Signs your friend may have an eating disorder

You’ve seen the images of what a “stereotypical” person with an eating disorder is supposed to look like. The subjects are usually young, white, emaciated females. But those pictures do not reflect the whole story, as eating disorders can affect people of all ages, genders, races, body types and socioeconomic groups.

According to the National Alliance on Mental Illness, eating disorders are a group of related conditions surrounding a preoccupation with food and weight that cause serious emotional and physical problems. Common eating disorders include anorexia, bulimia, binge eating disorder (BED), orthorexia and avoidant-restrictive food intake disorder (ARFID).

“You don't need to be underweight to have a serious eating disorder,” says Tammy Nguyen, LCSW, from the Eating Disorders Program at Sharp Mesa Vista Hospital. “An eating disorder can affect you psychologically and emotionally, even if you appear completely healthy physically.”

While symptoms of an eating disorder usually appear in adolescence, you might worry about some of the behaviors you’ve noticed in your adult friends. Is their desire to “eat clean,” cut carbs or skip dessert driven by a goal of living a healthy lifestyle with common-sense nutritional habits? Or are these behaviors signs your friend might be living with an eating disorder?

Signs of an eating disorder

Eating disorder symptoms are common among people of all ages. It's important to watch not only for obvious weight loss — or gain — but also for signs including:

• Preoccupation with weight, food, calories, carbohydrates, fat grams and dieting

• Refusal to eat certain foods, such as carbohydrates, meat, dairy or sugary foods — any foods they deem not healthy, pure or clean

• Discomfort eating around other people

• Food rituals, such as mashing, excessive chewing and pushing food around the plate

• Skipping meals, making excuses to avoid meals or eating very small meals

• Excessive consumption of water

• An excessive, rigid exercise regime — despite weather, fatigue, illness or injury

It’s also important to pay attention to how a loved one talks about themselves. “Pay attention to negative self-talk and an excessive amount of body checking,” Nguyen says. “It can get in the way of everyday life. Someone might not want to go out because they think they look terrible.” 

Feelings of guilt or shame during or after eating can also signal that someone is struggling, and physical symptoms may show up as well. 

“From a nursing standpoint, some of the first warning signs are fatigue, menstrual changes and dizziness,” says Camille Silverio, MSN, RN, a nurse at Sharp Mesa Vista. “A sudden drop in blood pressure or a change in someone’s period is a reason to seek care sooner rather than later.”

Differences between eating disorders in teens and in adults

The National Eating Disorders Association (NEDA) reports that eating disorder triggers in adults usually differ from those in adolescents. In adults, an eating disorder is more likely to be triggered — or activated — by life-altering events, such as marriage, pregnancy, divorce, death of a loved one, menopause and other milestones.

What’s more, recovery from an eating disorder may be more difficult for adults than youths.

Along with the general challenges related to aging and illness recovery, adults may feel ashamed or embarrassed to have what many consider a “teenager’s disorder” and avoid seeking treatment. They may also struggle to make time for treatment because of responsibilities at home and work.

How you can help a friend or loved one

Friends and family play a big role in recovery. “They're very important as a support system,” Nguyen says. “Our programs facilitate normalizing recovery within the family and the people around them.”

If you have a friend or loved one who is showing signs of having an eating disorder, Nguyen and Silverio recommend setting aside a private one-on-one time to talk and lead with compassion rather than judgment.

Be calm, caring, honest and prepared for a defensive reaction when initiating a discussion. Remove stigma, shame and judgment from the conversation and offer firm support in encouraging them to seek help. Additional tips from NEDA include:

• Use “I” statements, such as “I’ve noticed you aren’t joining us when we go out for lunch or dinner anymore,” or “I am worried about how often you work out.”

• Avoid overly simplistic solutions, such as “Just stop,” or “Just eat,” which can make them feel frustrated, defensive and misunderstood.

• Encourage them to seek professional help and offer to help them find a doctor, therapist or program.

At Sharp Mesa Vista, a team of therapists, nurses, dietitians and doctors helps patients normalize eating and build lasting recovery skills.

“Eating disorders are treatable,” Silverio says. “Recovery is never a straight line, but a setback doesn't mean you're failing. The sooner you reach out for help, the better.”

Learn more about specialized eating disorders treatment at Sharp Mesa Vista Hospital.