The early signs of an eating disorder

If you are concerned that someone close to you has started to develop an unhealthy relationship with food or exercise, we understand that alongside your worry, you may also be confused about how you can support them.

Within this blog, we will provide you with trusted advice and information around the following:

• The early signs of an eating disorder
• How to talk about your concerns with someone who has an eating disorder
• The support and treatment available to people with eating disorders

What are the early signs of an eating disorder?

A preoccupation with food

One of the common early signs of an eating disorder is a preoccupation with food and/or exercise.  A person may spend more time speaking about food, looking for recipes online, and cooking and baking for others.

You may also notice:

• Precise tracking of energy intake or steps
• A sudden disinterest in certain food groups
• An increased interest in different diets or health foods

As an eating disorder progresses, you may also pick up on certain food rituals and behaviours around meal times such as:

• Eating foods in a certain order
• Cutting food into tiny pieces
• Having very specific portion sizes
• Only using certain crockery and cutlery
• Excessively chewing

When someone has an eating disorder, they will often continue to add more rules and rituals as time goes on.

A regimented exercise routine

A person struggling with an eating disorder will often have a disordered relationship with exercise too. If you are concerned that someone is showing the early signs of an eating disorder, you may have started to become aware of the following:

• Their exercise routines are often very strict and inflexible
• They display distress if their routine is disrupted or if they can’t train
• Exercising takes precedence over other elements of their life including health, work and relationships
• Despite evident tiredness and fatigue, they continue to exercise, even if they’re unwell
• Exercise is used to work off calories, lose weight or offset an eating binge

An obsession with tracking

A person who is developing an unhealthy relationship with food is likely to keep track of their food and fitness. This tracking will be strict and regimented, where they monitor some or all of the following:

• The number of calories consumed and burned
• The number of steps taken
• Changes in body weight and body measurements

Over time, tracking food and fitness can prevent people from being able to listen to signals from their body. Rather than focusing on what their body wants and needs, they come to rely on rules and restrictions outlined in tracking apps and devices to dictate how they should eat, drink and exercise.

Starting to use diet pills or laxatives

Studies have shown that using diet pills and laxatives increases the risk of someone developing an eating disorder. The products disrupt the normal functioning of the body and prevent a person from paying attention to their bodily cues.

Low body confidence

You may notice that the person is dissatisfied with how they look. They may express this to close family and friends, and they will believe other people see them in the distorted way in which they see themselves.

Discussing this dissatisfaction is one of the early signs of an eating disorder. However, that can disappear as a person becomes more unwell and tries to hide their thoughts, feelings and behaviours from people who have expressed concern.

Deception

When someone has an eating disorder, they will often start to lie to other people about their eating and their exercise in an attempt to maintain control.

Some comments and behaviours that you may have started to notice include:

• They have already eaten
• They are too full and will eat later
• They feel poorly more often or have a stomach ache
• They want to eat elsewhere, such as in their room
• They say they don’t like the food that has been prepared
• They eat much slower than usual

This deception is something that typically worsens over time, as the person attempts to hide what is going on from other people.

Changes in mood

When someone is struggling with an eating disorder, this can impact their mood. They may become irritable and angry more quickly than usual, and they may also seem sad and reserved.

These mood changes can happen for a number of reasons. If the person is restricting the amount of food that they eat, nutritional deficiencies may mean they have less control over their emotional regulation. They may also become more irritable or angry when conversation turns to their food intake and exercise, as they are likely to feel criticised.   

Someone who has an eating disorder is also likely to struggle with their self-esteem and body confidence. This in turn can cause them to feel upset and low in mood. 

Starting a conversation with someone who you think has an eating disorder

We understand that this discussion may be difficult to start, but if someone is showing the early signs of an eating disorder, such as anorexia, reaching out to them is so important.

When a person is in the initial stages of an eating disorder, they will often be more receptive to the idea of seeking help. We know that the earlier we can treat an eating disorder, the more likely that we can hope for a better prognosis.

• Choose somewhere safe and comfortable, and avoid having the conversation if either of you are stressed, angry or upset
• Introduce the topic by letting the person know that you are worried about them and that you’ve noticed a few changes
• When talking about your concerns, don’t focus on their food, weight or exercise
• Avoid listing the things that you have noticed, as this could cause them to feel embarrassed. They may also become defensive and try to close down the conversation
• Start sentences with phrases like “I have noticed...” or “I’m a little worried…” rather than “You have been doing…” or “You have changed this…” so that you don’t sound accusatory
• Ask questions about how they’ve been feeling lately, if anything has been bothering them or if they’re worried about something. Leave pauses in the conversation so that the person has time to think and reply
• Encourage the person to speak to a doctor about what they are going through. Remind them that while they may feel scared about doing so, many people have struggled with this sort of thing and have been able to recover with the right support. It’s nothing for them to feel embarrassed about. You may also want to suggest going with them to their appointment

The person may get angry or upset during your first conversation. If this happens, try not to feel too disheartened. Instead, let them know that you will always be there to support them and will listen when they are ready to talk. Then, try to have the conversation at another time when you both feel calm.

Support and treatment available for the early signs of an eating disorder

There are a number of treatment options available for people displaying the early signs of an eating disorder. This may include psychotherapy, nutrition education and medication if appropriate.

Common treatment paths include:

• A day treatment programme is often recommended for people in the earlier stages of an eating disorder. These provide psychiatric, therapeutic, nutritional and dietetic support, along with the option of returning home in the evenings if appropriate
• A residential treatment programme is most commonly used for people who need more intensive treatment, as this provides them with 24/7 care and monitoring within a live-in facility or hospital
• Weekly therapy sessions can be used by people in the earlier stages of an eating disorder. They allow people to meet with a therapist, dietician and/or nutritionist and begin addressing their unhealthy relationship with food, drink and exercise, while continuing with their responsibilities (such as attending work)

If you would like to find out about the treatment options that are available here at Priory, please visit our eating disorder treatment page for further information.

Additional support groups and resources to help people with eating disorders

• BEAT – the eating disorder charity offers telephone and online support as well as message boards and forums where people are able to receive peer-to-peer support
• Anorexia and Bulimia Care – this charity has regional support groups and telephone support lines for people with eating disorders as well as their worried family and friends
• Young Minds – this charity offers support to young people who are struggling with conditions such as eating disorders, and also provides support to their parents
• SEED – the voluntary organisation has a diary of different support groups for both sufferers and carers