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Health Information | 12/03/2019

Understanding and Getting Help for an Eating Disorder

By  Atrius Health
Generally speaking, an eating disorder is an illness in which a person has an abnormal relationship with food and their body. There are various components of eating disorders, including both a behavioral (physical) element and a cognitive (mental) element. The physical part of the illness can include behaviors such as when someone actively restricts the number of calories they eat, or they overeat and then purge to attempt to avoid gaining weight. There is also the cognitive part of the disorder, which involves the person’s thought process; this may include obsessing over food and the number of calories consumed, or constantly calculating how much exercise they have to do to compensate for eating.

Who can develop an eating disorder?

When the term eating disorder comes up, many people may envision a teenaged white female with anorexia. However, the reality is that eating disorders are prevalent across cultures, races, ages, and genders. For example, African-American teenagers are 50% more likely than Caucasian teenagers to exhibit bulimic behavior, such as binging and purging (Goeree, Sovinsky, & Iorio, 2011). Male athletes, such as wrestlers who are continuously being weighed, can become obsessive about their weight. Current research is limited, but the LGBTQ population has been found to have higher incidences of eating disorders than their heterosexual counterparts. Although eating disorders can develop in any person at any age, an especially vulnerable period is 18 to 25 years old when young adults are in a transitional stage of life.

What are some reasons that someone might develop an eating disorder?

There are many psychological, interpersonal, social, and biological factors that come into play when we think about who might develop an eating disorder. No one reason causes someone to develop an eating disorder. Below are some factors that can make someone more susceptible to engaging in eating disordered behaviors:

  • Psychological – those who struggle with anxiety, depression, low self-esteem, poor body image or perfectionism can be more prone to developing a disorder. For example, students who are top athletes at school may feel pressure to maintain their status because they don’t want to let anyone down. In turn, they engage in unsafe behaviors such as excessive exercising.
  • Trauma – those who have suffered from abuse (including but not limited to physical or sexual abuse, bullying, etc.) may engage in eating disordered behaviors as a means to gain control over a part of their life.
  • Society/Cultural – societal pressures are a significant factor, especially for the younger population. The need to fit in and comparing oneself to others regarding body weight, shape, or size, is prevalent for middle and high school-aged students. For example, messages on social media allude that being thin will make you more popular, happy, and even successful.
  • Genetics – Genetics may play a role in whether or not someone develops an eating disorder, so exploring family history can be helpful. The Anorexia Nervosa Genetics Initiative (ANGI) has been studying the role of genes in anorexia nervosa.

Warning Signs and Symptoms

Warning signs and symptoms of an eating disorder can be both physical and mental. Here are some things to look out for: 
  • Preoccupation or obsession with weight, food, calories, body image, or exercise that interferes with everyday functioning. For example, a teen who won’t go to the movies with friends because they didn't exercise or a teen or adult who is late to school or to work because of their behaviors.
  • Skipping events – avoiding work, school, social, or family events because there may be food.
  • Moodiness - people who are restricting their diet can become very irritable.
  • Avoiding the doctor – this may be a way someone feels they will be protected from addressing their health concerns.
  • Hiding their body by wearing baggy clothing.
  • Drastic weight loss or an increase in weight. A significant decrease in weight could indicate anorexia or bulimia, while a significant increase in weight could indicate a binge eating disorder.
  • Dizziness or passing out from restricting food and liquids.
  • Swelling in the face – purging can result in swelling in the face.
  • Dental issues – when someone purges, stomach acid can wear away the back of the teeth and many times, dentists identify this behavior.
  • Not feeling comfortable eating in front of others. For example, a teen may start taking their dinner to their room.
  • Missing periods – female teens or women with eating disorders can miss their menstrual periods.

Treatment for Eating Disorders

There are different levels of care when it comes to the treatment for an eating disorder, and the appropriate level depends on the severity of the behaviors and medical issues.
  • Inpatient care is the highest level of care in an inpatient medical setting, such as a locked hospital unit. Those who need inpatient care have severe behaviors and are typically medically unstable.
  • Residential care involves 24-hour care for a medically stable patient, and may not be within a hospital setting. Patients participate in group and individual therapy and psychiatric medication management.
  • Partial hospital program (PHP) – patients participate in group and individual therapy, as well as therapeutic meals during the day, in an outpatient setting. This typically is as long as a typical school day, Monday through Friday.
  • Intensive outpatient program (IOP) has a similar yet shortened structure to the partial hospital program. These programs usually run three days or evenings a week, lasting for three to four hours each day.
  • Outpatient therapy – patients are seen in an office setting for weekly individual therapy sessions. Family therapy or group therapy may also be recommended.
  • Medication – there no medications that can cure an eating disorder. Medications can, however, can be helpful in treating any underlying conditions such as anxiety or depression.

What should you do if you suspect someone has an eating disorder?

It's hard to say, "Hey, what’s going on with you? Why aren’t you eating?" because the person might get very defensive. When approaching someone about an eating disorder, know in advance that the person might deny they have a problem, they might get defensive and even angry with you, but that doesn't mean that you're doing anything wrong. I recommend saying something like, "I'm getting a little concerned about you. I've noticed that you're not eating dinner with us anymore” or “I notice you always bring your dinner into your room" or "I noticed that you're constantly going to the bathroom right after dinner.” Continue with, “I just want to make sure everything is okay?" or “can I help you find someone to talk to?”

Confronting and accusing someone of having an eating disorder usually doesn’t go well, so it’s best to share your concerns in a non-confrontational manner. This may include offering your support and willingness to assist them in seeking treatment. At times, finding reasons for improving their health, such as future goals, can be effective in motivating someone to seek help. Let the person know that you care about them and offer your help by something such as, "If you do ever have concerns and want to talk, please know I'm here." That way, you leave the door open for them to talk with you.

Educating yourself about eating disorders is also important so that you know what to look for and how to talk about this condition. This toolkit from the National Eating Disorder Association (NEDA) offers some excellent information about eating disorders, how to support a loved one, treatment information, and more. Having a conversation with someone about a potential eating disorder is not easy. It's important as a parent, spouse, or friend to say something if you're scared that something might be wrong or they are in a medical crisis. Undiagnosed and untreated eating disorders can become life-threatening illnesses. If you’re not sure how to approach someone yourself, try contacting a medical professional or a school counselor to get their opinion.

If you ever suspect a true medical or psychiatric emergency, please contact 911 or visit the closest emergency room for evaluation.

Additional Resources:
National Eating Disorder Association (NEDA),
Multi-Service Eating Disorder Association (MEDA),  
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About The Author

Atrius Health

Atrius Health, an innovative healthcare leader, delivers an effective system of connected care for adult and pediatric patients at more than 30 medical practice locations in eastern Massachusetts. By establishing a solid foundation of shared decision making, understanding and trust with each of its patients, Atrius Health enhances their health and enriches their lives.

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