Eating Disorder Basics

What is an eating disorder?

  • Eating disorders (ED) are about so much more than just food.
  • Often individuals ask “why don’t they just eat more?” or “why not try to have more disciplined eating?”. Well, it might help to know that eating disorders are neurobiologically based, and influenced by genetics, environment, stress, and cultural perspectives. The behaviors themselves might have nothing to do with food and body image but instead, serve to express an individual’s psychological needs and status.
  • Many individuals have a drive for thinness, fear of gaining weight, and difficulty seeing themselves accurately. Many engage in some sort of maladaptive coping strategy to foster control, compensate for intolerable feelings, and communicate distress. Examples include but are not exclusive to: restricting food intake, intentionally vomiting, over-exercising, eating more than others would eat in the same sitting, obsessing about “energy in, energy out” or how “clean” they are eating.
  • You can’t always tell someone has an eating disorder just from looking at them. Individuals in average and large size bodies can experience starvation and malnourishment with the same medical consequences. Malnutrition is a multi-organ system insult. Each organ system has adaptive responses to survive nutritional threats.
  • The ways that eating disorders across cultures may be different as compared to the American white population. Considerations need to be made regarding possible stigma in seeking care, assumptions that can be made about a person of color’s body, and the institutional racism that exists in health care. Eating disorders affect everyone, regardless of gender, age, race, ethnicity, culture, size, socioeconomic status, or sexual orientation.

But really SKINNY people have eating disorders, right? Like with a BMI under 18?

  • BMI is an antiquated equation (weight/height2) originally created by a statistician to define the ideal European man (based on French and Scottish men). At the time that the BMI was developed, there was a racial preference for white bodies in Europe, and seeing that individuals in black bodies tended to be larger, they placed a lower social value on larger bodies and described them as gluttonous. It was not developed as a determinant of health and was inappropriately selected as a metric with defined categories that were arbitrarily set. Truly, mathematically, it is meaningless and unfortunately has been and continues to be misused in research, by insurance companies, and impedes access to individualized healthcare.
  • You know who isn’t a European man? More than half of the population! According to the 2022 US Census, 50% of the US population identifying as female, 25% of the US population identifying as non-white, and 28% of the US population 18 years of age and under (though really, development does not finish until age 25 so this number is likely much larger).
  • Weight and shape are NOT indicators of health. BMI is NOT an indicator of anything at all. What we see is that BMI overestimates health risks in the Black population and underestimates health risks in the Asian population. Again, someone in a normal sized or larger body by standard measurements can still have an eating disorder and have the same risks of mortality as a result of malnutrition as someone with a BMI under 18.
  • For more information:

Who can have an eating disorder?

  • At least 30 million individuals of all ages, races, ethnicities and genders suffer from an eating disorder in the US alone.
  • Athletes have an increased risk
  • LGBTQAI+ individuals have increased risk.
  • Neurodivergent individuals and those with Autism Spectrum Disorder have an increased risk.
  • Poor individuals and unhoused individuals have an increased risk.
  • Individuals with OCD, Anxiety, Depression, and trauma have an increased risk.
  • Please read more-

What does eating disorder treatment look like?

  • There are different levels of care depending on the severity of an individual’s behaviors and their psychological and medical statuses.
  • The main goals of treatment are nutritional restoration and behavior interruption
  • Treatment programs offer medical, psychiatric, therapy and dietary services to assure advantageous care with a multidisciplinary approach.
  • Inpatient/ Residential (IP, RES) programs provide 24 hour care and supervision. When individuals struggle to interrupt harmful behaviors, lack motivation and have lost more than 15% of their total body weight, they do better in 24 hour care. This may include medical stabilization at a traditional hospital before admitting to a care facility. The average IP/RES admission is 12 weeks with nutritional restoration as a primary focus as it can be extremely difficult to achieve this at lower levels of care.
  • Partial Hospitalization Programs (PHP) are the next step and allow time for “dress rehearsals” for individuals before they return home. This level of care is structured with day treatment 5-7 days a week, 8-10 hours a day depending on the program. Usually the program is 4-6 weeks in length. Meal plans are stabilized at this level or right before admission if individuals are stepping down from higher levels. This allows focused therapeutic and dietetic support as the individual continues to adjust to changes in habits, coping mechanisms and is reintroduced to other stressors.
  • Intensive Outpatient Treatment (IOP) allows further practice for individuals, reducing programming to 3 days a week, 3-5 hours a day. Now the individual can return to school, work, and life while still staying connected with treatment supports.
  • Outpatient Treatment (OP) is usually the longest period of treatment for an individual on their recovery journey. The first 6 months after an individual discharges from any of the higher levels of care are the most critical for prognosis and avoiding relapse. The brain actually takes a year to recover from the effects of malnutrition! It is also essential to find eating disorder informed providers before an individual’s status declines. This can improve the chances of full remission and repeat treatment admissions. Outpatient treatment is most successful when utilizing a multidisciplinary approach as seen at higher levels of care to continue to support the individual medically, therapeutically, and dietarily. This is often hard to find and assemble in most areas of the country.

Does treatment work?

  • It does! Recovery IS possible!
  • Prognosis for full recovery is improved with early recognition and prompt intervention with intensive treatment.

But what about diets? If I diet, that’s still healthy, right?

  • Studies show that the 95-97% of individuals who engage in intentional restriction (reduction of caloric intake) will regain weight + 10% more
  • 35% of “normal dieters” progress to pathological dieting. Of those, 20-25% progress to partial or full-syndrome eating disorders1
  • Weight stigma is real! Western culture/diet culture confirms, affirms and insists that losing weight is the most important measurement of “health”.
  • We all have implicit bias and that includes weight and it’s important to find providers that get it.

Do I or does someone I know struggle with an eating disorder?

  • Check out the specific features for each eating disorder diagnosis below:
    • Anorexia Nervosa (AN)/ Atypical AN
    • Bulimia Nervosa (BN)
    • Binge-Eating Disorder (BED)
    • Avoidant/Restrictive Food Intake Disorder (ARFID)
    • Orthorexia
    • OSFED
  • Take our free screening tool! ED Screener