Nutrition Through The Ages: Special Edition - Disordered Eating & Eating Disorders

Updated: May 24, 2023

Body image concerns can become deeply embedded, and ultimately dangerous, during adolescence. This is when thoughts, emotions, and behaviors can evolve into lifelong battles as people try to "fix" their appearance to fit an assumed expectation that can be both unrealistic and unhealthy. But, disordered eating and eating disorders are not JUST about eating and the foods that are eaten. While many disordered eating behaviors are linked to body image concerns, there's so much more that goes into the development of an eating disorder; and, not only do eating disorders impact weight (gain and loss), they can "affect physical, psychological, and social functions" in an individual.

You may be wondering why adolescence is such a notorious jumping off point for the types of behaviors associated with disordered eating. First and foremost, adolescence is marked by change (physical, emotional, and social). This is a time to build healthy behaviors around managing emotions, problem-solving, coping, and interpersonal skills as well as sleeping and eating; but the reality is many in this age group do not develop some of these beneficial behaviors. You may be shocked to learn that at least 1 in 5 adolescents (between the ages of 10 and 17) experience a diagnosable mental health disorder that causes some sort of impairment; and with that, "depression, anxiety, and mood/behavioral disorders are among the leading causes of illness and disability among adolescents".

The National Institute of Mental Health (NIMH) notes the following:

Eating disorders are serious, biologically influenced medical illnesses marked by severe disturbances to one’s eating behaviors.
Although many people may be concerned about their health, weight, or appearance from time to time, some people become fixated or obsessed with weight loss, body weight or shape, and controlling their food intake.
The exact cause of eating disorders is not fully understood, but research suggests a combination of genetic, biological, behavioral, psychological, and social factors can raise a person’s risk.
Eating disorders can affect people of all ages, racial/ethnic backgrounds, body weights, and genders.
Eating disorders are not a choice; however with treatment, people can recover completely from eating disorders.

Disordered Eating vs. Eating Disorders

The difference between disordered eating and eating disorders can be thought of as the difference between describing behaviors and a diagnosis (or non-diagnosis) related to those behaviors.

Warning Signs/Symptoms:

preoccupation with weight, body image, calories, carbs, fat grams, dieting in general
excessive and/or rapid weight loss
excessive exercise/preoccupation with "burning calories"
frequent bathroom visits after meals
refusal to eat certain foods leading to major diet restrictions/limitations (avoiding whole food groups and/or macronutrients)
seeming uncomfortable eating around others
frequent mirror checks
skipping meals and/or taking too small of portions to support their nutritional need
mood swings
moving from one fad diet to another
noticeable weight fluctuations
menstrual irregularities (or complete loss of cycle)
dizziness/fainting
experiencing cramps and/or other GI complaints
muscle weakness
brittle/thin hair
getting sick often
dental problems
sleep problems

Disordered Eating

The Academy of Nutrition and Dietetics note the following common disordered eating behaviors:

Frequent dieting, anxiety associated with specific foods or meal skipping
Chronic weight fluctuations
Rigid rituals and routines surrounding food and exercise
Feelings of guilt and shame associated with eating
Preoccupation with food, weight and body image that negatively impacts quality of life
A feeling of loss of control around food, including compulsive eating habits
Using exercise, food restriction, fasting or purging to "make up for bad foods" consumed

When broken down individually or when relying on a few of these behaviors "to maintain weight", some disordered eating behaviors may not "feel" as though they are problematic. But, in some ways, it's that exact thinking that allows behaviors like these to intensify and domino into others. Individuals may not even realize how much of their lives are influenced and consumed by these behaviors, and meanwhile their mental and physical health can be suffering. Just because an individual is not "diagnosed" with an eating disorder does not lessen the impact of the behaviors.

Common Eating Disorders (Children & Adolescence)

A 2021 clinical report of the American Academy of Pediatrics (AAP) notes some important characterizations/distinctions about eating disorders (as experienced in adolescence):

Although previously mischaracterized as diseases of non-Hispanic white, affluent adolescent girls, eating disorder behaviors are increasingly recognized across all racial and ethnic groups, and in lower socioeconomic classes.
Eating disorders can occur in individuals who present in a myriad of body sizes, and their presence in those of larger bodies is increasingly apparent.
Increased rates of disordered eating may be found in sexual minority youth. Transgender youth may be at particular risk
Adolescents with chronic health conditions requiring dietary control may be at increased risk of disordered eating (diabetes, celiac disease, etc.).
Adolescent athletes may engage in unhealthy weight-control behaviors, in an attempt to improve performance or achieve a desired body size.
Adolescents may engage in dietary practices that overlap with or disguise eating disorders (vegetarianism/veganism, gluten avoidance, etc.). Orthorexia fits here and will be discussed in detail in a future special edition post as it has gained intense popularity among young adults/adults in their desire to "eat clean".

Anorexia Nervosa

Anorexia is characterized primarily by restrictive eating, food avoidance, and/or excessive exercise. According to AAP, anorexia can be diagnosed by type (restrictive or binge/purge with restriction) by a health professional using the following criteria:

Restricted caloric intake relative to energy requirements, leading to significantly low body weight for age, sex, projected growth, and physical health
Intense fear of gaining weight or behaviors that consistently interfere with weight gain, despite being at a significantly low weight
Altered perception of one’s body weight or shape, excessive influence of body weight or shape on self-value, or persistent lack of acknowledgment of the seriousness of one’s low body weight

NOTE: Anorexia nervosa can be fatal. It has an extremely high death rate compared with other mental disorders. People with anorexia are at risk of dying due to medical complications associated with starvation, and suicide is the second leading cause of death for people diagnosed with anorexia nervosa.

Bulimia Nervosa

Bulimia is characterized primarily by recurrent episodes of eating unusually large amounts of food and feeling a lack of control over their eating. The binge portion is then followed by some form of compensation to prevent weight gain (forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or any combination of these behaviors). According to AAP, bulimia can be diagnosed by a health professional using the following criteria:

Repeated episodes of binge eating within a distinct period of time (eg, 2 h), characterized by both of the following: eating an amount of food that is clearly larger than what most individuals would eat during a similar period of time under similar circumstances and a sense that one cannot limit or control their overeating during the episode
Repeated use of inappropriate compensatory behaviors for the prevention of weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise
On average, the binge eating and compensatory behaviors both occur at least once a week for 3 months
Self-value is overly influenced by body shape and weight

Binge-Eating Disorder

Binge-Eating (BED) is characterized primarily by a loss of control with eating and reoccurring episodes of eating unusually large amounts of food without compensatory behaviors (purging, excessive exercise, or fasting). According to AAP, BED can be diagnosed by a health professional using the following criteria:

Repeated episodes of binge eating within a distinct period of time (eg, 2 h), characterized by both of the following: eating an amount of food that is clearly larger than what most individuals would eat during a similar period of time under similar circumstances and a sense that one cannot limit or control their overeating during the episode
The binge-eating episodes include 3 or more of the following: eating much more quickly than normal, eating until uncomfortably full, eating large amounts of food when not feeling hungry, eating alone because of embarrassment at how much one is eating, and feeling guilty, disgusted, or depressed afterward
Marked anguish is experienced regarding binge eating
the binge eating occurs at least once a week for 3 months

Avoidant Restrictive Food Intake Disorder (ARFID)

Avoidant Restrictive Food Intake Disorder (ARFID) is characterized primarily by limiting the type or amount of food eaten although it is not related to a distorted body image or extreme fear of gaining weight. According to AAP, ARFID can be diagnosed by a health professional using the following criteria:

A disrupted eating pattern as evidenced by persistent failure to meet appropriate nutritional and/or energy needs associated with 1 (or more) of the following: significant weight loss or, in children, failure to achieve expected growth and/or weight gain, marked nutritional deficiency, reliance on enteral feeding or oral nutritional supplements, significant interference with psychosocial functioning
A lack of interest in eating or food; avoidance based on the sensory qualities of food; concern about unpleasant consequences of eating
The eating disturbance cannot be attributed to a coexisting medical condition nor better explained by another mental disorder
The disturbance cannot be better explained by lack of available food or by an associated culturally sanctioned practice

Have you witnessed any of the above listed signs/symptoms exhibited in a friend or family member? Do you recognize these behaviors in your own habits? Nutrition Counseling/Therapy are options for support. There are dietitians who are Certified Eating Disorder Specialists (CEDS) who work specifically with individuals struggling with disordered eating behaviors. Finding a healthy, non-adversarial relationship with food can be difficult and intimidating, and it can become harder with time as behaviors build. Help is available.

Treatment

While treatment for eating disorders may vary based on the type of disorder and behaviors associated, recognizing the signs/symptoms and treating as early as possible can be key to recovery as individuals with eating disorders are at a higher risk for medical complications.

Treatment may include:

therapy (individual, group, and/or family)
medical care (as needed)
nutrition counseling
medication

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Resources

Adolescent Mental Health. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health. Accessed 9 Sept. 2022.

Eating Disorders | NAMI: National Alliance on Mental Illness. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Eating-Disorders. Accessed 26 July 2022.

“Eating Disorders.” National Institute of Mental Health (NIMH), https://www.nimh.nih.gov/health/topics/eating-disorders. Accessed 26 July 2022.

“Eating Disorders: About More Than Food.” National Institute of Mental Health (NIMH), https://www.nimh.nih.gov/health/publications/eating-disorders. Accessed 26 July 2022.

“Eating Disorders - Symptoms and Causes.” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/eating-disorders/symptoms-causes/syc-20353603. Accessed 16 Sept. 2022.

Eating Disorders (for Teens) - Nemours KidsHealth. https://kidshealth.org/en/teens/eat-disorder.html. Accessed 26 July 2022.

Hornberger, Laurie L., et al. “Identification and Management of Eating Disorders in Children and Adolescents.” Pediatrics, vol. 147, no. 1, Jan. 2021, p. e2020040279. DOI.org (Crossref), https://doi.org/10.1542/peds.2020-040279.

Mental Health Disorders in Adolescents. https://www.acog.org/en/clinical/clinical-guidance/committee-opinion/articles/2017/07/mental-health-disorders-in-adolescents. Accessed 9 Sept. 2022.

National Eating Disorders Association. https://www.nationaleatingdisorders.org/.

What Is Disordered Eating? https://www.eatright.org/health/diseases-and-conditions/eating-disorders/what-is-disordered-eating. Accessed 26 July 2022.

What Are Eating Disorders. www.nationaleatingdisorders.org. Accessed 12 July 2022