When does an unhealthy relationship with food become an eating disorder?

In our health and image-conscious culture, following a particular diet or exercising a great deal is common and even encouraged.

With increased awareness of food allergies and other dietary requirements, many people also restrict or eliminate certain foods.

What qualifies as 'disordered eating', and how common is it?

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Disordered eating describes negative attitudes and behaviours towards food and eating that can lead to a disturbed eating pattern.

It can involve:

Eating disorders are complex psychiatric illnesses that can negatively affect a person’s body, mind and social life. They’re characterised by persistent disturbances in how someone thinks, feels and behaves around eating and their bodies.

To make a diagnosis, a qualified health professional will use a combination of standardised questionnaires, as well as more general questioning. These will determine how frequent and severe the behaviours are, and how they affect day-to-day functioning.

Examples of clinical diagnoses include anorexia nervosa, bulimia nervosa, binge eating disorder and avoidant/restrictive food intake disorder.

The answer can vary quite radically depending on the study and how it defines disordered behaviours and attitudes.

An estimated 8.4 percent of women and 2.2 percent of men will develop an eating disorder at some point in their lives. This is most common during adolescence.

Disordered eating is also particularly common in young people, with 30 percent of girls and 17 percent of boys aged 6–18 years reporting engaging in these behaviours.

Although the research is still emerging, it appears that disordered eating and eating disorders are even more common in gender-diverse people.

There is some evidence that eating disorder prevention programmes that target risk factors – such as dieting and concerns about shape and weight – can be effective to some extent in the short term.

The issue is that most of these studies last only a few months. So we can’t determine whether the people involved went on to develop an eating disorder in the longer term.

In addition, most studies have involved girls or women in late high school and university. By this age, eating disorders have usually already emerged.

So, this research cannot tell us as much about eating disorder prevention, and it also neglects the wide range of people at risk of eating disorders.

In defining the line between eating disorders and disordered eating, orthorexia nervosa is a contentious issue.

The name literally means “proper appetite” and involves a pathological obsession with proper nutrition, characterised by a restrictive diet and rigidly avoiding foods believed to be “unhealthy” or “impure”.

These disordered eating behaviours need to be taken seriously as they can lead to malnourishment, loss of relationships, and overall poor quality of life.

However, orthorexia nervosa is not an official eating disorder in any diagnostic manual.

Additionally, with the popularity of special diets (such as keto or paleo), time-restricted eating, and dietary requirements (for example, gluten-free), it can sometimes be hard to decipher when concerns about diet have become disordered, or may even be an eating disorder.

For example, around 6 percent of people have a food allergy. Emerging evidence suggests they are also more likely to have restrictive types of eating disorders, such as anorexia nervosa and avoidant/restrictive food intake disorder.

However, following a special diet such as veganism or having a food allergy does not automatically lead to disordered eating or an eating disorder.

It is important to recognise people’s different motivations for eating or avoiding certain foods. For example, a vegan may restrict certain food groups due to animal rights concerns, rather than disordered eating symptoms.

It’s always best to seek help early. If you’re concerned about your own relationship with food or that of a loved one, here are some signs to look out for:

*Gemma Sharp is a researcher in body image, eating and weight disorders at Monash University. She receives funding from an NHMRC Investigator Grant. She is a Professor and the Founding Director and Member of the Consortium for Research in Eating Disorders, a registered charity.