Questions from patients about nutrition can run the gamut from how they can kick-start their metabolism to how to ease more plant-based foods into their diet and what modifications they can try to curb cravings and feel fuller longer.

During your discussions with patients, there are cues to recognize that may signify patients may have some behavior or nutritional patterns that could cause concern. One of these conditions is known as disordered eating, which has symptoms that manifest some risk. Here is more clinical background about disordered eating to treat patients effectively.

Definitions to Understand and Act On

Here is a clinical definition, provided by Grace Derocha, a registered dietician nutritionist in Detroit who is a media spokesperson for the Academy of Nutrition and Dietetics.

“Disordered eating refers to a spectrum of irregular, dysfunctional, or distressing eating behaviors that do not necessarily meet full diagnostic criteria for an eating disorder [ED] but still carry medical and psychological risk. These behaviors can include chronic dieting, rigid food rules, meal skipping, binge eating episodes, compulsive exercise, or using food for emotional regulation.”

Here is a patient-friendly definition you can share.

“Disordered eating occurs when eating behaviors — whether restricting, overeating, or cycling between the two — begin to interfere with physical health, emotional well-being, or daily functioning, even if they do not meet criteria for a formal eating disorder.”

“This framing helps adults understand that clinical impairment, not just weight or appearance, is the key concern,” clarified Derocha.

Indicators of Disordered Eating in Patients

The fast answer of whether disordered eating is an ED is negative, said Derocha. “Disordered eating exists on a continuum between normal eating and a diagnosable ED,” she said.

While it is not a standalone DSM-5 diagnosis, it is clinically significant because:

• It’s a “major risk factor” for developing anorexia nervosa, bulimia nervosa, or binge-ED, she said.
• Studies show that up to 50% of adults with disordered eating later meet criteria for an ED.
• Physiologic and psychological consequences can mirror those of full-syndrome EDs, though often less severe initially, she said.

Cues and Signals in Adults

Derocha suggests primary care physicians screen for the following behavioral, cognitive, and physical indicators:

• Chronic or extreme calorie restriction
• Persistent or cyclical dieting, often with rapid shifts in rules (“yo-yo dieting”)
• Binge episodes or loss of control eating
• Skipping meals or long fasting windows not driven by medical guidance
• Overly rigid eating schedules or “clean eating” taken to extremes
• Avoidance of entire food groups without medical rationale
• Compensatory behaviors (eg, excessive exercise, misuse of laxatives or diuretics)
• Eating in secret; shame or guilt around meals

Here are some of the cognitive indicators to watch for:

• Preoccupation with weight, shape, or “perfect” nutrition
• Emotional eating in response to stress, anxiety, or loneliness
• Anxiety about social eating situations

Physical indicators to keep in mind when assessing patients

• Fluctuating weight (up or down)
• Gastrointestinal discomfort, constipation, or bloating
• Fatigue, dizziness, hair thinning
• Irregular menses in premenopausal adults

Why Diagnosis Is Important

Disordered eating affects the entire person: physical, mental, and emotional wellbeing. “Besides the physical impacts on the body, disordered eating can also affect a person’s ability to focus and concentrate at work or school, to maintain personal and professional relationships, and to even achieve financial freedom,” said Sue-Ellen Anderson-Haynes, a registered dietitian nutritionist in the Boston area and spokesperson for the Academy of Nutrition and Dietetics. “Understanding that there is a problem and getting treatment is the most important step anyone can take to live a healthy lifestyle.”

Getting disordered eating patterns under control means patients can eat without fear, eat for health, and live in peace to know that wholesome food is nourishing to the body and soul, she said. Advise patients that recognizing hunger cues, and knowing when to stop eating, are also key in the journey to recovery, she further explained.

Furthermore, many cues that someone could be engaging in disordered eating patterns are first seen by family and friends.

“For example, skipping meals at home when the family eats, rigid food rules, frequent bathroom visits during mealtime, counting calories, weighing food or constantly preoccupied with body checking,” noted Anderson-Haynes.

No reported disclosures.