Learn more about disordered eating and body image bystander intervention:
Often begin or worsen during transition periods, such as starting college.
A friend of yours appears to have lost quite a bit of weight lately. You notice that her eating habits are becoming more and more unusual. She is skipping meals and altering foods when she does eat (e.g., pulling cheese off pizza).
When approached, she is defensive, denying that anything is wrong. Since she has been restricting food, her academic performance has suffered, she hangs out with friends much less, and seems to be pushing you away. What do you do?
- Have you personally ever struggled with eating issues?
- Do you know anyone with disordered eating? What impact did that have on you and/or your relationship with the person?
- What are some underlying reasons people develop disordered eating? Control issues, self-esteem, peer/societal pressure, Others? Does gender play a role? Can it be genetic?
- Is this an identity-based issue (e.g. being an athlete, being in a sorority, being a gay man)? If yes, how so?
- What role do the media play in this?
Disordered eating consists of the spectrum of unhealthy eating from dietary restraint to clinical eating disorders. All eating disorders are included in disordered eating but not all disordered eating meets criteria for an eating disorder.
According to the National Eating Disorders Association, 20 million women and 10 million men suffer from clinical eating disorders at some time in their lives, although most cases remain unreported. Eating disorders occur in every gender, race, ethnicity, age, and social class. Other research suggests that over the course of their lives, approximately 50% of all Americans suffer from disordered eating, which may include non-clinical levels of anorexia, bulimia, binge eating or purging. Disordered eating also includes jumping from one kind of diet to the next, obsessions with food, weight, and body image, and creating “buckets” of food groups as “good” and “bad,” rather than “always” and “sometimes.”
A research project done by the NCAA looked at the number of student athletes who had experienced an eating disorder in the previous two years. Of the reported problems, 93% were in women’s sports. The sports that had the highest number of participants with eating disorders, in descending order, were women’s cross country, women’s gymnastics, women’s swimming, and women’s track and field events.
The male sports with the highest number of participants with eating disorders were wrestling, cross country and track and field.
The three most common eating disorders:
- Anorexia (Anorexia nervosa) (Self-Starvation Syndrome)
- Bulimia (Bulimia nervosa) (Binge/Purge Syndrome)
- Binge Eating (Compulsive Overeating)
- Major life changes
- Relationship problems
- Desire to maintain control
- Change in environment
- Societal, familial, psychological and genetic
- Competitive thinness
- Pressures associated with sport life
- Control-focused individuals
- Participating in spaces that emphasize outward appearance
Many who suffer from eating disorders move from “healthy” to “unhealthy” behaviors without always realizing it, and they do so with rationalizations in mind. Here are a couple of the many examples.
Lots of people want to be good to their bodies and the environment by eating locally-produced, organic, superfoods. Due to several factors, however, sometimes people move from a mindset of “I’m eating these kinds of foods because they are always good for me” to “I’m not eating any foods that fall into these categories.” The move from what’s good for me all the time to restrictions can create problems, as the categories of restricted foods starts to go up.
Athletics is sometimes used to “legitimize” an eating disorder by the persons explaining their symptoms (dieting, excessive exercise, etc.) as a way of becoming better athletes or to perform better. They sometimes get away with this because of the similarity between good athlete traits and eating disorder symptoms. There is the mistaken belief that a decrease in weight or body fat increases performance. But remember: disordered eating is usually only a symptom. It is important to try and found out what the real problem is.
Did you know…?
- Dieting is the primary precursor for the development of an eating disorder and connected to disordered eating, since most who diet end up gaining back the weight they lost.
- The Female Athlete Triad is the combination of disordered eating, amenorrhea (loss of menses), and osteoporosis (loss of bone mineral density), where one leads to and interacts with the other. The presence of any Triad symptom indicates a need to assess for the others.
- Disordered eating can lead to other problems: dehydration, depression, anxiety, malnourishment, decreased concentration and decreased the ability to make good decisions.
- Eating disorders, particularly among men, are often accompanied by other disorders including unsafe use of alcohol and depression.
Anorexia and Bulimia
- Eating disorders often begin or worsen during transition periods such as starting college.
- Eating disorders can also be triggered when people seek acceptance into groups or social settings, including sororities, weddings, formals, and Spring Break.
- Usually, the longer a person has the disorder, the more purposes, and functions it serves. It can become the primary means of coping with life.
- Dramatic weight loss in a relatively short period of time.
- An intense and irrational fear of body fat and weight gain; hard for the person to concentrate on anything besides weight or food.
- A determination to become thinner and thinner.
- A misperception of body weight and shape to the extent that the person feels fat even when underweight.
- Basing self worth on body weight and body image. Obsession with others’ weight and appearance.
- Personality traits such as perfectionism, being obsessive, approval seeking, low self esteem, withdrawal, irritability, and all or nothing thinking.
- Frequent skipping of meals, with excuses for not eating; food restriction and self-starvation.
- Eating only a few foods, especially those low in fat and calories. Secrecy around eating.
- Unusual food rituals (e.g., moving food around plate, cutting portions into tiny pieces).
- Frequent trips to the bathroom after meals.
- Frequent weighing of self and focusing on tiny fluctuations in weight.
- Excessive focus on an exercise regimen outside of normal practice and conditioning.
- Using (or hiding use of) diet pills, laxatives.
- Avoidance of social gatherings where food is involved, or isolating themselves.
- Fatigue and overall weakness.
- Eating very large quantities of food at one sitting but is normal weight or slightly above weight.
- No menstrual periods or irregular periods.
- Eating large amounts of high-caloric and high-fat foods in an extremely short amount of time.
- Sleeping for increased amounts of time, particularly after eating immense amounts of food.
- Eating in secret and, possibly, denying food intake
- Feelings of guilt and shame surrounding the binging.
- Feeling out of control and unable to stop consuming food.
- Changing food rituals or when one eats.
- Includes some fasting periods to try and regain control.
- Changes in daily life to create space for binge eating.
- Not always a perceptible change in body weight.
- Talk to your friend. Keep the discussion informal and confidential, and focus on concerns about your friend’s health and your relationship with her/him, not on weight or appearance.
- Support your friend, even if they say they don't need help or nothing is wrong. Many with an eating disorder struggle in recovery because they isolate themselves from friends and family. Your friend will need you.
- Encourage the individuals to be a part of social functions and reassure them that you (and hopefully others) will not pressure them to eat if they do not want to.
- Let the individuals have as many options surrounding food as possible—for example let them choose the restaurant if you are going out to eat.
- LISTEN. Find out what other things are going on in their lives.
- Let them know that you will pass no judgments on them.
- Ask them what you can do to help make dealing with food easier.
- Be aware of how you talk about others’ bodies – Comments can sometimes slip out but can be unintentionally hurtful or confusing to others.
- Promote the idea that good nutrition leads to good health and increased performance.
- Discuss your concerns with a professional. Learn about eating disorders. Find out how to have conversations with your friend.
- Encourage the individual to seek professional help. Health care professionals are bound by confidentiality.
- Support yourself. Seek counseling or find trusted friends and family members. Helping people with eating disorders also affects you, so make sure you get the support you need.
- You are not a professional and will not be able to fix the situation—however, you can offer resources and support.
- You may be rejected. People with eating disorders often deny their problem because they are afraid to admit they have a problem. Don’t take the rejection personally, and try to end the conversation in a way that will allow you to come back to the subject at another time.
- Disordered Eating Continuum
- Eating Disorders Brochure (National Institute of Mental Health)
- Eating Disorders Toolkit for Educators (National Eating Disorders Association)
- Reaching Out to Someone Who May Have an Eating Disorder: Some Do's & Don'ts (Renfrew Center)
- What Should I Say? Tips for Talking to a Friend (National Eating Disorders Association)
- What the Stopwatch Doesn’t Tell – How Coaches Can Help
- Tips for Coaches and Trainers
- Eating Disorders Centers
- The Women's Center
- Counseling & Psychological Services
- Campus Health & Wellness Center
- Lehigh's Dietician/Nutritionist
- Athletic Trainers
- NCAA Coaches Handbook – Managing the Female Triad
- International Olympic Committee Position Stand on the Female Athlete Triad –
- Female Athlete Triad – www.femaleathletetriad.org
- NCAA Nutrition and Performance – www.ncaa.org/nutritionandperformance
- National Eating Disorders Association (NEDA) – www.nationaleatingdisorders.org
- National Osteoporosis Foundation – www.nof.org
- Sports, Cardiovascular and Wellness Nutritionists (SCAN) – www.scandpg.org
- Academy for Eating Disorders (AED) – www.aedweb.org
- American College of Sports Medicine – www.acsm.org
- American Dietetic Association (ADA) – www.eatright.org
- The Renfrew Center Foundation – www.renfrew.org
- Eating Issues/Body Image Continuum – (See below)
- Bloomington Center for Counseling and Development – www.bloomington-eating-disorders.com
- National Association of Anorexia Nervosa and Associated Disorders – www.anad.org