A coworker tells you over lunch that they’ve stopped eating carbs.
Your cousin falls silent at the dinner table to log their meal in a weight loss app.
And your best friend texts the group chat that they’re hitting the gym to “earn” the brunch you’re meeting up for later.
Scenarios like these have become normalized, but they’re all behaviors that a growing number of healthcare professionals consider signs of disordered eating.
For many, it’s difficult to know when habits — particularly those that diet culture has labeled “healthy” — fall into this category.
This is especially true for people who don’t match the stereotypes surrounding eating disorders, such as People of Color, men, and people at higher body weights.
But whether you’re experiencing disordered eating, dealing with a full-threshold eating disorder, or just hoping to improve your relationship with food, resources and support abound — no matter who or where you are.
What Is Disordered Eating?
The term “disordered eating” refers to food- and diet-related behaviors that don’t meet diagnostic criteria for recognized eating disorders (EDs) but may still negatively affect someone’s physical, mental, or emotional health.
Chelsea Levy, MS, RD, CDN, is an Intuitive Eating counselor and weight-inclusive dietitian in New York City who works with people recovering from disordered eating and EDs. She told Healthline that disordered eating and full-threshold EDs fall along a spectrum.
“On one end is healthy eating, or just regular old eating, and then all the way on the other side of extreme or unhealthy behaviors would be an eating disorder,” she said. “Disordered eating would be somewhere in between.”
Disordered eating habits may include:
- avoiding entire food groups, certain macronutrients, or foods with specific textures or colors without a medical reason
- binge-eating
- engaging in compensatory behaviors, such as exercising to “make up for” food you’ve consumed
- exercising compulsively
- cutting food into small pieces, slowing down the pace of eating, or otherwise attempting to trick yourself into feeling fuller from less food
- fasting to lose weight
- feeling guilt, disgust, or anxiety before or after eating
- following strict food rules or rituals
- intentionally skipping meals or restricting food intake — including skipping meals before or after you’ve consumed a large meal, food you consider unhealthy, or alcohol
- opting to eat only foods you consider “clean” or healthy
- participating in fad diets to lose weight
- engaging in purging behaviors, such as using laxatives or making yourself vomit to control your weight
- tracking food or calories to the point of preoccupation
- weighing yourself or taking body measurements often
While disordered eating isn’t considered an eating disorder by itself, people who engage in disordered eating are at high risk of developing EDs over time.
And even when disordered eating doesn’t lead a clinical ED, it’s associated with long-term mental and physical health problems such as psychological distress and poorer overall health.
What About Fad Diets?
Many fad diets encourage eating habits that are considered disordered — so much so that some professionals suggest that following any diet to lose weight is a sign of disordered eating.
Rebecca Eyre, MA, LMHC, is an eating disorder therapist and the CEO of Project HEAL, a nonprofit that offers direct services to help people overcome systemic and financial obstacles to accessing eating disorder treatment.
To her, intentional weight loss efforts are inherently disordered.
“Dieting doubles your risk of an eating disorder, and I think what that really means is disordered eating doubles your risk of an eating disorder,” she told Healthline. “It’s really dangerous to toy with that, especially when you consider how rarely dieting leads to the desired outcomes.”
She pointed to research indicating that most people regain more than 50% of the weight they lose within 2 years of starting a diet.
That weight regain can lead to weight cycling — a pattern of dieting to lose weight, gaining weight back, and attempting to lose it again via dieting.
Levy said that our bodies have a set point weight that’s largely defined by genetics. Dieting forces a body away from its set point, and once the diet has ended, the body will do what it can to return to the set point, such as slow down metabolism and increase appetite.
“ANY TYPE OF FAD DIET IS HARMFUL. TO WHAT DEGREE IS INDIVIDUAL … MAYBE SOMEBODY GOES ON A COUPLE OF DIETS IN THEIR LIFETIME, AND THEY END UP LEADING A LONG, HEALTHY LIFE. THAT IS ABSOLUTELY POSSIBLE. THAT’S NOT TO SAY THAT THEY DIDN’T DO ANY HARM TO THEIR BODY — AND ANOTHER INDIVIDUAL MIGHT END UP WITH AN EATING DISORDER.”
— Chelsea Levy, MS, RD, CDN
Among adolescents, dieting is the most important predictor of developing an ED. Those who diet moderately and those who follow extreme restrictions are 5 and 18 times more likely, respectively, to develop an ED than those who don’t diet.
Not to mention, dieting and weight cycling are associated with other negative health outcomes, such as nutritional deficiencies, cardiovascular and metabolic harm, hormonal imbalances, and depressive symptoms.
Disordered Eating vs. Eating Disorders: What’s The Difference?
There are eight categories of full-threshold feeding and eating disorders:
- anorexia nervosa
- bulimia nervosa
- binge eating disorder
- avoidant/restrictive food intake disorder
- pica
- rumination
- other specified feeding and eating disorders (OSFED), which includes purging disorder, night eating syndrome, atypical anorexia nervosa, subthreshold bulimia nervosa and binge eating disorder, and orthorexia
- unspecified feeding and eating disorders (UFED)
Disordered eating involves the same behaviors as full-threshold EDs and can lead to their development, so it can be challenging to identify where the line between the two falls. That’s partly because the “line” can vary from person to person.
In general, the difference comes down to the frequency and severity of the disordered habits. Eating disorders are considered more severe, and a person who has an eating disorder will engage in disordered habits more often with greater impact on their health.
“Are these behaviors taking you away from your job, from socialization, from school and education, or not? And those behaviors can look identical, but how frequently they occur and how they impact you psychologically, and also day-to-day in your functioning, are probably the biggest factors of distinguishing between disordered eating and eating disorders,” Levy said.
Formal ED diagnoses may also take into account a person’s weight, how long they’ve had symptoms, and any effects their behaviors may have had on their physical health.
The Difference Between An ED And Disordered Eating: Does It Matter?
Disordered eating habits and clinical EDs are both associated with poorer mental and physical health, so it may seem as though distinguishing between the two isn’t the most important.
One on hand, this is true: Anyone who wants to improve their relationship with food should feel empowered to do so, whether or not they have a full-threshold ED.
But according to Levy, since ED diagnoses are generally applied when a person has already begun to experience poor physical health outcomes, “it is important to know if you do have a diagnosable eating disorder that is acute because of severity for your safety.”
Eyre said that having specific diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), a resource used for classifying mental health conditions, is useful for other reasons, such as research and insurance authorization for treatment.
Additionally, using the term “disordered eating” may help more people understand when their eating habits cause harm.
“As soon as we talk about eating disorders, everybody has a very extreme image of what that means, and there’s so many problems with that,” Eyre said. “One of the problems of that is that it makes people feel like they need to be a certain kind of sick, a certain degree of severity, in order to even conceive of themselves as having an eating disorder.
“The language of ‘disordered eating’ is much more accessible and approachable and invites people into the conversation about their relationship with food in a way that’s less stigmatizing.”
Weight Stigma And Discrimination Can Prevent People From Receiving ED Diagnoses
Criteria for ED diagnoses can be exclusionary. For example, to receive a diagnosis of anorexia nervosa, a person must have a low body mass index (BMI).
But BMI has been challenged as a tool for measuring an individual’s health, and this method of classifying eating disorders ignores the fact that disordered eating and its associated harms affect people at every body size.
People at higher body weights seem to be much more likely to engage in disordered eating habits, including those that could meet ED criteria. However, because they have higher BMIs, they’re often excluded from receiving diagnoses and, therefore, treatment, Eyre said.
Disordered Eating Affects All Genders, Races, Body Sizes, And Income Levels
Eyre put it simply: “In my opinion, most people have a disordered relationship with food.”
Disordered eating and eating disorders can affect anyone, regardless of their identities or experiences, though some groups may be at higher risk than others.
While misconceptions suggest that the people at highest risk for eating disorders are thin, white, cisgender, affluent women and girls, the reality is quite different:
- People at higher body weights are more likely to exhibit disordered eating behaviors. In fact, Eyre said that just 6% of people with eating disorders are medically underweight.
- Research on EDs and disordered eating in Communities of Color is lacking. However, studies suggest that People of Color are just as likely as white people to engage in disordered eating, while advocates and other studies say that People of Color may be even more likely.
- Sexual minority adolescents — those who are lesbian, gay, bisexual, pansexual, or other non-heterosexual identities — are more likely to engage in disordered eating than heterosexual adolescents.
- LGBT adults and youth are more likely to engage in disordered eating or receive ED diagnoses than their cisgender, heterosexual counterparts.
- Transgender people are at especially high risk of developing EDs. One study involving 289,024 college students found that more than 15% of trans people surveyed reported ED diagnoses, compared with 0.55% of cisgender, heterosexual men and 1.85% of cisgender, heterosexual women.
Socioeconomic Status
Disordered eating can be found in every tax bracket.
Food insecurity is a risk factor for disordered eating, especially bulimic-spectrum behaviors and binge-eating, and rates of disordered eating are increasing among those with below-median income more quickly than among more affluent people.
Age
While many people think EDs affect only teenagers, people of any age can experience them. Disordered eating is increasing among people ages 45 and older more quickly than among younger adults.
A 2008 survey found that women in their 30s and 40s reported disordered eating at the same rate as women in their 20s.
Children are also susceptible to disordered eating. A new study including more than 12,000 9- and 10-year-olds found that as many as 5% of them participated in disordered eating.
Men
Men are another population that has been under-resourced when it comes to disordered eating.
Men account for about 25% of anorexia and bulimia diagnoses, and at least 1 in 7 men will experience an eating disorder by age 40.
A Finnish study found that 7% of men surveyed engaged in disordered eating. And disordered eating is rising more steadily among men than among women. A study among 9- and 10-year-olds found that boys are just as likely as girls to report disordered eating.
Overall, people across all genders, ages, and socioeconomic levels can and do experience disordered eating, and they see the same level of quality of life disruption as a result.
Disordered Eating Is Pervasive — But Why?
Most eating disorders and cases of disordered eating are rooted in body image concerns, which are often influenced by fatphobia. Fatphobia — the fear or hatred of fatness — seeps into everyday life, from the kitchen table to the doctor’s office.
The weight loss industry, the media, and influencers alike encourage behaviors and products meant to keep weights low and waistlines small, despite evidence increasingly suggesting that weight loss diets do more harm than good for many people.
The normalization and celebration of these behaviors is one reason disordered eating endures. Put simply, it’s hard to spot.
Medical professionals in the United States and the United Kingdom receive little training on EDs and are often the ones prescribing weight loss to patients. There’s especially sparse education on EDs in adults, men, People of Color, and LGBTQIA+ people.
Plus, whether a behavior becomes disordered can depend on context.
For example, while fasting for weight loss may be disordered, fasting for religious reasons isn’t necessarily harmful. And having “food rules” could indicate disordered eating, but having preferences or following cultural eating practices wouldn’t.
Additionally, major players in the weight loss industry have rebranded as fad dieting has fallen somewhat out of favor, making it even tougher to identify disordered eating.
What may have been called a diet a decade ago might now be labeled “psychology,” “wellness,” or a “lifestyle” — labels that seem much more innocuous and actually co-opt language used in eating disorder recovery spaces.
But it’s all still rooted in the same goal: intentionally shrinking the body to align with beauty standards that prioritize both thinness and whiteness.
“Everyone in our culture is touched by diet culture and this weight-centric medical model,” Levy said. “We all deserve to unlearn these disordered rules around what health looks like, around eating and having a healthy relationship to food and body.”
Repairing A Disordered Relationship With Food
Whether you feel that your relationship with food may be disordered, could meet ED criteria, or is just something you’d like to improve, support is available — and you deserve access to care.
“IF YOU’RE ASKING THE QUESTION ‘IS MY RELATIONSHIP WITH FOOD DISORDERED?,’ TALK TO SOMEBODY. YOU DON’T HAVE TO HAVE THE MOST SERIOUS EATING DISORDER THAT’S EVER EXISTED IN ORDER TO NEED HEALING.”
— Rebecca Eyre, MA, LMHC, Project Heal CEO
Consider speaking with an eating disorder-informed physician, licensed therapist, nondiet registered dietitian, or other healthcare professional.
They can help you talk through your feelings surrounding food, your body, and your weight and guide you in reframing any beliefs that might propel disordered eating.
Levy recommends that people who occupy marginalized identities work with professionals who have lived experiences in common with them or can demonstrate allyship.
That’s because culturally competent medical care, including in the nutrition field, helps foster trust and increases the likelihood that the person seeking care will receive realistic recommendations that fit their lifestyle.
“Finding an eating disorder dietitian who is Health at Every Size [certified] is probably the first indication of the right direction,” she said. “Check out their website and see what their ‘about’ page talks about, and then have a conversation for 15–20 minutes to see if they might be able to support you.”
And Eyre said that healing from disordered eating doesn’t have to take place solely inside a clinician’s office, either. She suggests considering podcasts, apps, blogs, and other resources to support your recovery.
You might consider some of these options:
- a quiz from Psych Central to help determine whether you could benefit from seeking support
- Healthline’s picks of the best eating disorder recovery apps of 2022
- Healthline’s picks of the best online eating disorder support groups of 2022
- Way Health, a nondiet app to support healing your relationship with food
- ThirdwheelED, a blog by two queer people who write about ED recovery with “the dual perspectives of patient and nontraditional caregiver”
- Healthline’s favorite eating disorder recovery blogs
But remember: Full-threshold eating disorders have a high likelihood of being life threatening. It’s very important to connect with a medical professional if you believe you have symptoms consistent with an eating disorder.
Organizations That Can Help You Access Care
Whether it’s finding an ED-informed healthcare professional or affording the cost of treatment, plenty of barriers to recovery exist. But many organizations can help offset some of these challenges.
You may want to check out some of these groups:
- Project HEAL: a nonprofit (of which Eyre is CEO) offering financial assistance for ED treatment, including funding and help navigating insurance
- Equip Health: a telehealth platform co-created by Project HEAL cofounder Kristina Saffran to support those with eating disorders via the evidence-based Family Based Treatment modality
- Arise: a new digital healthcare startup offering free and low cost ED and disordered eating recovery programs
- FEDUP Collective: a trans-led group that helps trans people connect to free and low cost ED care, grocery funds, meal support, and more and maintains a list of trans-identified and trans-allied clinicians and a scorecard ranking ED recovery facilities for trans inclusion
- Association for Size Diversity and Health: an organization that promotes the Health at Every Size framework, provides resources for people affected by fatphobia, and is currently developing a directory of weight-inclusive healthcare professionals
- National Eating Disorders Association: a national organization that manages a helpline and has compiled a list of free and low cost resources, as well as information about accessing treatment
- National Association of Anorexia Nervosa and Associated Disorders: a nonprofit offering peer-led support for those with restrictive disordered eating habits, including a helpline, a mentorship program, treatment referrals, and a directory of eating disorder-informed clinicians
- National Alliance for Eating Disorders: a nonprofit offering virtual therapist-led support groups, referrals to treatment, and a helpline for those in need of support, as well as direct outpatient services in South Florida
The Bottom Line
The phrase “disordered eating” is becoming more common, but it can be tough to determine whether your habits might fall into that category.
Overall, disordered eating includes food- or diet-related behaviors that are consistent with eating disorder pathology but aren’t considered severe or frequent enough to meet the requirements for an ED diagnosis.
Disordered eating may involve compensatory behaviors, fasting, bingeing, purging, or following fad diets, among other behaviors. These habits are also common in EDs, and the difference between the two, according to experts, isn’t always clear-cut.
“I see eating disorders as a diagnosis from a clinician under the DSM-5, whereas disordered eating might look like some sort of dieting that could turn into an eating disorder,” Levy said.
Cultural ideas about disordered eating prioritize young, thin, white, cisgender, affluent women and girls, but older adults, people at higher body weights, People of Color, LGBTQIA+ folks, people with lower incomes, and men also experience it — even more often, in some cases.
It’s important to work with an eating disorder-informed healthcare professional if you suspect that you’re dealing with an ED or if you’re unsure whether your habits might constitute an ED.
But your day-to-day functioning doesn’t need to be severely compromised for you to deserve support.
“I think we should all assume, baseline, given what I understand to be true about disordered eating and eating disorders, that we all have room to heal our relationships with food,” Eyre said.
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Important Notice: This article was originally published at www.healthline.com by Rose Thorne where all credits are due. Medically reviewed by Adrienne Seitz, MS, RD, LDN, Nutrition
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