Working toward a healthier relationship with food

Eating disorder awareness can make a big difference: The earlier an eating disorder is detected and treated, the better a person's chances are for full recovery. Knowing the risk factors, signs and symptoms can help you recognize these patterns in yourself and your loved ones so that you can seek necessary treatment.

What you eat and how you exercise both play important roles in your overall health. Spending some time thinking about weight, diet, activity levels and general health can be valuable for improving lifestyle habits, but for people with eating disorders, thoughts about food can become obsessive and result in eating patterns and other behaviors that may be dangerous to their health.

Who is at risk for eating disorders?

Nearly 1 in 10 Americans — 28.8 million people — will have an eating disorder at some point in their lifetime. Although eating disorders are most common in teens and young adults, no one is immune to the risk of developing an eating disorder. Eating disorders can affect people of all ages, regardless of weight, race, ethnicity, socioeconomic status, and sexual or gender identity.

The emphasis on body image starts early in life. Children as young as three can develop a negative body image. Meanwhile, rates of obesity continue to rise among children and adults in the U.S., and these conditions can lead to serious health problems.

Many people with obesity also struggle with eating disorders, but patients and their doctors don't always recognize the relationship or how treatment for one condition could make the other worse. Measures to prevent or treat obesity can actually lead to eating disorders in some cases. Up to 35% of people who diet use 'extreme dieting' methods, which can raise the risk of developing an eating disorder.

Common eating disorders

There are several types of eating disorders, each with different signs and symptoms.

Anorexia nervosa

People with anorexia nervosa avoid food or restrict caloric intake to the point where they may become dangerously underweight — even as they continue to think of themselves as overweight. Some people with anorexia eat very little food or only certain kinds of food. Others may consume large amounts of food and then induce vomiting or use laxatives to purge their bodies and avoid weight gain. People with anorexia may be at a higher risk of complications and death from malnutrition or suicide.

Bulimia

People with bulimia eat unusually large amounts of food and then use induced vomiting, fasting, exercise or laxatives to prevent weight gain. People with bulimia may be overweight, but many have a normal body mass index. Signs and symptoms of bulimia include chronic sore throat, tooth decay from vomiting, gastrointestinal distress and electrolyte imbalances.

Binge-eating disorder

Binge-eating disorder is similar to bulimia but without the purging. People with this disorder typically eat large amounts of food, often in a short amount of time, even if they are not hungry. They may feel great shame and distress over this habit and may frequently diet but not actually lose weight. People with binge-eating disorder are likely to be overweight.

Avoidant restrictive food intake disorder (ARFID)

As with anorexia, people with ARFID may severely restrict the type and amount of food they eat. However, people with ARFID are not motivated by distorted body image or fear of weight gain. ARFID is more common in young children but can occur in adults as well. While many children are picky eaters, children with ARFID do not eat enough calories to grow and develop properly. Symptoms in children or adults may include lack of appetite or interest in food, upset stomach or abdominal pain, limited range of food preferences and dramatic weight loss.

How to start a conversation about eating disorders

If you struggle with an eating disorder or think you recognize some of the signs or symptoms of an eating disorder in yourself or a loved one, you may not know where to start to get help. Eating disorders and body image are often attached to feelings of guilt and shame, and can be difficult to discuss. If you are concerned about a loved one and you're not sure how to approach the topic, consider gently sharing your concerns and suggesting that they get a check-up at the very least.

Because the topics of weight, diet and exercise often come up in discussions of health, even a trip to the doctor's office may feel overwhelming. But early treatment for eating disorders increases the chances of full recovery.

The following steps can help you prepare for a healthcare visit or a conversation about eating disorders.

1. Take some time to consider how you've been feeling about your body and your eating habits. You may want to write down your thoughts in a journal or notebook to take to the doctor's office. You can use these questions to guide your thinking:
   • How do you feel about your body?
   • What does healthy eating mean to you?
   • Do you eat when you're stressed or bored, even if you are not hungry?
   • Do you eat so much that you feel uncomfortably full?
   • Are there situations in which you'd be more likely to skip a meal or eat more than usual?
   • What are your activity levels like? What kinds of physical activities do you enjoy? How much time do you spend exercising?
   • What questions do you have about what's healthy for your body?

If you have concerns about any of your answers, bring them up with your doctor.

2. If you have questions about your eating habits, you don't have to wait for the doctor to bring up the topic. However, if you are seeking care for something unrelated to your weight or how you eat — such as a sore throat or a broken bone — feel free to ask the doctor to stick to the subject at hand and not to shift the conversation toward diet or weight issues.
3. A healthcare visit often includes stepping on the scale. Feel free to turn away from the read-out and ask the examiner not to tell you your weight. How you feel is more important than the number on the scale.
4. If your doctor makes a recommendation — whether it concerns weight loss or evaluating a possible eating disorder — make sure you have the tools and resources you need to follow up, such as suggestions for helpful literature or the contact information of a dietician. You and your doctor should work together to set specific, achievable goals using methods that are most likely to work for you.

By taking time to build eating disorder awareness and think about your eating habits, you may be able to develop a healthier relationship with food and exercise, address possible eating disorders early and live your healthiest life.