What to know to help yourself or a loved one

National Eating Disorders Awareness Week was created in 2000 by the National Eating Disorders Association as part of their outreach to the 14 million people who experienced eating disorders in 2019, according to the World Health Organization. This number included almost 3 million children and adolescents.

Eating disorders include:

Anorexia nervosa (an intense fear of gaining weight and a distorted body image, leading to self-imposed starvation and extreme weight loss)

Bulimia nervosa (recurrent episodes of binge eating followed by extreme compensatory behaviors to prevent weight gain, such as self-induced vomiting, misuse of laxatives or diuretics, and excessive exercise)

Binge-eating disorder (recurring episodes of binge eating without the extreme compensatory behaviors such), and

Other specified feeding or eating disorders (OSFED), which include a variety of eating disorders that do not fall neatly into one of the above categories.

This year, National Eating Disorders Awareness Week begins on Monday, February 26.

Signs of an eating disorder can vary depending on the specific type of disorder an individual is experiencing, but there are some common symptoms to be aware of. It’s important to keep in mind that not everyone with an eating disorder will display all of these signs, and some individuals may exhibit different behaviors or symptoms. Nevertheless, here are some general signs to watch for:

1. Significant weight changes: Rapid weight loss or gain may be a noticeable sign, but not all individuals with eating disorders experience extreme weight changes.
2. Preoccupation with food, calories, and dieting: Constantly talking about food, following restrictive diets, and counting calories excessively may indicate an unhealthy relationship with food.
3. Distorted body image: Perceiving one’s body inaccurately, often seeing oneself as overweight despite being underweight or having a healthy weight.
4. Avoiding eating in public: Feeling uncomfortable or anxious about eating in front of others, making excuses to avoid social situations involving food.
5. Excessive exercise: Obsessive exercising, even when injured or fatigued, and feeling guilty or anxious if unable to exercise.
6. Secrecy around eating habits: Hiding food, eating in secret, or making excuses to avoid meals with others.
7. Changes in eating habits: Skipping meals, eating very small portions, eating only certain types of foods, or binge-eating followed by purging behaviors (e.g., vomiting, misuse of laxatives or diuretics).
8. Mood swings and irritability: Fluctuations in mood, depression, anxiety, or withdrawal from social activities.
9. Physical symptoms: These can include dizziness, fatigue, fainting, hair loss, irregular menstruation (in females), dental problems, and digestive issues.
10. Obsession with body weight and shape: Placing excessive importance on achieving a specific body weight or shape, tying self-worth to appearance.

Left unattended, eating disorders can cause serious—even fatal—physical and psychological health effects, including:

Malnutrition: Restrictive eating behaviors, purging, or binge eating can lead to inadequate intake of essential nutrients, resulting in malnutrition. Malnutrition can affect every system in the body and lead to weakness, fatigue, muscle wasting, and compromised immune function.

Cardiovascular complications: Eating disorders can cause cardiovascular problems such as low blood pressure, irregular heart rate (arrhythmia), electrolyte imbalances, and heart failure. Electrolyte imbalances, in particular, can be life-threatening and may result from purging behaviors.

Gastrointestinal issues: Regular binge eating and purging can damage the digestive system, leading to problems such as acid reflux, gastrointestinal bleeding, constipation, and inflammation of the esophagus or stomach.

Electrolyte imbalances: Purging behaviors (such as vomiting, laxative misuse, or diuretic abuse) can disrupt electrolyte levels in the body, which are essential for proper nerve and muscle function. Severe electrolyte imbalances can lead to cardiac arrhythmias, seizures, and even sudden cardiac arrest.

Bone density loss: Chronic malnutrition and hormonal imbalances associated with eating disorders can lead to decreased bone density (osteopenia or osteoporosis), increasing the risk of fractures and skeletal abnormalities.

Menstrual disturbances: In females, eating disorders can disrupt normal hormonal function, leading to irregular or absent menstrual periods (amenorrhea), infertility, and complications during pregnancy.

Dental problems: Purging behaviors, such as self-induced vomiting, can erode tooth enamel, leading to dental decay, cavities, and sensitivity to hot or cold foods.

Hair and skin issues: Malnutrition and dehydration associated with eating disorders can lead to hair loss, dry skin, brittle nails, and the development of lanugo (fine, downy hair) on the body as a response to malnutrition.

Psychological complications: Eating disorders are often accompanied by psychological symptoms such as depression, anxiety, obsessive-compulsive tendencies, and distorted body image. Left untreated, these psychological issues can exacerbate the severity of the eating disorder and impair overall functioning.

Increased risk of suicide: Individuals with eating disorders are at a heightened risk of suicidal ideation and suicide attempts, particularly when they experience severe depression, hopelessness, or feelings of worthlessness.

Although eating disorders are complex and can be rooted in a combination of genetic, psychological, and societal factors, I believe that Cultural Stress is one of the most significant. Twenty-four-hour exposure to idealized body images via advertising and social media adds to the sense that many people—women in particular—have that they can never do enough or be good enough. In addition, 24-hour digital connectivity too often takes the place of in-person social activities, and screen time also displaces healthier, physical activities that help to maintain stable weight and eating habits.

I advise my patients to follow the Four Pillars of Modern Wellness, which encompass:

Eating your water. (Staying hydrated and eating a varied diet that emphasizes whole grains, fruits and vegetables, embryonic foods such as eggs, seeds, and nuts, and fatty fish high in omega-3 fatty acids will help to stabilize weight, hormones, and blood sugar levels.)

Moving your body. (Exercise gets the heart and lungs pumping, the blood flowing, and activates your other organs. It also builds muscle, which is 70% water, whereas fat is only about 10% water. Thus, exercise not only keeps you toned and fit, it helps to keep you hydrated. Exercise is also a great stress reducer—stimulating the production of endorphins, the “feel good” hormones, and getting us out of our heads, where worry is generated, and into our bodies.)

Be kind to your mind. (Cultural stress is with us virtually 24/7, so it’s up to us to counter our stressful environments with positive self-talk and affirmations, plenty of rest and relaxation—unplugged, if at all possible!—and other soothing techniques, such as slow, deep breathing. For help with positive self-talk, please feel free to download and use my collection of Insights.)

Nourish your skin. (Your skin is your body’s largest organ. It is literally the “first line of defense” between you and the world outside and the “last line of defense” for keeping your body hydrated. When you nourish your skin—through healthy eating, exercise, rest, and daily protection from the elements, along with moisturizing—you are nourishing your body. Skincare is healthcare. And when you treat your body right, it shows in your skin, the body’s window to wellness. A healthy body also builds self-esteem, an antidote to eating disorders.)

It’s important to approach any concerns about potential eating disorders with sensitivity and empathy. If you or someone you know may be struggling with an eating disorder, encourage them to seek professional help from a doctor, therapist, or specialist trained in treating eating disorders. Early intervention and support can make a significant difference in recovery.