Sitting across from me on the blue couch in my office, the mom says- “We wanted to nip this in the bud before it got serious.” Meanwhile, her listless and pale daughter squirms with anxiety. After finishing a thorough nutrition assessment, it is evident that their idea of early and my idea of early are two different scenarios.
This is the situation I see time and time again when parents are bringing their children in for nutritional evaluation for an eating disorder or disordered eating. The parents feel like they are catching the symptoms early, when typically it has gone well beyond “catching it early.” Even more concerning is that usually, by the time someone is in my office their eating disorder has progressed to a level where it is medically unstable and/or where a client is unable to make behaviors change without more support. This requires a referral to inpatient or residential treatment to help stabilize their health, re-nourish their body, and challenge the eating disorder thoughts. This kind of care is scarce in Texas, is very expensive, significantly interferes with normal life, and can last anywhere from 30-120 or more days.
If you are noticing changes in your child’s, or friend’s, or family member’s eating behavior- please don’t wait! Don’t wait for things to get better, or for the phase to pass, or dismiss the symptoms. Eating disorders are not a phase and not something that you can just snap out of. Eating disorders are serious mental illnesses and they are the deadliest mental illnesses. Research shows that early intervention can prevent the onset of a full-blown eating disorder, and that eating disorders caught early have the best chance for full recovery. This early intervention can prevent years of struggle and save lives!
Too often the signs and symptoms of an eating disorder are overlooked- when in fact they are the early warning signs. If you see changes in your loved ones eating patterns or body image- don’t wait. I would much rather tell someone that there is nothing to worry about, than have the same situation repeated over and over where a family thinks they are preventing an eating disorder when one has already developed. The cost of one nutrition evaluation is far cheaper than an extended stay in a hospital or residential treatment center and it can save lives. Nobody thinks their loved one will be affected by an eating disorder until it happens. Please don’t wait- see the list of signs and symptoms below- and reach out for help from a trained eating disorder professional.
Eating Disorder Signs and Symptoms
Please note that this list is not all-inclusive and that it includes signs and symptoms for ALL eating disorders. Therefore, not all signs and symptoms will be present. If you are noticing any of these behaviors please seek further evaluation from a trained eating disorder professional such as a registered dietitian, a therapist, or a medical doctor.
Weight focus or changes
¨ Overly focused on weight, shape, or size (suddenly or on-going)
¨ Obsessive weighing
¨ Panicked or upset at the idea of taking the scale away
¨ Eating large amounts of food but losing weight or not gaining.
¨ Eating large amounts of food and gaining weight.
¨ Steadily gaining weight
¨ Steadily losing weight
¨ Complaining about being fat
Food focus or changes
¨ Dieting. Skipping Meals.
¨ Frequent excuses for not eating.
¨ Overly focused on food.
¨ Disappearance of food
¨ Hiding food or food wrappers
¨ Eating in secret
¨ Unable to go out to eat
¨ Limited food choices
¨ Lying about eating
¨ Fasting occasionally for various reasons.
¨ Feeling as if you never see them eat.
¨ Won’t drink beverages with calories
¨ Won’t drink water out of fear of gaining weight
¨ Won’t swallow spit (wipes or dabs spit instead of swallowing)
¨ Changes in food preferences
¨ Avoids foods he/she used to like.
¨ Sudden change to vegetarianism or veganism.
¨ Paranoid about eating certain foods.
¨ Overly focused on what others eat.
¨ Cooks for & feeds others, but will not eat the food themselves.
¨ Excessive amounts of non-calorie or very low calorie foods.
¨ Calorie counting, carbohydrate counting, fat counting, sodium counting
¨ Use of food as a reward.
¨ Food rituals
¨ Face or cheeks appear swollen & puffy.
¨ Scars on the back of the hand.
¨ Blood shot eyes & burst blood vessels in the face or around the eyes.
¨ Increased number of cavities or teeth discoloration; tooth decay.
¨ Hair loss.
¨ Dry Skin
¨ Brittle nails
¨ Growth of downy hair all over body (lanugo).
¨ Loss of menstrual cycle
¨ Tired or lack of energy/ fatigue
¨ Cold all the time.
¨ Obsessive exercise.
¨ Exercising when ill or hurt.
¨ Exercising in poor or dangerous weather.
¨ Upset if unable to exercise.
¨ Misses or avoids social or family events because he/she has to exercise.
¨ Amount of time spent exercising or intensity continually increases.
¨ Exercising to make up for what was eaten.
¨ Exercising in secret (Many of my clients report hiding in their room and exercising without their family or friends knowing.)
¨ Finding hidden food, wrappers, laxatives, diuretics, and/or diet pills.
¨ Signs of vomiting, although he/she was never ill.
¨ Signs of enema or laxative use.
¨ Disappears during and/or after eating.
¨ Difficulty sleeping and/or staying asleep
¨ Suddenly wearing baggy clothes or layers.
¨ Mood Swings.
¨ Depressed and angry for no apparent reason.
¨ Defensive about losing weight.
¨ Defensive about gaining weight.
¨ Temper tantrums over food not being “just right.”
¨ Flat mood or lack of emotion.
¨ Lack of awareness about the severity of the situation.
¨ Avoiding Social Situations (especially if they involve food).
¨ Losing friends & withdrawing.
¨ Avoiding activities that they used to enjoy.
¨ Low blood pressure
¨ Slow heart rate
¨ Osteopenia/ Osteoporosis,
¨ Muscle loss
¨ Low thyroid
¨ Electrolyte imbalance
¨ Tooth decay
¨ High blood pressure
¨ High cholesterol
¨ Heart disease
¨ Type two diabetes
¨ Gallbladder disease
Again, please note that this list is not all-inclusive and that it includes signs and symptoms for ALL eating disorders, so not all will be present. If you are noticing any of these behaviors please seek further evaluation from a trained professional who specializes in eating disorders such as a registered dietitian, a therapist and a medical doctor. Eating disorders are a specialized area and providers should have training specifically in eating disorders beyond what they have received in school. For a comprehensive list of what to look for in a provider please visit the National Eating Disorders Association website by clicking here.
For a comprehensive list of signs and symptoms for specific eating disorders from the Academy for Eating Disorders click here.