How Nurses can Recognize Signs of an Eating Disorder

• In the U.S., 10,200 people die each year as the direct result of an eating disorder – equivalent to one death every 52 minutes. So understanding signs of an eating disorder is paramount.
• Eating disorders typically start in childhood and adolescence and unhealthy thoughts about body appearance can occur as young as age six. 
• Early recognition of eating disorders is important as these conditions can lead to illness, disability, and death.

Recognizing signs of an eating disorder could help decrease the number of people in the U.S. who die annually as a result of the condition. 

Eating disorders — which are the direct result of more than 10,000 deaths per year — are conditions in which people have unhealthy thoughts and behaviors surrounding food and body image. Early recognition, such as nurses screening for those at risk, paying attention to the signs, and identifying certain trends in body weight and behaviors, can positively impact patients who have these conditions. 

How to Recgnize Anorexia Nervosa

Anorexia Nervosa is a condition in which people severely restrict food, eat small amounts of certain foods, or avoid food entirely. People with this condition may weigh themselves repeatedly. The two types of anorexia nervosa are: restrictive (extreme food limits) and binge-purge (food limits accompanied with binge-eating and purging episodes). 

General signs to look for: 

• Obsession with being thin (or extreme fear of gaining weight) 
• Distorted body image (see themselves as overweight when they are dangerously underweight) 
• Denial of seriousness of low body weight 

Abnormal labs and vital signs: 

• Anemia 
• Low blood pressure and slower heart rate 
• Slower breathing 

Assessment findings:  

• Emaciated appearance 
• Feeling cold all of the time 
• Brittle hair and nails 
• Growth of fine hair across body (lanugo) 
• Multiorgan failure 
• Infertility 

How to Recgnize Bulimia Nervosa

Similar to the binge-purge type of anorexia nervosa, people with bulimia nervosa uncontrollably binge-eat and purge. However, people with this condition can be any weight. In fact, a person with bulimia nervosa can appear healthy and have a normal weight. 

General signs to look for: 

• Chronic inflamed and sore throat (from vomiting) 
• Swollen salivary glands in the neck and jaw 
• Decaying teeth (due to exposure to stomach acid) 

Abnormal labs and vital signs: 

• Electrolyte imbalances that are too high or too low 

Assessment findings:  

• Acid reflux and other gastrointestinal problems 
• Intestinal irritation (from laxative misuse) 
• Signs of dehydration  

How to Recognize Binge-Eating Disorder 

Binge-eating disorder is similar to bulimia nervosa in that it occurs when people uncontrollably binge-eat. The difference is people with binge-eating disorder do not purge afterwards. People with this disorder are often overweight or obese. 

General signs to look for: 

• Eating unusually large amounts of food in short time periods 
• Eating even when full or until uncomfortably full 
• Eating fast during binge episodes 
• Feeling ashamed or guilty about eating  
• Frequent dieting attempts 

Assessment findings:  

• Obesity or being overweight 

How to Recognize Avoidant Restrictive Food Intake Disorder (ARFID) 

In avoidant restrictive food intake disorder (ARFID), a person restricts the amount or type of food they eat and, as a result, does not get enough calories. ARFID is the medical term for “picky eater.” Although seemingly similar, ARFID is different from anorexia nervosa in that it is not related to a distorted body image or extreme fear of gaining weight. People with ARFID usually develop the disorder in middle childhood. 

General signs to look for: 

• Dramatic restriction in food type or amount 
• Lack of appetite or interest in food 
• Picky eating that gets progressively worse 

Assessment findings:  

• Poor nutritional status 
• Dramatic weight loss 
• Gastrointestinal issues 

Why is early recognition of eating disorders important?

Early recognition of eating disorders is vital as these conditions can lead to illness, disability, and death. Eating disorders can cause strokes and heart attacks as a direct result of electrolyte imbalances or indirectly through weight gain.  

Eating disorders are also considered one of the deadliest mental illnesses. In the U.S., 10,200 people die each year as the direct result of an eating disorder. Studies show that 26% of people with eating disorders attempt suicide. In fact, suicide is the second leading cause of death in people with anorexia nervosa.  

[If you or anyone you know is suicidal, call 911 right away. For resources and crisis support, call the Suicide Hotline by simply dialing the numbers 988.] 

Nurses should start screening in school-aged children and adolescents, as eating disorders often occur in these groups, with: 

• 42% of first through third grade girls wanting to be thinner 
• 81% of 10-year-old children having a fear of being fat 
• School-aged children starting diets as young as 9 years old.  
• More than one-third of adolescent girls participating in crash dieting, self-induced vomiting, fasting, or using diet pills or laxatives. 

What Resources are Available to People who have Eating Disorders? 

Two national organizations offer a plethora of resources that nurses can share with people who have an eating disorder or those who might have questions (like parents/guardians) about signs of an eating disorder. 

National Eating Disorders Association (NEDA) is the largest nonprofit group supporting people (and families) affected by eating disorders. The organization focuses on prevention, recovery, and cures, as well as access to quality care. It also provides resources that nurses can use to help screen for eating disorders.  

National Association of Anorexia Nervosa and Associated Disorders (ANAD) is the leading nonprofit group in the U.S. providing free peer support services to people who have an eating disorder. The organization has a free helpline available for referrals, support, and general questions. 

The Bottom Line

Unhealthy thoughts about food, body weight, and shape might lead to eating disorders. Early recognition involves paying attention to the signs that someone may have an eating disorder and identifying risk factors to prevent the disorder from happening. Early recognition can lead to better health outcomes for children, adolescents, and the population. 

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