by Alyssa Greene, LPCC

Depending upon your training, it may be difficult to know what to look for when it comes to eating disorders. We know it is typical to not receive a lot of training on eating disorders, despite it being the second most fatal mental illness after opioid overdose.

Some traits that may alert you to potential eating disorders, or disordered eating, include perfectionism, highly involved in extracurricular activities, overly productive, and rigid thinking patterns around their body, food, health, or movement. Of course, having these traits does not mean your patient has an eating disorder, but they may be a risk factor.

Behaviors that your patient or their families may share that could indicate a potential eating disorder include:
• skipping meals and snacks
• isolating from family or friends around mealtimes
• needing to be involved in the food making process
• exercising outside of their typical pattern
• looking at their body or measuring their body or avoiding mirrors.

If a patient has Type 1 Diabetes, look for skipping of insulin. It is also common for those with shame or guilt around their body or health to avoid healthcare altogether. This is even more common in people in larger bodies due to weight stigma found in healthcare settings and practices. As a result of these behaviors, it may be common to see these symptoms: changes in weight (either loss or gain), increased isolation and anxiety, malnourishment, mood swings, and reduced enjoyment in food or meals.

Unfortunately, many with eating disorders report that their behaviors or symptoms worsened after unhelpful conversations with their healthcare providers. Here are some ways to address a possible eating disorder without unintentionally making symptoms worse:
1. Normalize regularly that weight isn’t the only component of health you focus on. If this is not a part of your practice already, look into Health At Every Size principles.
2. Ask non-judgmental questions (ex: “How is this different from a year ago? What information did you find that led you to change how you ate?”)
3. Avoid bringing up childhood obesity and BMI, especially in higher weight children. Just because someone is in a larger body does not mean they have an eating disorder or a “poor” relationship with food.
4. Don’t compare the child’s body to others in their family.
5. Use neutral terms around food and bodies. It’s best to avoid terms around food such as: “good” or “bad foods”, clean, junk foods, healthy vs. unhealthy. These terms can increase feelings of shame when they eat food they believe may not fit that label.