surfaces?
• Are they constantly checking their body by pinching, squeezing, or pulling at their skin or body fat?
• Are they weighing themselves more often, like multiple times per day or after every meal? Are they upset if you move or throw away the scale?
• Do they think of themselves as “fat” despite others believing they are thin or have lost weight?

Changes in other medical symptoms

• Have they stopped menstruating?
• Do they complain of being full after just a small amount of food?
• Have they had an increase in anxiety or obsessive behaviors? Are they moodier or irritable much of the time?
• Do they seem low energy and need to sleep more during the day?
• Despite being tired all the time, do they struggle with insomnia?

Common misconceptions about eating disorders

You can’t tell if someone has an eating disorder from their appearance alone

Less than 6% of people diagnosed with an eating disorder are clinically underweight. Eating disorders can affect anyone in ANY body size. Just because someone is in the “normal” BMI range or “looks healthy” does not mean they can’t have an eating disorder.

The same goes for individuals in larger bodies with BMI’s considered “overweight” or “obese.” In many cases, these individuals are the last to get diagnosed for eating disorders because dieting and weight loss for people in larger bodies is often celebrated as a “healthy lifestyle” change, even if their behaviors are decidedly disordered.

An eating disorder professional can discern weight loss as a result of healthy, sustainable habits from weight loss as a result of disordered behaviors. Remember: Weight loss is not healthy if it comes at the cost of your mental health, regardless of your size.

Eating disorders can affect highly intelligent people

It is a mistake to assume that just because someone “is smart enough to know better” they don’t have or won’t get an eating disorder. Eating disorders can affect individuals who are sensitive, intuitive, and often very intelligent.

They may feel things very deeply and may dwell or fixate on troubling experiences more so than others. Often individuals with eating disorders identify as having “addictive” personalities and struggle with obsessive or perfectionist tendencies.

Eating disorders may run in your family

Eating disorders are hereditary, meaning they can run in families. Having a complete family medical history that includes mental health is important. This includes instances of eating disorders, substance abuse, alcoholism, depression, and suicide.

Having these diagnoses in the family does not mean that someone is “doomed” to suffer from an eating disorder. And in the end, it can help identify risk and make early diagnosis easier.

Eating disorders flare when triggered

Triggers are life events that may stir up disordered thoughts in an individual with an eating disorder. Common triggers include puberty, an illness in the family (especially one that requires dietary intervention), times of transition like divorce, moving, or going to a new school, and trauma.

Triggers may also be anything that exceeds the individual’s ability to cope, as disordered behaviors often provide a sense of comfort when situations or emotions feel out of control.

These events do not “guarantee” the onset of an eating disorder in all people but it is important to be aware of them, especially for individuals who may be at greater risk due to their genetics or personality.

How to tell if someone has an eating disorder and needs help

Eating disorders are mental health illnesses, like anxiety or depression, that require treatment. Even if you feel the conversation will be uncomfortable, or your loved one won’t be receptive, it’s important to communicate with them about their disordered behaviors and be prepared to offer help.

Your valid expressions of concern may be met with defensiveness. Remember to be understanding of the fact that if your loved one is dealing with disordered eating, this is not something that they are choosing for themselves or can stop doing at a moment’s notice.

Take action for your loved one by:

• Scheduling a consultation with their primary care provider or therapist for an assessment and potential diagnosis
• Assemble a care team with a registered dietitian, therapist, and psychiatrist who all specialize in eating disorder treatment
• Determine the correct level of care for your loved one as they may need more support than what can be provided outpatient; consider intensive outpatient, partial hospitalization, or residential care
• If they live with you, help your loved one follow their meal plan by providing meal support
• Explore support groups that cater to your loved one’s clinical needs and individual personality
• Engage in recovery focused activities or guide them towards resources that can support their journey

At our practice, we use the EAT-26 screening tool that you can access here. If you wan to know more about how to tell if someone has an eating disorder and how you can support your loved one, our team has multiple dietitians that specialize in disordered eating that can help. Reach our office to schedule an appointment at 301-474-2499 or by email at admin@rbitzer.com for more information.