How to Recognize Eating Disorders in Your Patients Over the Holidays

The holiday season is beginning. Although this time of year can bring much joy, it can also come with difficulties, especially for those with eating disorders. In a season that often involves large shared meals, diet talk, and an abundance of sweet treats, it’s no wonder that this time may be challenging for a person struggling with disordered eating or an eating disorder. 

When seeing patients during the holiday season (and all year long), providers like you have a unique role in recognizing eating disorder symptoms. Your appointments are a valuable opportunity to notice signs of trouble and provide support during what is often the most challenging time of year for those with these illnesses.  

Read on to learn about the challenges facing those with eating disorders during the holidays, as well as what providers can do to support those struggling.

Holiday Challenges for People with Eating Disorders

There are a myriad of challenges for people with eating disorders during the holidays, including large social gatherings and food-related events. One common stressor is negative talk about food and bodies. It might sound like: “I am so bad for eating this pie after all I’ve eaten today” or “I’m going to have to start a diet after this meal.” People may even share unsolicited feedback about others’ bodies or eating habits, such as: “Are you sure you should get a second helping?” or “Have you lost weight?” All of these types of comments can trigger eating disorder behaviors and thoughts for people with these illnesses. 

Another common difficulty during the holidays is the numerous food-centered activities. Oftentimes, someone with an eating disorder pulls away from those around them, keeping hidden any changes to their body or eating habits. For example, they may decline an invitation to bake holiday cookies with their family out of fear related to eating the cookies. Or they may decide to attend a meal with their extended family and then stress the whole time about the food all around them. They may not be able to enjoy the holiday at all because of all-consuming thoughts about food and their body. 

Warning Signs of Eating Disorders 

As a provider, you can watch out for signs of eating disorders during this challenging time of year. Because denial and shame are common in people experiencing eating disorders, it is rare for those affected to disclose the thoughts, feelings, and behaviors they may be experiencing during their illnesses. Providers, therefore, should stay gentle and alert, remaining mindful of the possibility of illness in all patients. Eating disorders do not have one “look,” but some typical signs can indicate the presence of one.

While your patient may not explicitly name their eating disorder, they may refer to other conditions associated with it. Watch and listen for signs or complaints of physical illness, including:

• Menstrual irregularity/amenorrhea
• Sore throat
• Gastroesophageal reflux
• Dizziness
• 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.

How to Ask Your Patients About Food or Body Image Concerns

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. Below are the screening questions we recommend asking:

1. Do you worry about your weight and body shape more than other people?
2. Do you avoid certain foods for reasons other than allergies or religious reasons?
3. Are you often on a diet?
4. Do you feel your weight is an important aspect of your identity?
5. Are you fearful of gaining weight?
6. Do you often feel out of control when you eat?
7. Do you regularly eat what others may consider to be a large quantity of food at one time?
8. Do you regularly eat until feeling uncomfortably full?
9. Do you hide what you eat from others, or eat in secret?
10. Do you often feel fat?
11. Do you feel guilty or depressed after eating?
12. Do you ever make yourself vomit (throw up) after eating?
13. Do you use your insulin in ways not prescribed to manage your weight?
14. Do you take any medication or supplements to compensate for eating or to give yourself permission to eat?
15. Do you exercise for the sole purpose of weight control?
16. 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.

The holidays can be an extremely stressful time for people with eating disorders. Providers can do their part by keeping an eye out for the signs of eating disorders and then referring those struggling to proper care. 

To learn more about eating disorders and the holidays, join us for a complimentary webinar hosted by Hilmar Wagner, MPH, RDN, LN, CD, and Krista Crotty, LMFT, PsyD, on Thursday, November 10th. Learn more and register here.