How to Identify Eating Disorders This Holiday Season
The holiday season is upon us, and while it often brings joy and celebration, it also presents challenges for individuals with eating disorders. With food-centric gatherings, disrupted eating routines, and a surge in diet conversations, it’s no wonder this time of year can be particularly tough for those struggling with food.
As a provider, you have the power to recognize the symptoms of disordered eating and eating disorders and connect them with the care they need. In this blog, we’ll explore the challenges faced by those with eating disorders during the holidays and discuss ways providers can offer support to those struggling.
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The holiday season can be a minefield for individuals with eating disorders. As social gatherings revolve around food, this time of year often magnifies distorted thoughts and behaviors in those grappling with their relationship with food. Negative commentary about food and bodies can be particularly detrimental, with comments like “I’m so bad for eating this pie” or “The diet starts after this meal” exacerbating anxiety in those already anxious around food. Disruptions to meal times and routines can also trigger anxiety. In response, people with eating disorders may avoid events altogether, or conceal the changes in their eating habits or body out of fear and shame.
As a provider, you can play a vital role in recognizing the signs of eating disorders and addressing them with care. It’s important to remember that eating disorders do not have one specific look, so it’s important to remain vigilant and attentive to all patients. While individuals may not explicitly mention their eating disorder, they may refer to related conditions.
Watch and listen for signs or complaints of physical illness, including:
- Menstrual irregularity/amenorrhea
- Sore throat
- Gastroesophageal reflux
- Dry skin and nails
- Hair loss
- Stomach cramps or abdominal pain
- Muscle weakness
- Cold intolerance
- Leg cramps
Because even “normal” physical results cannot rule out an eating disorder, consider the emotional and verbal signs as well: Does your patient talk about wanting to diet despite being a normal weight? Do they seem hesitant to step on the scale? Do they mention stress eating or excessive exercise?
Continue to screen for anorexia, bulimia, binge eating disorder, and OSFED (Other Specified Feeding or Eating Disorders) eating disorders by asking questions about your patient’s relationship with their body, food, and exercise.
Discussions about food can be highly triggering for those with eating disorders, so it is wise to open these conversations with broad, non-leading questions. “Tell me about your diet and exercise,” for example, may invite comments that “Are you eating and exercising in a healthy way?” would not. People with eating disorders often have distorted beliefs about food, weight, and exercise, and providers can work to uncover these distortions with open-ended questions.
It is also essential to maintain a weight-neutral approach when asking patients to step on the scale. Even well-meaning remarks (“I wish the scale was this kind to me!”) can be damaging to those experiencing or at risk of developing an eating disorder. Such comments can inadvertently reinforce dangerous behaviors, especially when they come from such a credible source.
If you do suspect an eating disorder in your patient, follow up with questions to specifically screen for these illnesses. Consider guiding them through our online quiz to get started. Here are a few questions we recommend asking:
- Do you worry about your weight and body shape more than other people?
- Do you avoid certain foods for reasons other than allergies or religious reasons?
- Are you often on a diet?
- Do you feel your weight is an important aspect of your identity?
- Are you fearful of gaining weight?
- Do you often feel out of control when you eat?
- Do you regularly eat what others may consider to be a large quantity of food at one time?
- Do you regularly eat until feeling uncomfortably full?
- Do you hide what you eat from others, or eat in secret?
- Do you often feel fat?
- Do you feel guilty or depressed after eating?
- Do you ever make yourself vomit (throw up) after eating?
- Do you use your insulin in ways not prescribed to manage your weight?
- Do you take any medication or supplements to compensate for eating or to give yourself permission to eat?
- Do you exercise for the sole purpose of weight control?
- Have people expressed concern about your relationship with food or your body?
Asked in an open, non-judgmental manner, these questions fit as part of a standard medical assessment and can quickly alert you to a potential eating disorder. Refer any patients with concerning signs to specialty care, where the symptoms can be identified, evaluated, and properly treated. The sooner a patient receives care, the better the outcome.
This holiday season, as you care for your patients, remember that your expertise and support make a significant difference. By recognizing the challenges faced by those with eating disorders during the holidays (and beyond), you give hope for brighter holidays to come.