Because early intervention in an eating disorder generally leads to quicker recovery, recognizing the early signs and symptoms is crucial. However, eating disorders can be hard to recognize in the early stages for several reasons. First, the initial changes may be subtle. Your loved one may simply cut back on sweets or decide to exercise a bit more. Naturally, these changes typically elicit praise from others, not censure. In addition, it takes time for the disordered eating to impact the physical body enough to be noticed by others. People suffering with Anorexia may also resort to wearing baggy clothing in an attempt to hide weight loss or other bodily changes. Thus, by the time significant weight changes or other forms of physical deterioration become obvious, the disease is no longer in the early stages. For individuals suffering from Bulimia, the physical signs are even more subtle, as weight fluctuations tend to be less drastic than the weight loss associated with Anorexia. By the time changes in hair, skin, teeth, nails or other more serious medical complications arise, the disease is well progressed.
Second, the initial changes often mimic modern attitudes about food, nutrition and weight loss. For example, deciding to “eat more healthy” may translate into consuming more fruits and vegetables, less starchy or fatty foods, or deciding to eliminate meat from the diet. None of these decisions would be considered out of the norm and may be supported by family and friends as representing better food choices consistent with increased health consciousness. Thus, the accolades that individuals receive further fuel the disease. Indeed, as long as a proper nutritional balance is maintained, such changes would be fine if they stopped there. The problem with sudden or severe dietary changes, however, is that these changes may play a role in triggering the onset of an eating disorder for those who are already vulnerable either genetically or environmentally or both.
Third, due to common misconceptions about the disorder as well as the stigma surrounding the disease, people are reluctant to consider the presence of an eating disorder or simply do not know how to recognize the symptoms. In addition, because eating is both an intensely private as well as public behavior, friends or loved ones may be reluctant to observe or confront the issue, particularly if they are only noticing small changes.
Fourth, because denial of the problem is a common characteristic of those with an eating disorder, casual observers are easily persuaded that no problem exists and the person is able to progress further into the disease before their repeated denials become suspect. Individuals with eating disorders also become quite skilled at the appearance of eating. For example, they may cut food into smaller and smaller bites, push the food around on the plate or even dump food into a napkin to give the appearance of having consumed at least part of their meal. In addition, the early stages of disordered eating may be cleverly hidden in the form of refusing “unhealthy” food such as not eating hors d’oeuvre at a party, refusing dessert or swearing off dairy or meat products. The avoidance of a particular food form is not so much the problem. It is the increasing restriction of additional food forms that become an issue and signals a potential problem.
Finally, for families who experience other life challenges such as parents who have little time with their children due to stressful working situations or when the various activities of all the children pull parents in too many directions at once, leaving little time for family meals or gatherings, disordered eating may go unnoticed for quite some time by simple lack of opportunity for observation.
To protect against disordered eating, particularly if eating disorders run in the family, make a point to have frequent meals together so that you have an opportunity to observe the eating behavior of your loved ones and to be aware of their normal eating patterns and preferences so that you would be able to spot significant changes. Be sure to model healthy attitudes toward food, diet, exercise and your physical body both in word and in action. Provide balanced, nutritious meals and insist that they eat properly at school. Do your best to avoid over-reliance on fast food or restaurant meals.
Most importantly, if you are concerned about your child’s nutrition or food intake, take corrective action immediately to make certain that potential problems are exposed and remedied before disordered eating has an opportunity to take root. Remember, however, that disordered eating is not really about the food. It is a negative coping skill for an underlying emotional problem. Until the underlying problem is corrected, one poor coping skill (e.g., disordered eating) may simply be substituted for another (e.g., substance use). Make a point to look beyond the surface symptoms and into the emotional pain that is fueling it all. For more information on the role of food in eating disorders, see the ezine article: “What Are Eating Disorders: Is It About the Food?”