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Eating disorders affect 9% of the U.S. population (30 million people)

Eating disorders are the second deadliest mental illness, behind only opioid addiction

Weight gain early in treatment is considered a primary predictor of success with FBT, which is the gold-standard treatment for young people

Nutrient needs of patients are complex and non-intuitive

Taken together, these facts make it clear just how important weight gain is to lasting recovery. And yet, there is no data on dietary interventions used in eating disorder treatment. A variety of different approaches are used in practice, and research is sparse on which may be the most effective. This gap was the impetus behind Equip’s latest “Renourish” study.

The Renourish study, which began in the spring of 2022, is Equip’s first randomized trial, and the first study (to our knowledge) to compare virtually delivered dietary interventions commonly used in eating disorder treatment.

We enrolled 100 patients aged 6-24 with a diagnosis of either anorexia nervosa (AN) or avoidant/restrictive food intake disorder (ARFID), and had self-selected for virtual eating disorder treatment. Upon admission, patients were assigned to receive one of two dietary interventions:

Calorie-based: Caregivers are provided a daily calorie goal by their registered dietitian. .

Plate-by-Plate™: This is a visual approach, designed for FBT, whereby caregivers are asked to follow a series of simple steps to assemble a plate that is “normal,” with representation of most/all food groups and emphasis on variety. Counting calories and weighing are discouraged.

The primary objective of the study is to examine any potential differences in weight changes across the two groups during the first sixteen weeks of treatment. We’re also looking at other outcomes, such as eating disorder symptoms, anxiety, depression, and caregiver burden. Interviews were conducted with both caregivers and clinicians (RDs) to assess their experience with each approach.

Data analysis is not yet complete (but will be soon—stay tuned for our Renourish Outcomes paper, which will follow in a few months!), but you can 

read more about the Renourish study through our protocol paper here

. The findings will help us better understand (1) effectiveness and acceptability of dietary interventions commonly used in FBT, and (2) the needs of the families we’re serving here at Equip.

Hellner M, Steinberg D, Baker JH, Blanton C. Digitally Delivered Dietary Interventions for Patients with Eating Disorders Undergoing Family-Based Treatment: Protocol for a Randomized Feasibility Trial. JMIR Res Protoc 2023;12:e41837. doi: 

Which Dietary Intervention Is Best for Eating Disorder Treatment?

,” you’ll get back countless websites listing warning signs and common symptoms, but these lists aren’t comprehensive. And while some eating disorder signs are pretty intuitive and might raise eyebrows on their own—like, say, significant changes in body weight and extreme dieting—there are many more subtle signs of an eating disorder, which often go unnoticed.

 was diagnosed fairly quickly, it would have happened even faster if I was aware that a newfound obsession with interacting with food in a non-eating way was a sign of an eating disorder,” says J.D. Ouellette, Equip’s Director of Lived Experience. “I’ve always cooked and baked a lot, so looking up and making new recipes seemed normal to me. What wasn’t normal was the scale of it all: Food Network 24/7, Pinterest for recipes, organizing all our family recipes, cooking and baking amazing, delicious food… but not eating any of it.”

This behavior that Ouellette observed is just one of many less obvious eating disorder behaviors. Raising awareness around these symptoms is extremely important, as a huge number of eating disorders go undiagnosed: 

, just 10% of college students reporting symptoms got a diagnosis. What’s more, many of the eating disorders that do get diagnosed could have been caught earlier if loved ones had known the less conspicuous warning signs, which matters because 

 significantly increases the likelihood of recovery.

Read on to learn 11 subtle signs of an eating disorder you might not be aware of, and what to do if you’re concerned about yourself or a loved one.

Why do some eating disorder signs go unnoticed?

It can be tricky to spot an eating disorder for a number of reasons. Firstly, many eating disorder behaviors are done in secret, and the person struggling often goes to great lengths to hide their eating disorder. But even some red flags that happen in public go unnoticed—or we notice, but don’t think it’s anything to be concerned about. There are a few potential reasons for this:

Our inability to see certain disordered behaviors can, in many ways, be chalked up to the fact that a lot of these behaviors are praised in our society, which is steeped in 

. “So many signs of eating disorders are socially normal and even applauded,” says Ouellette. “

Working out twice a day, seven days a week

? Go you! Restricting calories and categories of food? Wish I had your self-discipline! Lost a few pounds? Living the dream!”

Jessie Menzel, Equip’s VP of Clinical Programs, agrees, explaining that society has normalized behaviors that could be red flags, “things like changing one’s diet to be ‘healthier,’ deciding to become a vegetarian, trying to eat fewer sweets, starting to skip meals, or even forgetting to eat.”

Eating disorder warning signs might also be ignored because trusted figures dismiss them. “Parents are often directly assured ‘nothing is wrong’ by their medical provider,” says Menzel. She explains that concerned parents might hear things like, “picky eating is normal,” “they’ll grow out of it,” or “it’s a good thing that they’re trying to eat healthier.” These providers are not ill-intentioned—this kind of response is a natural result of the fact that most healthcare providers receive very little training on eating disorders, and may have a very narrow idea of what an eating disorder might look like.

Another reason signs of an eating disorder might get missed is because someone doesn’t fit society’s stereotype of who gets an eating disorder. “I think the most common reason eating disorder signs tend to go unnoticed is that someone doesn’t ‘look’ the part of someone with an eating disorder,” says Menzel. “Whether it be because they aren’t white or wealthy or because their body is larger or because they aren’t a cis girl or woman. There are entire groups of people who we think ‘can’t’ get eating disorders, and therefore, we don’t ask.”

The truth is that eating disorders affect people equally across age, gender, race, class, and body size, and—despite what the media has told us for decades—you just can’t tell if someone has an eating disorder by looking at them.

Hidden signs of eating disorders that are often missed

For a thorough look at the more straightforward symptoms of eating disorders, our 

 is a great resource. Here we’ve outlined some of the less intuitive, often missed, and less obvious signs of eating disorders. This list isn’t exhaustive, and eating disorders manifest differently in every person, but it’s a good place to start.

1. Cooking and baking food without eating it

In addition to the behaviors Ouellete shared above, one particular memory stands out to her: her daughter prepared 50 cellophane gift bags for school Valentine’s Day, each filled with candy and immaculately decorated heart-shaped cookies—but she didn’t eat a single bite herself. At the time, this stood out to Ouellette as confusing, but she didn’t flag it as related to an eating disorder. However, preparing food without eating it is actually a fairly common eating disorder behavior.

Ouellette remembers thinking that her daughter’s desire to eat anywhere but home was just typical teenage behavior, but eventually realized that it was a ruse not to eat at all. Someone with an eating disorder might also want to 

 because of the shame they feel around eating. This could be true for all types of eating disorders, not just those associated with 

3. Encouraging other people to eat high calories foods they’re not eating

People with eating disorders might try to satisfy their own hunger by watching others eat the foods they won’t allow themselves. (In fact, 

 that so-called “mukbang videos,” live-streamed videos where viewers watch someone eat, are associated with disordered eating.)

If you’re worried you or a loved one may have an eating disorder, you can take a screener here.

Free eating disorder screener

Eating disorder thinking tends to put a high value on precision, especially when it comes to food. Because of this, those struggling may refuse things with trivial caloric content, like a piece of gum or a small bite of a dish. This can also go the other way: they may refuse to share food because they have exactly accounted for what is on their plate, no more and no less.

5. Excessive interest in what other people are eating

Similar to cooking for others and watching others eat high-calorie foods, this sign likely emerges out of the fact that eating disorders cause people to become 

. Those who are struggling might show an abnormal interest in the food of others, asking questions about what they ate that day, what something tastes like (without accepting a bite of it), etc.

Just as a person with an eating disorder might refuse tiny amounts of food because of their precise accounting, they may also become incredibly upset if the food they receive is “wrong” or “off” in any way. That might mean that a parent buys a different brand of crackers from the store, or a server at a restaurant puts dressing on the salad rather than on the side.

Ouellette remembers thinking that the change in her teen daughter’s attitude was “developmentally appropriate teen moodiness.” And in some cases, that might be true—which is why it can be extra tricky to identify 

—but significant personality changes can also be a red flag. Malnourishment combined with uncontrollable eating disorder thoughts make it impossible for a person’s mind to function normally, and their behaviors and mood will reflect that.

It’s not uncommon for people with eating disorders to become more childlike in some ways. For Ouellette, that meant her daughter suddenly calling her “Mommy” instead of “Mom” at age 17. This is usually a coping strategy to manage the overwhelming stress, anxiety, and emotions caused by the eating disorder.

This might have to do with food schedule, or simply the schedule in general. Ouellette remembers her daughter developing “extreme punctuality, to the point where 30 seconds early or late was distressing.” (As a person in recovery from 

, I remember breaking down crying if dinner slipped to 6:05 rather than 6 p.m. sharp).

, so those who are restricting their food intake might have difficulty sleeping through the night (plus 

, a hormone that helps us regulate our circadian rhythms). If your loved one is suddenly experiencing chronic sleeplessness or feeling tired all the time, disrupted eating patterns might be behind it.

While there are certainly legitimate and even positive reasons that someone might decline an invitation, frequently opting out of social gatherings could mean that a person is prioritizing their eating disorder behaviors over the relationships in their life, or going out of their way to avoid social events that involve food. Social isolation isn’t just a potential red flag, it can also worsen the eating disorder, since these illnesses thrive in secrecy.

None of these signs on their own definitively means that someone has an eating disorder, and someone can have an eating disorder without exhibiting any of these signs. But by being aware of the less obvious signs of eating disorders and remaining alert to anything that seems amiss, you’ll ensure you’re doing all that you can to catch a potential problem early on. Says Menzel, “anytime you notice a shift in a loved one’s eating—no matter the reason—it warrants paying close attention and asking questions.”

How to address early warning signs of an eating disorder

If you’re concerned about a loved one (or yourself), don’t ignore it. Eating disorders don’t go away on their own, and get worse when left unaddressed. As intimidating as it might be, it’s important to take the first step toward getting the help you or your loved one need. The guidance below can help you get started.

If you’ve noticed some of the subtle eating disorder signs outlined above, or other worrisome behaviors, your first move should be to talk with your loved one. Don’t assume that they have an eating disorder—instead, come to them with genuine curiosity, while also expressing your concerns.

Don’t ambush them with the conversation, or try to bring up your concerns when they’re busy or stressed. It’s also important not to talk to them too close to a mealtime. Find a quiet, private time to talk, and ask them, “Is now a good time for us to talk for a few minutes?”

Use “I” statements rather than “you” statements.

 For instance, saying “I’ve noticed that you’ve stopped eating breakfast in the morning. Can you tell me a bit about why you’ve made that change?” instead of “You don’t eat breakfast anymore.”

Bringing up specific things you’ve noticed will likely make your conversation more productive, as it’s easy for someone to dismiss more general, vague concerns.

No matter what you’re feeling—anger, fear, confusion, frustration—avoid being accusatory, angry, or judgmental when you speak. Your job isn’t to convince your loved one to change their behaviors, but rather to create a safe space so that they are open to receiving treatment.

People with eating disorders often don’t realize they’re sick, or don’t want to get better, so you will likely experience denial or pushback. This is normal. Do your best to remain firm, calm, and supportive.

Don’t expect a transformation or revelation from one conversation. It may be that you need to have several conversations over a few days before you make any progress. But remember, even if your loved one will not admit they have a problem or that they need help, you can still help them get treatment. 

Many people begin treatment without wanting to

, and still achieve full, lasting recovery.

Recovering from an eating disorder requires professional help. It’s important to work with trained eating disorder specialists, who understand all the different ways that eating disorders can show up and how to effectively treat them. If you’re unsure whether you or your loved one have an eating disorder, they can also provide a professional assessment.

Here is some guidance on getting professional eating disorder treatment:

Taking an online screener can be a good, low-lift first step for determining if you should reach out for help. Our 

free, 5-minute eating disorder assessment

 will let you know if you should be concerned (if you’re worried about ARFID, use our 

. Eating disorders affect multiple facets of a person’s life, and it’s important to have providers who can address all of them. An effective eating disorder treatment team should include (at minimum) a licensed therapist, a registered dietitian, and a medical provider. It might also include a psychiatrist, mentors, or other providers.

Consider all the different treatment options available. There are in-person treatment programs, as well as virtual programs like Equip. There are also different levels of care, which essentially means how much time per day or week is spent in treatment (learn more about different 

levels of care in eating disorder treatment

). Equip is an effective treatment approach for all levels of care, as long as a patient is medically stable.

Try free resources. If you’re not yet ready to dive into treatment, there are many free and low-commitment resources you can explore in the meantime. Some great organizations to check out are 

We said it before but we’ll say it again: eating disorders don’t go away on their own. In fact, over time they only tend to become more severe and more entrenched. So if you’re noticing subtle signs of an eating disorder in someone you love (or yourself), it’s important to get help as soon as you can.

There are a lot of reasons to intervene early, not the least of which is that the earlier someone gets care, the more of their life they get to spend enjoying a full, free existence, rather than the small, constrained life that the eating disorder allows. Early intervention also has several research-backed benefits.

Getting help early is associated with better treatment outcomes. 

 that early intervention improves a person’s chance of achieving lasting recovery, and 

 that intervening and improving symptoms early lowers a person’s risk of struggling with an eating disorder-long term. Additionally, 

 that looked at 130 different studies found that early intervention programs significantly reduce eating disorder risk factors and encourage help-seeking behaviors.

Eating disorders can take a significant toll on 

. And the longer someone struggles with an eating disorder, the greater the risk that they’ll experience some of the short- and long-term health complications of an eating disorder.

Early intervention helps stop the progression of the eating disorder, which also helps prevent the many health consequences they can lead to, which include cardiovascular issues, metabolic imbalances, bone health concerns, and many more. It also helps prevent other comorbid psychological concerns, like 

The Equip takeaway on subtle signs of eating disorders

It’s important to understand that eating disorders aren’t always obvious. In fact, they often aren’t—that’s part of the reason why 

only about 20% of people with eating disorders

 get treatment. Knowing the subtle signs to watch for, like the ones described in this article, can help ensure that your loved one (or you) get the help you need.

If you’re worried about a loved one, don’t ignore your concerns. Eating disorders only worsen over time, and it’s better to be safe than sorry. Approach your concerns with empathy, curiosity, and kindness. If an eating disorder is present, these next steps can help you get the support necessary to achieve lasting recovery:

Explore the free resources from organizations like F.E.A.S.T., Project HEAL, ANAD, and the National Alliance for Eating Disorders.

Reach out to eating disorder treatment providers or programs to find the right treatment for you or your loved one. If you’re interested in Equip treatment, you can 

Sonneville, K R, and S K Lipson. “Disparities in eating disorder diagnosis and treatment according to weight status, race/ethnicity, socioeconomic background, and sex among college students.” The International journal of eating disorders vol. 51,6 (2018): 518-526. doi:10.1002/eat.22846

Treasure, Janet, and Gerald Russell. “The Case for Early Intervention in Anorexia Nervosa: Theoretical Exploration of Maintaining Factors.” The British Journal of Psychiatry, vol. 199, no. 1, 2011, pp. 5–7., doi:10.1192/bjp.bp.110.087585.

Kircaburun, K., Yurdagül, C., Kuss, D. et al. Problematic Mukbang Watching and Its Relationship to Disordered Eating and Internet Addiction: A Pilot Study Among Emerging Adult Mukbang Watchers. Int J Ment Health Addiction 19, 2160–2169 (2021). 

https://doi.org/10.1007/s11469-020-00309-w

Washington University School of Medicine. "Starvation keeps sleep-deprived fly brain sharp." ScienceDaily. ScienceDaily, 5 September 2010. www.sciencedaily.com/releases/2010/08/100831172443.htm

11 Subtle Signs of an Eating Disorder that Are Easy to Miss 

Diet culture is omnipresent in our lives, but it’s always shape-shifting (for instance, people talking about “wellness” rather than weight loss). One of the more recent ways that 

 has shown up is in the trend of intermittent fasting, or not eating for certain hours of the day. Over the past few years, countless people have jumped on the intermittent fasting bandwagon, usually out of a genuine desire to improve their health. But the reality is, intermittent fasting itself can be a 

 behavior, and can lead to other problematic and unhealthy habits. Read on to learn more about the risks and benefits of this practice, the relationship between intermittent fasting and eating disorders, whether it’s safe for those in recovery, and more.

Intermittent fasting is an eating approach that 

 the ketogenic (keto) diet in popularity among Americans. Instead of setting rules about what types of foods you can and can’t consume (like forbidding carbs with keto), intermittent fasting involves rigid rules about when—rather than what—you eat.

“There’s a length of time in the day when a person chooses to eat, and a length of time they choose to fast,” explains dietitian 

. “There are several methods with varying time ranges, such as a 16-hour fast with eight hours of eating, or fasting days, in which a person may cut way back on their caloric intake for five days, and then eat in a surplus for the remaining two days of the week.” According to Equip dietitian Rui Tanimura, RD, other intermittent fasters may have one large meal per day and avoid all meals and snacks otherwise. Exactly how it looks will vary from person to person, but the basic principle is the same: limiting food intake during set periods of time, and allowing unrestricted access to food during other periods of time.

The supposed benefits of intermittent fasting

Proponents claim that intermittent fasting has several significant health benefits, such as increasing lifespan, improving conditions associated with inflammation (like Alzheimer’s), preventing cancer, and improving heart health. Weight loss, it should probably go without saying, is also high on the list of touted benefits. “Supporters claim that it’s an effective approach to control or change weight, improve metabolism, and to prevent overeating,” says Tanimura.

While there are some studies supporting the benefits of intermittent fasting, it’s not the type of research that shows direct causation—in other words, the studies might show that intermittent fasting is associated with lower blood pressure, but don’t prove or claim that intermittent fasting itself caused this change. The existing research also lacks data from which we can make any evidence-based recommendations about intermittent fasting.

“Intermittent fasting, just like any other fad diet, has far-reaching claims attached to it,” says Chaffin. “The problem is, 

 on intermittent fasting has been done almost exclusively in a lab on animals.” For example, 

 showing a link between intermittent fasting and longevity was conducted with fruit flies, and 

. Research that associated intermittent fasting with improving inflammation-linked diseases like Alzheimer’s and that 

“Intermittent fasting, just like any other fad diet, has far-reaching claims attached to it,” says Chaffin. “The problem is, the 

 showing a link between intermittent fasting and longevity was conducted with fruit flies and 

 that associated intermittent fasting with improving inflammation-linked diseases like Alzheimer’s and that 

Chaffin says the reason for the limited number of human trials is because of the restrictive nature of intermittent fasting. “ It’s not sustainable, so many people drop out or are unable to complete the trial,” she explains.

 showing positive associations between intermittent fasting and cardiovascular risk factors like diabetes and hypertension, yet they are too small and too short in duration to draw conclusive recommendations. “There’s just simply no way to know the benefits versus risk factors without looking at a large population of people over a long period of time,” Chaffin says. “The studies that do show ‘improvements’ only last somewhere between one to 12 weeks total. Compared to a lifetime, it’s a tiny blip of time.”

When it comes to what the research says about weight loss, it’s more of the same story, with studies being 

 to prove the diet “works” in the long run. “Most intermittent fasting 

 continues to need more longer-term outcomes,” says Tanimura. Moreover, a recent 

 examining the effects of intermittent fasting on weight loss for 12 weeks showed no differences in weight loss between intermittent fasters and consistent eaters.

, intermittent fasting comes with several potential side effects, like extreme hunger, fatigue, insomnia, nausea, and headaches. Plus, 

 shows that dieting can lead to eating disorders.

, intermittent fasting comes with several potential side effects. Intermittent fasting risks include:

Additionally, intermittent fasting can have negative psychological impacts, including irritability, anxiety, and poor concentration. 

 that dieting is one of the biggest risk factors for developing an eating disorder.

If you’re concerned about your eating habits, our free, 5-minute assessment can help you determine next steps.


Is your diet an eating disorder?

Is intermittent fasting an eating disorder?

In short, no, intermittent fasting is not an eating disorder. However, all restrictive diets—including intermittent fasting—can be considered a form of 

, a term used to describe a vast range of unhealthy eating behaviors that don’t necessarily constitute a full-blown eating disorder. That’s because any sort of rigid food rules, like the ones necessary to maintain intermittent fasting, foster unhealthy behaviors around food and a hyperfixation on food and body size, and sever the natural connection between our minds and bodies. “When we use external factors like the time to tell us when we can and can’t eat, we’re telling our bodies that they are not to be trusted, and that the cues and signals they give us can be ignored,” Chaffin explains.

And while intermittent fasting itself is not an eating disorder, it does encourage several behaviors associated with eating disorders. One 

 of young adults and teens of all genders showed a significant link between intermittent fasting and eating disorder behaviors like 

, vomiting, and severe food restriction. 

, RD, points out that the very structure of intermittent fasting lends itself to another eating disorder behavior: binge eating. “Intermittent fasting involves restriction for a large part of the day followed by a food free-for-all, which could look or feel like 

While rigid rules and the behaviors described above are often symptoms of eating disorders, not all intermittent fasters will experience disordered eating behaviors or thoughts. However, “that can change if the diet is followed for a long period of time,” Wallace says. “You won't find intermittent fasting listed as a diagnostic criteria in the DSM, but it can quickly shift from being an experiment for your health to a disordered relationship with food, or a full-blown eating disorder.”

How intermittent fasting can lead to an eating disorder

As Wallace explained, intermittent fasting has the potential to lead to an eating disorder over time. What may start out as a genuine attempt to experience health benefits can become a slippery slope that descends into disordered eating patterns, which often build off of one another and become more extreme. Remember, any 

 carries psychological and physical health risks.

“Your body doesn't understand that this ‘famine’ is self-inflicted, so it's going to be on high alert to increase its ability to survive and find food,” explains Equip Nutrition Director Erin Reeves, RD. “You might be 

 or feel more out of control when you do eat because your body can't trust there won't be a famine again.”

Tanimura tried intermittent fasting herself, and says it was one of the behaviors that ultimately led to her eating disorder diagnosis. “It is an extreme behavior that can likely trigger other eating disorder behaviors or attitudes, such as body dissatisfaction, a desire to adopt severe restriction methods, binge eating, low self-esteem, food rules, and attempting to ignore and suppress 

Intermittent fasting and eating disorder recovery

Attempting intermittent fasting while in eating disorder recovery would be similar to trying to drink one glass of wine a day when you’re in recovery from alcohol use disorder: it would likely be a fast track to relapse. As an eating disorder dietitian, this analogy is how I help my clients in recovery understand that going on the next diet du jour may set them up for a 

Plus, the principles of intermittent fasting and eating disorder recovery are in direct conflict with each other. “The components of intermittent fasting do not align with the pillars of eating disorder recovery, such as creating consistent meal and snack times every two to four hours, feeling and honoring our hunger and fullness cues, and removing debilitating food rules,” Tanimura explains.

What’s more, intermittent fasting and other diets are externally driven, taking us further away from our bodies, ourselves, and our values—just like eating disorders do.

“I would never recommend dieting to a person in recovery, and intermittent fasting is going to be particularly triggering due to its similarity to disorders like 

,” Wallace says. “If you’re in recovery from an eating disorder and are interested in the alleged health benefits of intermittent fasting, I suggest talking to an eating disorder clinician about how to incorporate health-promoting behaviors into your recovery rather than pursuing a diet such as intermittent fasting.”

Healthy alternatives to intermittent fasting

Whether you have an eating disorder or not, the healthiest way of eating is one that supports your mental, emotional, and physical well-being, and helps you live in alignment with your core values. One specific eating framework, called 

, fosters healthy food and body relationships, and includes principles like honoring hunger and fullness cues and getting satisfied at all meals and snacks. Intuitive eating encourages internal guidance (rather than relying on the clock or rules) from your own body and mind and helps you reconnect to your innate ability to nourish yourself.

However, if you are struggling with an eating disorder and early in the recovery process, it’s important to work with your treatment team to find the best eating pattern for you right now. That may be using 

, the plate-by-plate-approach, or a different structure. Eating intuitively in recovery usually takes time and intentional steps with professional guidance and support, and it usually happens later in recovery.

Here are a few general tips for finding balance in eating and building a positive relationship to food, which will support your overall mental and physical well-being:

Eat every few hours during the day, including meals and snacks.

Ensure you eat from all the food groups on a regular basis (carbs, fats, proteins, dairy or dairy alternatives, fruits, and veggies).