When Dieting Goes Too Far: Eating Disorder Warning Signs and Getting Help

The short version

Eating disorders are serious medical and mental health conditions, and they aren't a choice or a lack of willpower.
You can't tell by looking. People at any weight can have one, including people in larger bodies.
If you recognize yourself here, please step back from weight-loss advice, including on this site, and talk to someone.
Support is available. ANAD's free helpline is 1-888-375-7767. In a crisis, call or text 988.

If you need help now

For support and treatment referrals:

ANAD Eating Disorders Helpline: 1-888-375-7767, free, weekdays 9 a.m. to 9 p.m. Central. You can leave a message outside those hours.
National Alliance for Eating Disorders Helpline: 1-866-662-1235, staffed by licensed therapists, weekdays 9 a.m. to 7 p.m. Eastern.
Your doctor or a therapist. You can say: "I'm worried about my eating and I'd like some help."

Warning signs

You don't need to have all of these, or to look a certain way, to deserve help.

Thoughts and feelings

You're preoccupied with food, calories or your weight, and it's hard to think about other things
Your mood or self-worth depends on the scale
You feel intense fear of gaining weight
You feel shame or guilt after eating
You've been told you're at a healthy weight, or underweight, but you still feel you need to lose more

Eating behavior

Skipping meals or eating very little, and finding that the rules keep getting stricter
Cutting out more and more food groups
Eating large amounts in a short time and feeling out of control
Making yourself vomit or using laxatives, diuretics or diet pills to control your weight
Eating in secret or avoiding meals with others
Rigid rituals around food

Exercise

Exercising even when you're sick or injured
Feeling panicked if you miss a workout
Treating exercise as a way to "pay for" food

Physical signs

Rapid weight loss, or frequent ups and downs
Dizziness or fainting
Feeling cold all the time
Missed periods
Hair loss
Stomach problems
Sores on your knuckles, or swollen cheeks, or damaged teeth

Types of eating disorder

Anorexia nervosa: Restricting food, with a fear of weight gain and a distorted body image. It has one of the highest death rates of any mental illness.
Atypical anorexia: The same behaviors and medical danger, without being underweight. It often goes unnoticed in people who started in larger bodies, and may even get praised.
Bulimia nervosa: Cycles of binge eating followed by purging or other compensation.
Binge eating disorder: Repeated episodes of binge eating without purging. It's the most common eating disorder in the US.
ARFID: Avoiding or restricting food for reasons other than body image, such as sensory issues or fear of choking.
Other forms: Many people don't fit neatly into a category, and they still deserve care.

Why this is on a weight-loss website

Dieting is one of the risk factors for eating disorders, so we'd be irresponsible not to include this. If this sounds like you, weight-loss advice can make things worse, including the guides on this site. It's okay, and a good idea, to stop reading them. Please also avoid calorie counting, fasting and restrictive diets until you've spoken with someone who knows your situation.

Your clinician should also know about any past eating disorder before prescribing weight-loss medication or suggesting surgery.

Getting help

Treatment works, and earlier is better, but it's never too late. It usually involves a team: a therapist, a dietitian and a medical doctor. Therapies like cognitive behavioral therapy and family-based treatment have good evidence, and medication can help with some conditions.

If you're worried about someone else

Choose a calm, private moment.
Talk about what you've noticed and how you feel: "I've noticed you've been skipping dinners, and I'm worried about you."
Don't comment on their weight or appearance, even as a compliment.
Don't try to force them to eat, or get into fights about food.
Offer to help find a provider or go along with them.
Expect some denial, and keep showing up.
If someone's in medical danger, get help right away, even if they object.

The ANAD helpline also supports family members and friends.

Sources

This guide is general information, not medical advice. Please check with a clinician before making big changes, especially if you have a health condition, take medication, or are pregnant. Read the full disclaimer.