National surveys estimate that 20 million women and 10 million men in America will have an eating disorder at some point in their lives and sadly eating disorders have the highest mortality rate of any psychiatric illness. Medical complications from binge eating, purging, starvation, and over-exercise, and suicide are common among individuals with eating disorders. People who struggle with eating disorders also have a severely impacted quality of life and recovery can be a long and slow process.

There are several different eating disorders, including anorexia nervosa, avoidant restrictive food intake disorder, binge eating disorder, bulimia, pica, orthorexia, and unspecified eating disorder. There are many online resources that list the physical and emotional symptoms of each eating disorder and understanding what these physical symptoms are can help. It’s also really important to recognize that not everyone who struggles with an eating disorder is severely underweight. It’s also important to know that if someone is showing physical signs of an eating disorder, then the illness is already fairly advanced and the individual needs professional help. Author Harriet Brown likens it to a cancer that has already reached stage III, or worse.

The good news is that recovery is possible with the proper treatment. And an active support system often plays a key role in recovery. But where do you start if you suspect a loved one or friend has an eating disorder?

Here are 7 signs that indicate someone may be struggling with an eating disorder:

1. Discusses weight concerns frequently.

  • Individuals who are constantly on a diet and are emotional when they don’t reach goal weights.
  • Expresses concern about body shape or weight, or expresses a desire to lose weight or look different.
  • Talks excessively about food, healthy foods, “clean” eating, “bad foods”, or avoids eating foods because they are on a diet.

2. Uses exercise to manage weight and to “undo” what they ate.

  • Increases an exercise regimen or physical activity without also increasing caloric intake.
  • Becomes anxious or upset if he or she cannot exercise.
  • Frequently chooses exercise sessions over events or social gatherings.

3. Highly concerned about meal preparation.  

  • Becomes unusually interested in cooking, but might not actually be eating the meals or treats he or she makes.
  • Makes safe meals instead of eating what the family is eating.
  • Constantly avoids restaurants because there is nothing they can eat on the menu.

4. Expresses desire and concern to have control over mealtimes and food.

  • Becomes anxious and/or upset when unable to control mealtimes or meal plans change.
  • Expresses anxiety, anger, or frustration when dinner plans change or the restaurant isn’t serving the meal they planned to order.
  • Avoids eating if mealtime is at a different time.

5. Odd behaviors during and after meals. 

  • Consistently uses the bathroom after a meal.
  • Refuses to eat in anyone else’s presence.
  • Engages in rituals with food, such as cutting it into small pieces or eating things in a certain order.
  • Takes abnormally long time to complete a meal.

6. Has frequent mood changes that are unexplainable or are triggered by food, body image, or exercise. 

  • Appears more depressed, anxious, irritable or fatigued than normal.
  • Mood changes if conversation relates to food, body image, exercise, or size.

7. Change in energy levels. 

  • Seems to have less energy, less vivacious, or less interested in the activities they once loved. Seems “down” all the time.
  • Or seems to have become super(wo)man, taking on all sorts of responsibilities and activities, giving 100 percent of oneself 100 percent of the time.

The presence of one or more of these signs doesn’t necessarily mean that the individual has been diagnosed with an eating disorder, but it does represent a red flag calling for extra awareness and extra support.

Onset of Eating Disorders.

It often takes psychological therapy to identify what triggers the onset of an eating disorder. But an individual’s stress, trauma, and social environment could also help provide clues that someone might be struggling with an eating disorder. Eating disorder behaviors can develop as coping mechanisms for a person and provide false sense of control.

If you see some of the above signs, take a moment to think about the stress that the person might be going through. Has there been any family change or tragedy? Has there been a personal trauma? Is he or she being bullied (especially about weight or body shape)? Are they inordinately anxious about school and grades? Do they feel like they have to live up to unrealistic standards or goals? If the answer is “yes”, this is the time to be watchful and supportive.

If you think your friend, daughter, son, partner, spouse, coworker or loved one is exhibiting signs of an eating disorder don’t panic, judge, or accuse. You’re already doing the right thing by taking the time to research eating disorders. Use sites like NEDA, Eating Disorder Hope, or Project Heal. Talk to a trusted health professional, such as a physician, pediatrician or a therapist, or reach out to me or someone else who has gone through similar struggles.

Most importantly, start the conversation with your friend or loved one. Gently express your concerns and show your support and love. Sometimes the person does not even know or want to admit they are struggling with an eating disorder. You may the first person or one of many who have expressed concern. No matter what make sure they know you are there for them.