Recognizing the Signs of Disordered Eating

By Lindsey Johnson
Person standing on white digital scale

According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), approximately 9% of the U.S. population (roughly 28.8 million Americans) will have an eating disorder in their lifetime. Eating disorders are the second deadliest mental health condition (after opioid overdose) and result in an average of 10,200 deaths per year—that’s one every 52 minutes.

Children and teens are not immune to disordered eating, with 81% of 10-year-old children feeling afraid of gaining weight and 35-57% of adolescent girls engage in crash dieting, fasting, self-induced vomiting, diet pills or laxatives. What are the warning signs, and how can you help your child if you suspect they may have disordered eating?

What is disordered eating?

Disordered eating is having a distorted perception in one’s relationship with food. According to the Eating Disorders, Compulsions and Addictions Service (EDCAS), those with disordered eating often display similar behaviors and thought patterns of those with an eating disorder, just to a lesser degree or frequency. For that reason, identifying and treating disordered eating is critical to helping people heal and not evolve to have a worsened conditions.

There are several eating disorders categorized in the Diagnostic and Statistical Manual of Mental Disorders-V (DSM-V): anorexia nervosa, bulimia nervosa, binge eating disorder (BED), avoidant restrictive food intake disorder (ARFID) and other specified feeding or eating disorder (OSFED). While the conditions are different, most people with eating disorders have a list of “good” and “bad” foods and a distorted perception of body image.

What are the warning signs?

Local dietitian Karin Kratina, PhD, RDN, LDN, SEP, who specializes in disordered eating, says “the first warning sign is almost always dieting or eating ‘healthy’ to lose weight. In my 40 years of specializing in treating those with disordered eating and eating disorders, every single client, without fail, started out by trying to change their food to alter their weight.”

Not everyone who tries to manage their weight develops an eating disorder, but recent research confirms dieting is the most important predictor of developing an eating disorder. This research showed that adolescents ages 14-15 who severely restricted their energy intake were 18 times more likely to develop an eating disorder, and those who dieted at a moderate level were five times more likely than non-dieting peers to develop a disorder.

“If a girl or boy goes beyond an initial ‘flirtation,’ a few days and then they move on with altering their food I would be concerned. Eating disorders usually start with teenagers, and even children as young as 5, wanting to eat ‘healthy’ and eliminate ‘bad’ foods,” Kratina said. “This can slip into skipping meals and restricting foods, then to sneaking food, binging and weight gain. Exercising to manage weight, which can perpetuate the cycle, is a potentially problematic behavior as well.”

Despite how our culture promotes dieting for weight loss, dieting can actually lead to increased weight.

According to Kratina, “there is typically an initial loss of weight, but within a couple of years, sometimes within months, that weight is regained, plus some. Research ominously reports that teenagers in the US who diet in ninth grade, around 15 years of age, are three times more likely than non-dieters to be overweight by 12th grade.”

Not only is dieting a red flag for future disordered eating, but it is not effective for long-term weight management. Kratina also shared that children who begin to focus on nutrition is a warning sign for her.

“I even fret when I hear a teen focused on nutrition,” she said. “They should be going to school and having fun, not worried about calories and carbs.”

Kratina also warned that weight fluctuations, in general, can be problematic.

“Unfortunately, kids are often praised for weight loss, making them feel the need to further manipulate the food in an effort to keep it off,” she said. “I often get calls from parents who describe how great their child did losing weight, and now they are a good size, but they also now have eating problems.”

Kratina explains parents will see mostly likely see emotional and behavioral symptoms. These include comparing their bodies to others, skipping meals and not wanting to eat with others. Other signs include checking the mirror for flaws in appearance and withdrawal from friends or family. Behavioral signs are heading to the bathroom after eating, rigid eating or exercise patterns, and monitoring how food is cooked. Parents may also see physical symptoms, such as frequently feeling cold, dizziness or fatigue. Other physical symptoms include cuts on the backs of hands from inducing vomiting, gastrointestinal discomfort and menstrual irregularities.

“By the time the physical symptoms show up, the eating disorder is usually well under way,” she said. “In fact, I tell parents that their child will likely have normal blood work in the initial stages of the eating disorder, that it becomes abnormal only when the eating disorder has become severe.”

What can I do to promote healthy eating patterns?

Kratina believes teaching kids specifics about nutrition is important.

“Concepts like vitamins and protein are way too abstract for kids,” she said. “Instead, parents should model balanced eating, and encourage children to connect to the sensory aspects of eating, helping them connect to their bodies rather than an intellectualized approach to food.”

She believes parents should encourage a well-rounded appetite. “For a parent to eat a wide variety of foods in front of them, with enjoyment, ease and comfort. They don’t have to talk about it or make it ‘a thing.’ Just enjoy their lives and their food.”

What do I do if I think my child has a problem?

Talk to your child about your concerns, but do not hesitate to seek treatment. Disordered eating often leads to more severe forms of eating disorders. Contact your pediatrician for advice or seek help from a dietitian and mental health counselor. There are a variety of practitioners trained to help. Identifying the problem sooner will lead to a better outcome and more successful treatment, according to Nemours Kids Health.

Children & Young Adults Eating Disorder Statistics

  • 42% girls in the first-third grade want to be thinner.
  • 81% of children who are 10 feel afraid of being “fat.”
  • 46% of children ages 9-11 are “sometimes” or “very often” on diets.
  • 35-57% of adolescent girls engage in crash dieting, fasting, self-induced vomiting, diet pills or laxatives.
  • In a college campus survey, 91% of the women admitted to controlling their weight through dieting.

Statistics from ANAD.