Eating disorders

Many people picture an eating disorder as someone who is very thin. In reality, people with eating disorders come in every size. Fewer than 6% of people with eating disorders are medically underweight, according to research shared by ANAD.

People in larger bodies are often missed, or even praised for losing weight, while they are seriously ill. That praise can make the illness stronger.

Eating disorders are most common in teens and young adults, but they can start at any age. They affect people of all ages, racial and ethnic backgrounds, body weights and sexes.

Groups who are often overlooked

• Boys and men, who make up as many as 1 in 4 people with eating disorders
• People of color, who have similar rates but are about half as likely to be diagnosed
• LGBTQ+ young people, who are more likely to have an eating disorder
• Adults in midlife and older age

Nobody chooses to have an eating disorder. Genes, brain chemistry, personality, life experiences and the world around us all play a part. Feelings like shame and guilt around food are part of the illness, not a sign of weak willpower.

Saying “just eat” or “just stop” is like telling someone with a broken leg to “just walk”. Recovery takes support and treatment, not willpower alone.

Parents and families often feel guilty, but they did not cause the illness. In fact, families can be one of the strongest helpers in treatment. Research suggests family-based treatment improves outcomes, especially for teens.

Eating disorders can harm the heart, bones, stomach, teeth and brain, sometimes without obvious signs. Anorexia has the highest death rate of any mental illness, and people with eating disorders face a higher risk of suicide.

Eating disorders can be treated successfully. Recovery often takes time, and there can be ups and downs along the way, but many people go on to have a peaceful relationship with food and their body.

Getting help early, having support from people who care, and sticking with treatment through the hard parts all make a real difference.

Anorexia is a serious, sometimes life-threatening illness. A person strictly limits what they eat because of a strong fear of gaining weight or a distorted view of their body. They may see themselves as bigger than they are, and tie their whole sense of worth to their size.

Two patterns

• Restricting: losing weight mainly through strict dieting, fasting or too much exercise
• Binge-eating/purging: restricting, but also having episodes of binge eating or getting rid of food, such as making yourself sick

Signs can include

• Skipping meals, cutting food into tiny pieces, or strict food rituals
• Avoiding eating in front of others
• Exercising hard even when tired, sick or injured
• Feeling cold, tired, dizzy or weak
• Hair thinning, dry skin, or periods stopping
• Perfectionism, irritability and pulling away from friends

Over time, starving the body can thin the bones, weaken the heart, and affect the brain and other organs. Anorexia often starts in the teen years or early adulthood.

What helps

• Family-based treatment, usually the first choice for teens
• Talking therapies for adults, such as CBT for eating disorders
• Working with a registered dietitian
• Regular health checks with your clinical provider

With bulimia, a person eats a large amount of food in a short time and feels out of control. Afterwards, they try to prevent weight gain, for example by making themselves sick, fasting, misusing laxatives or exercising hard. It often happens in secret, wrapped in shame.

People with bulimia are often an average weight or above, so it can go unnoticed for a long time. Their sense of self-worth is often tied closely to their body shape and weight.

Signs can include

• Going to the bathroom often right after meals
• Hiding food, or food going missing
• Strong guilt, shame or anxiety after eating
• Sore throat, swollen cheeks or jaw, or damaged teeth
• Stomach problems such as acid reflux
• Mood swings and low self-esteem

Making yourself sick can upset the balance of salts in your blood (electrolytes), which can affect your heart. That is why medical check-ups are part of care.

What helps

• CBT for eating disorders, often including guided self-help
• DBT skills for strong emotions and urges
• Nutrition support to build steady eating and break the binge–purge cycle
• Regular medical check-ups with your clinical provider

Binge eating disorder is the most common eating disorder. A person often eats an unusually large amount of food in one sitting and feels they cannot stop. Unlike bulimia, they do not regularly try to “undo” it.

Everyone overeats sometimes, like at a holiday meal. Binge eating is different: it keeps happening, week after week, feels out of control, and is followed by strong guilt or shame.

Signs can include

• Eating very fast, or until uncomfortably full
• Eating when not hungry
• Eating alone or in secret because of embarrassment
• Eating to cope with stress or numb feelings
• Feeling disgusted, guilty or low afterwards
• A cycle of strict dieting, then bingeing

What helps

• CBT to break the cycle and build new coping skills
• Interpersonal therapy, which looks at stress in relationships
• Guided self-help or group therapy
• A dietitian who focuses on steady, regular eating instead of strict dieting

ARFID is more than picky eating. A person limits how much or what kinds of food they eat because of fear (like choking or vomiting), a strong dislike of textures, smells or colours, or simply little interest in food. Unlike anorexia, it is not about body shape or wanting to lose weight.

It is most common in children, but adults can have it too. It is more common in people who have anxiety, ADHD or autism, or who had a scary experience with food, like choking.

Signs can include

• A very short list of “safe” foods that keeps shrinking
• Weight loss, or a child not growing as expected
• Stomach aches, low energy, feeling cold or dizzy
• Avoiding meals with others, at school, work or parties

People often describe three broad patterns, and someone can have more than one. Sensory: certain colours, textures, tastes or smells feel truly unbearable, not just unpleasant. Fear: a frightening experience like choking or vomiting leads to avoiding foods, or eating, altogether. Low interest: feeling full quickly, forgetting to eat, or finding food just not worth the effort.

Sensory sensitivity is real. For some people, a lumpy texture or a strong smell can trigger gagging or panic. This is a body reaction, not stubbornness. Shaming or forcing usually makes the fear stronger.

Picky eating or ARFID?

• Picky eating usually involves only a few foods, and a child still grows well. It often fades with age
• ARFID affects health, growth, energy or daily life, and does not go away on its own
• Picky eaters can usually manage a meal out. People with ARFID may avoid parties, school lunches or work events because of food
• With ARFID, the list of accepted foods often gets shorter over time

ARFID can share some features with autism, like sensory sensitivity, but they are different conditions. A person can have both.

Nutrition risks

• Not getting enough energy, vitamins or minerals
• Low iron (anemia), which can cause tiredness and feeling cold
• Dehydration and imbalances in the body’s salts (electrolytes)
• Slowed growth or delayed puberty in children and teens
• Weak bones over time
• Low blood pressure, dizziness or fainting

Some people with ARFID look healthy on the outside and even have normal test results, because the body adapts for a while. That doesn’t mean they are okay. Please consult with your clinical provider about checks and a nutrition plan.

What helps

• CBT, the main treatment, which gently reduces fear around food and builds comfort with new tastes and textures
• Slowly trying new foods, in small, safe steps, starting close to foods already accepted
• A care team that may include a therapist, a dietitian, a doctor and sometimes a speech-language therapist for feeding and swallowing
• For children, parents learning how to support meals calmly at home

Tips for families

• Keep meals calm. Avoid bribes, battles or forcing bites
• Always include at least one safe food on the plate
• Let your child touch, smell or lick a new food without having to eat it
• Praise trying, not eating amounts
• Eat together when you can, so food is linked with connection

OSFED is the name doctors use when someone is struggling seriously with eating, but their experience looks a bit different from anorexia, bulimia or binge eating disorder. People are not boxes, and eating disorders don’t always fit neat labels. OSFED is actually the most common type.

Examples

• Atypical anorexia: the thoughts and behaviours of anorexia, but weight stays in or above the “normal” range
• Purging disorder: making yourself sick or using other ways to get rid of food, without bingeing
• Bingeing, or bingeing and purging, that comes and goes rather than happening all the time
• Night eating syndrome: eating a lot late at night or after waking, and feeling upset about it

Pica is a feeding disorder where a person keeps eating things that are not food and have no nutrition. It is most common in young children, during pregnancy, and in people with autism or intellectual disabilities.

It can be harmless, but it can also be dangerous. Some items cause poisoning (such as lead), infections, blockages in the gut or damaged teeth.

Things people may eat

• Ice (common in pregnancy, and usually harmless)
• Dirt, soil or clay
• Chalk, paper or soap
• Hair, string or cloth
• Paint chips
• Pebbles, ash or coffee grounds

Babies and toddlers put almost everything in their mouths. That is a normal way of exploring, not pica. Pica is when someone keeps eating non-food items for at least a month, at an age when they would usually know not to, and it isn’t part of a cultural or religious practice.

Pica is often linked to low iron, zinc or calcium. Some people crave ice, clay or soil when their body is low in these. It is also more common in people under stress, people who faced hardship in childhood, and people with sickle cell disease.

Health risks to watch for

• Lead poisoning from old paint chips or soil
• Blockages in the gut, including from swallowed hair
• Infections and parasites from soil or animal waste
• Damaged teeth
• Injuries from sharp items
• Constipation and body salt (electrolyte) problems

What helps

• A medical check, including blood tests for low iron or other nutrition problems. Consult with your clinical provider about any nutrition needs
• Behavioral therapy to learn new habits and ways to cope
• Rewarding other activities instead of the pica behavior
• Making the home safer and keeping risky items out of reach
• Gentle supervision for young children or people with intellectual disabilities

In children and in pregnancy, pica often goes away by itself. For others it may come and go, but treatment helps a lot. The main danger comes from what is eaten, which is why safety steps matter so much.

With rumination, food comes back up from the stomach into the mouth, usually within minutes to two hours after eating. It is not vomiting: there is no sickness or retching, and it is not painful. It is an automatic habit the body has learned.

It is common in babies and in people with developmental disabilities, but it can happen at any age, often after a stressful time.

Experts think the muscle at the bottom of the food pipe learns to relax at the wrong time after eating, a bit like a burp that brings food with it. Because the food hasn’t mixed with stomach acid yet, it usually doesn’t taste sour. Many people don’t realise it is unusual until someone notices.

It is rare overall, but some studies suggest up to 1 in 10 people with another eating disorder, or with fibromyalgia, may have it. Stress, other stomach conditions and other mental health conditions can raise the risk.

Health risks

• Weight loss and not getting enough nutrition
• Slowed growth in children
• Tooth decay and bad breath
• Dehydration and body salt (electrolyte) problems
• Food going into the lungs, which can cause choking or pneumonia
• Shame and avoiding eating with others

What helps

• Behavioral therapy to notice the body’s signals and respond differently
• Diaphragmatic (slow belly) breathing after meals: breathe in slowly through the nose so the belly rises and the chest stays still, then breathe out slowly
• Biofeedback, relaxation skills and CBT

Behavioral therapy works well for most people, and children can unlearn the habit too. Please consult with your clinical provider if a child or adult is losing weight or bringing food up after most meals.

Orthorexia is not an official diagnosis, but clinicians are seeing it more often. It often starts with good intentions, like wanting to eat healthily. Over time, the food rules get stricter, more anxious and harder to live with.

Signs can include

• Cutting out more and more food groups
• Checking labels over and over
• Feeling very upset when “safe” foods aren’t available
• Avoiding meals out or events because of the food
• Spending hours on “healthy lifestyle” content
• Frequent cleanses or detoxes

Even without weight loss, cutting out food groups can cause tiredness, missing nutrients and weaker bones. Strict rules can also lead to bingeing, guilt, and more rules.

Moving your body can be joyful and healthy. But for some people, exercise becomes a rule they cannot break, or a way to “make up for” eating. It is a common part of anorexia and bulimia.

Signs can include

• Feeling guilty or anxious if you miss a workout
• Exercising through pain, illness or injury
• Skipping time with friends, school or work to exercise
• Exercising to “earn” food or “burn off” what you ate

When the body burns more energy than it gets from food for a long time, it can lead to a condition called RED-S. Signs include tiredness, stress fractures, missed periods and low mood.

You might notice

• Thinking about food, calories or your body most of the day
• Feeling your worth depends on your weight or shape
• Strong fear of gaining weight
• Seeing some foods as “bad”, “unsafe” or harmful
• Guilt or shame after eating
• Low mood, anxiety, irritability or perfectionism

These thoughts can feel very convincing. They are often the illness talking, not the real you.

You might notice

• Skipping meals, or eating very little
• Strict food rules or rituals, like eating foods in a set order
• Cutting out whole food groups
• Eating very fast, or eating large amounts in secret
• Going to the bathroom right after meals
• Hiding food, or food going missing
• Lying about what has been eaten

You might notice

• Big changes in weight, up or down (or none at all)
• Feeling cold, tired, dizzy or faint
• A racing or slow heart
• Stomach pain, bloating or constipation
• Hair thinning, dry skin or brittle nails
• Periods that become irregular or stop
• Sore throat, swollen cheeks or damaged teeth

You might notice

• Avoiding meals with family or friends
• Making excuses, like “I already ate”
• Wearing loose or baggy clothes to hide the body
• Pulling away from friends and things they used to enjoy
• Mood swings, or seeming anxious or low
• Exercising instead of spending time with others

Your body needs steady energy from food to keep your heart beating, your brain thinking, and your bones strong. When eating is badly disrupted, every part of the body feels it. Many of these effects get better with treatment and regular nourishment.

Not eating enough can lead to

• A slow heart rate, low blood pressure, and heart damage
• Feeling cold, dizzy or faint
• Muscle loss, weakness and tiredness
• Periods stopping, problems with fertility, and slowed growth in teens
• Thinning bones (osteoporosis) and a higher risk of fractures
• Trouble thinking clearly, and changes in mood

Purging can lead to

• Acid reflux and an irritated gut
• An imbalance of salts in the blood (electrolytes), which can affect the heart
• Severe dehydration
• Sore throat, swollen glands in the cheeks, and worn tooth enamel

Binge eating can lead to

• Blood sugar swings, and a higher risk of type 2 diabetes and heart problems
• Low self-esteem, low mood and pulling away from others
• Sleep problems
• Stomach pain, bloating and digestive problems

Eating disorders also affect the mind. People often feel anxious, low or alone, and the risk of suicide is higher. This is a big reason to reach out early.

Having a parent, brother or sister with an eating disorder raises the risk. So does a family history of depression or alcohol or drug problems. Brain chemicals like dopamine and serotonin may also play a part.

Some health conditions add risk too. For example, by their 20s, about 4 in 10 girls with type 1 diabetes had signs of a full or partial eating disorder in one study.

Things that can add risk

• Perfectionism, or very high standards for yourself
• Anxiety, depression or OCD
• Low self-esteem
• Needing to feel in control
• Using food to cope with hard feelings

More than 70% of people with eating disorders also live with another condition, most often anxiety or depression. Treating both together helps.

Things that can add risk

• Being teased or criticised about your eating, shape or weight
• Trauma, including sexual abuse
• Big life changes, like moving, a loss, or starting college
• Long-lasting stress

In one UK survey, 45% of children and teens said they were regularly bullied about how they look.

Diet culture is the constant message that your worth depends on your size, and that some foods are “sinful”. It is everywhere: in ads, conversations and “before and after” photos. Pressure to be slim, including in some sports, dance and modelling, is a known risk.

Dieting itself can be a starting point. One study found that 15-year-old girls who dieted severely were 18 times more likely to develop an eating disorder.

A 2023 review of 50 studies from 17 countries found that social media use is linked to body image worries and disordered eating in young people aged 10 to 24. The main reasons were comparing yourself to others, believing a “thin” or “fit” ideal, and seeing your body as something to be looked at.

Content that raises risk

• Appearance-focused apps and feeds
• Editing photos and chasing likes
• “Thinspiration” and “fitspiration” posts
• Content that promotes eating disorders

The good news: people who understood how social media works (media literacy) and who appreciated their bodies were less affected.

Almost everyone has days when they feel unhappy with how they look. Negative body image is when those feelings stick around, grow loud, and start to shape your choices, like what you eat, wear or avoid.

It can look like

• Saying unkind things about your body, out loud or in your head
• Comparing your body to others, again and again
• Checking mirrors, photos or the scale often, or avoiding them completely
• Hiding your body in baggy clothes
• Skipping swimming, parties, photos or sport because of how you look

Being unhappy with your body is one of the things that can raise the risk of an eating disorder. That is why caring for your body image matters.

For some people, worry about one part of their appearance becomes so strong that it fills hours of the day. Others may not notice the “flaw” at all, but to the person it feels huge and impossible to ignore. Doctors call this body dysmorphia (body dysmorphic disorder).

It can feel or look like

• Checking the mirror over and over, or avoiding mirrors
• Asking others again and again how you look
• Covering the area with clothes, hair or makeup
• Lots of grooming or skin picking
• For some, worrying that your body is too small or not muscular enough

It often begins in the early teen years. It is not vanity. It is a real and painful struggle, and it is treatable, most often with CBT.

Many images online are edited or filtered, so we compare our real selves to pictures that aren’t real. Comparing ourselves this way can bring anxiety, envy and obsessive thoughts. Filters also often push one narrow beauty standard, which can be extra hurtful for people of color.

Apps learn what you watch and show you more of it. A few clicks on diet or “body check” videos can quickly fill a whole feed.

Research on young people links social media to body worries and disordered eating, especially appearance-focused feeds, photo editing, and chasing likes. People who understood how social media works and appreciated their bodies were better protected.

Girls and women often get the message that they should be slim, smooth and young-looking. By age 14, research shared by ANAD found 60–70% of girls are trying to lose weight. The pressure doesn’t stop with age: in one study, about 7 in 10 women over 50 were trying to lose weight.

Body changes in puberty, pregnancy and menopause are natural, but they can stir up difficult feelings. Diet talk among friends and family can make it harder.

For many boys and men, the pressure is to be muscular and “jacked”. Online trends can push hours at the gym and very strict eating. Because these habits can look “healthy”, the struggle is often missed.

Some men worry that their body is too small or not muscular enough, even when others don’t see it that way. Men can find it hard to talk about body worries, but they are common and real.

You don’t have to love every part of your body to have a healthy body image. Many people aim for body neutrality: accepting your body without judging it, and focusing on what it does, not how it looks.

Try this

• Thank your body for one thing it did today, like hugging someone or carrying you home
• Catch an unkind thought, and ask: “Would I say this to a friend?”
• Wear clothes that fit and feel comfortable now
• Mute or unfollow accounts that make you feel worse
• Follow people with many body shapes, ages and abilities
• Remember that most images online are edited
• Spend time on things you enjoy that have nothing to do with looks

Eating disorders most often begin in the teen years and early adulthood. Growing bodies, school pressure, friendships, and social media can all add up.

Signs parents might notice

• Skipping lunch at school or “eating at a friend’s”
• Sudden interest in strict diets or “clean eating”
• Lots of exercise in their room, or long workouts
• Not growing or developing as expected
• Mood changes, especially around mealtimes

For teens, family-based treatment is usually the first choice. Parents become part of the care team and help their child eat enough to heal.

Men make up as many as a quarter of people with eating disorders, but they are much less likely to be diagnosed. Shame and the idea that eating disorders are a “girls’ problem” can keep men from asking for help.

For some boys and men, the worry is less about being thin and more about being lean or muscular. Strict “bulking” and “cutting”, rigid meal plans, and exercising through pain can all hide an eating disorder.

Athletes are at higher risk when weight or body shape matters in their sport, such as gymnastics, wrestling, swimming, running or dance. Pressure to “make weight” or look a certain way can turn into disordered eating.

Training hard without eating enough can lead to RED-S (relative energy deficiency in sport). Signs include tiredness, poorer performance, slow recovery, stress fractures, missed periods and low mood.

What helps

• A registered dietitian who understands sport
• Rest from training while the body recovers
• Support from a mental health professional
• Coaches and teammates who focus on health, not weight

Eating disorders are not only a young person’s illness. One study of women aged 50 and over found that about 71% were trying to lose weight, and 41% had current or past core eating disorder symptoms.

Big life changes like menopause, retirement, illness, divorce, or losing a loved one can trigger an eating disorder, or bring back an old one. Signs may be mistaken for “normal ageing”.

People of color have similar rates of eating disorders to white people, but are about half as likely to be diagnosed. Doctors may be less likely to ask them about eating disorder symptoms.

LGBTQ+ young people are about three times as likely to have an eating disorder as their straight peers. Stress, stigma and body pressures can all play a part.

Mealtimes can be the hardest part of the day for someone with an eating disorder. A calm, predictable atmosphere helps more than pressure or debate.

Ideas

• Keep table talk light and away from food, weight or diets
• Avoid commenting on how much or what they eat
• Stay with them after meals, doing something relaxing together
• Follow the plan from their care team, if they have one
• Don’t make them the only one eating differently in a way that draws attention

For ARFID, pica or rumination, the care team may give very specific advice, like always including a safe food, or practicing belly breathing after meals. Asking the team how you can help at home is a great step.

For children and teens, family is often at the heart of treatment. In family-based treatment, parents are supported by the care team to take charge of meals for a while, so the young person can recover.

What helps at home

• Act early. Speak to your child’s doctor if eating, weight or growth changes worry you
• Stay united with other caregivers so your child hears one message
• Separate the illness from your child: you’re on their side, against the eating disorder
• Keep up fun and connection that has nothing to do with food
• Let the school know, if your child agrees, so they can support lunchtimes

Ideas

• Help look up a doctor, therapist or dietitian who knows eating disorders
• Offer to go with them to the first appointment
• Help with forms, insurance calls or travel
• Keep inviting them to things, even if they say no
• Share ANAD’s free support groups and recovery mentors

Supporting someone with an eating disorder can be frightening and tiring, and recovery often takes time. It’s okay to feel frustrated, scared or sad.

Look after yourself

• Talk to someone you trust about how you’re feeling
• Join a support group for families and carers
• Keep up your own meals, sleep and hobbies
• Remember you can’t make someone recover. You can only offer support
• Get your own counseling if you need it

Enhanced CBT (CBT-E) is a form of cognitive behavioral therapy built for eating disorders. It works on the beliefs that keep the illness going, especially judging yourself mostly by shape and weight. A broader version also works on perfectionism, low self-esteem and relationship problems.

It is often around 20 sessions, or about 40 for people who are underweight. A 2018 review found strong evidence that CBT-E is an effective treatment for eating disorders.

What you might work on

• Building a steady pattern of meals and snacks
• Noticing the thoughts and feelings around eating
• Slowly facing feared foods and situations
• Loosening the link between your body and your worth
• Planning ahead for setbacks

In family-based treatment, parents or carers work with a therapist to help their child eat enough to heal. Over time, the young person takes back control of their eating. Research suggests it improves outcomes, especially for teens.

For under-18s with anorexia in the UK, family therapy is usually the first option, often around 18 to 20 sessions over a year.

Dialectical behavior therapy (DBT) is based on CBT and made for people who feel emotions very strongly. It balances accepting yourself with making changes, which can help when food is used to cope with feelings.

The four skill areas

• Mindfulness: staying in the present moment
• Distress tolerance: getting through a hard moment without making it worse
• Emotion regulation: understanding and managing feelings
• Interpersonal effectiveness: asking for what you need and setting boundaries

A registered dietitian with eating disorder training helps you eat enough, regularly, and with more variety. They focus on steady nourishment rather than strict rules or dieting.

They may help you

• Plan regular meals and snacks
• Slowly add back “fear foods”
• Understand what your body needs and why
• Break the binge–restrict cycle

Eating disorders can affect the heart, bones and blood. Regular check-ups during and after treatment help catch problems early. For what checks you need, consult with your clinical provider.

Most people are treated as outpatients and live at home. If someone needs more support, care can step up, then step back down as they get better.

Common levels

• Outpatient: about one session a week
• Intensive outpatient: several sessions a week
• Day or partial programs: treatment for much of the day, home at night
• Residential programs: living at a treatment center for a while
• Hospital (inpatient): for people who are very unwell

Shame and secrecy keep eating disorders going. Being with people who understand, without judging, can make recovery feel less lonely and more possible.

Free peer support

• ANAD runs free, virtual support groups open to anyone, whatever their background or diagnosis.
• ANAD’s free recovery mentors offer one-to-one support from someone further along in recovery.
• Research shared by ANAD found people with peer mentors were more likely to go to their provider appointments.

Ways your community can help

• Agree as a family, team or friend group to drop diet talk and body comments.
• Coaches and teachers can focus on health and effort, not weight.
• Faith groups, clubs and schools can share where to find help.
• Keep inviting friends who are struggling, even if they say no.
• Make meals and gatherings about connection, not about food or bodies.