Recognising and Addressing Eating Disorders: A Guide for Supporting those at Risk

By Tiluka Bhanderi, Specialist Eating Disorder Dietitian

Eating disorders are complex mental health conditions that can have serious physical and emotional consequences. They can affect anyone of any age, gender, ethnicity or background. An estimated 1.25 million people in the UK are affected by an eating disorder. Identifying the signs and symptoms early is crucial for providing timely support to those struggling with these disorders. In this article, we will discuss what to look out for with an eating disorder, both in terms of physical and mental health symptoms. Additionally, we will explore how to spot these signs and offer guidance on approaching someone with an eating disorder, including how to start the conversation.

Types of Eating Disorders:

Disordered eating behaviours can take many different forms which can include restricting food, binging or eating large quantities of food and compensating.

There are many types of eating disorders, some of the most common are below:

Anorexia nervosa – this is an eating disorder where a person controls their body weight to keep it as low as possible. They usually do this by restricting their intake. Anorexia is a complex disorder and is often connected to low self-esteem, negative body image, trauma and distress.

Bulimia nervosa – people with bulimia may binge eat and then engage in compensatory behaviours such as over exercising, purging or laxatives misuse as they feel guilty about what they’ve eaten. Often someone with bulimia nervosa will stay a ‘normal’ weight making it even harder to spot!

Binge eating disorder – a binge is an episode of excessive eating. People who binge eat large quantities of food over a short period of time. This can be days’ worth of food in one sitting. Binges may be planned in advance, and the food may be eaten in secret. Sometimes people may ‘zone out’ during a binge and struggle to remember what they ate during an episode.

Other Specified Feeding or Eating Disorder (OSFED) – an OSFED diagnosis encapsules those that present with some of the symptoms of other eating disorders but they don’t meet the full diagnostic criteria for these disorders. OSFED was known as ‘eating disorder not otherwise specified’ (EDNOS).

Avoidant/ Restrictive Food Intake Disorder (ARFID) – this is a condition where a person avoids certain foods or types of foods. This may be because of smells, taste or textures of foods. It is different to other restrictive eating disorders as a person with ARFID is not affected by body shape or image concerns and doesn’t restrict their intake for the purpose of losing weight.

What to look out for with an eating disorder:

Physical symptoms to look out for:

Ø Weight loss or fluctuations in weight

Ø Changes in eating habits e.g. dieting, overeating, secretive behaviours or purging

Ø Frequent digestive issues

Ø Fatigue or weakness

Ø Dizziness or fainting

Ø Brittle hair and nails or dry skin

Ø Cold intolerance

Ø Irregular or missing periods in females

Ø Swelling or puffiness in face/ jaw area

Other symptoms to look out for (mental, social etc):

Ø Obsession with food, body image or dieting

Ø Excessive exercise

Ø Social withdrawal or avoiding social events especially those including food

Ø Anxiety/ depression/ mood swings

Ø Preoccupation with food or cooking for others and not eating it themselves

Ø Secret eating

Ø Rituals around eating

Ø Changes in sleep pattern

Ø Going to the bathroom after eating

What and how to spot these:

§ Be observant – pay attention to changes in behaviour, eating patterns, appearance or mood. Changes may have occurred subtly over time or rapidly after a significant life event or traumatic situation. Notice if someone is becoming secretive or reserved around food.

§ Keep a log or diary of events – keeping a track of changes in mood, behaviour, social interaction and interaction around food, eating body image etc can be helpful in picking up patterns

How best to approach somebody with an eating disorder:

§ Engage in open communication – create a safe and non-judgemental space for conversation. Express your concern without making assumptions or accusations.

§ Choose an appropriate time and setting – approach the individual in a private, calm setting. Choose a time when they are not preoccupied or stressed.

§ Express your concerns and act with empathy – using ‘I’ statements can be helpful here to avoid sounding accusatory e.g. ‘I’ve noticed that’ instead of ‘you always…’.

§ Reassure them that you are there to support them.

§ Speak as though you are talking to a loved one – express care and concern for their well-being.

§ Offer support – let them know you are there to support not to fix, encourage them to seek professional help and offer to help them find resources or services available to them.

What specific wording to use when approaching someone with an eating disorder:

"I've noticed some changes in your eating habits and wanted to check in. How have you been feeling lately?"

"I care about you and have observed that you seem preoccupied with your weight. Can we talk about it?"

"I've noticed you've been skipping meals lately. Is everything okay, is there something you'd like to talk about?"

"I'm here for you, and I've noticed you’ve been (skipping meals, going to the bathroom after eating etc…) have you considered talking to a professional who can provide support?"

Approaching someone with an eating disorder requires sensitivity and empathy. By being observant, engaging in open communication, and expressing genuine concern, you can provide valuable support to those who may be struggling. Encouraging them to seek professional help is crucial, and offering your ongoing support can make a significant difference in their journey towards healing and recovering.

References:

§ BEAT has a useful document with an acronym to help look out for signs of an eating disorder: https://beat.contentfiles.net/media/documents/tips-2019.pdf

§ BEAT has a lot of useful resources for eating disorders: https://www.beateatingdisorders.org.uk/get-information-and-support/about-eating-disorders/downloads-resources/

§ First Steps ED offers support for those who may be struggling with their eating. They offer low cost psychotherapy, befriending and nutrition support: https://firststepsed.co.uk/

ABOUT THE AUTHOR:

Tiluka is a registered dietitian specialising in eating disorders and disordered eating in the NHS. She is a qualified yoga teacher and uses somatic healing techniques, mindfulness and guided meditations to help clients reconnect with their bodies.

Alongside working in the NHS, Tiluka works for an eating disorder charity, delivering workshops and seeing clients on a one-to-one basis.

Tiluka also has an interest in eating disorders and disordered eating in South Asian women and is passionate about encouraging voices from ethnic minorities to be heard!

You can contact Tiluka and follow her work on Instagram @tiluka_dietitian