Eating disorders are devastatingly common, affecting an estimated 9% of people in the US at some point in their lives, according to the National Alliance for Eating Disorders. Accurately screening for eating disorders is extremely important. While teens and young adults are at highest risk of developing an eating disorder, they can be present at any point along the life span, in all genders, in people of any race or ethnicity, any socioeconomic or educational status, and crucially, in any size body.
Undiagnosed Eating Disorders
At Lutz & Alexander Nutrition Therapy, we commonly work with people who struggled with eating disorders for years in secrecy, as children and/or as adults. All that time, they were going to school or work and having routine medical check ups, and their eating disorder wasn’t recognized or taken seriously – in many cases, because they weren’t clinically “underweight.”
BMI is a harmful screening tool
Many medical providers, parents, and the general public have been misled to believe that eating disorders are only present, or are only dangerous, when someone is underweight. Plainly put, this is not true. According to the National Alliance for Eating Disorders, in the US only about 6% of those diagnosed with eating disorders are clinically “underweight.” Using BMI when screening for eating disorders is missing so many people and causing harm!
Eating Disorders are Dangerous at Any Size
While some people’s bodies do respond to disordered eating & exercise behavior by getting smaller and smaller, many don’t. Due to a complex interplay of genetic and environmental factors, many people’s bodies just do not follow that old diet math: “calories in, calories out.” Bodies can make many metabolic and/or behavioral adaptations to malnutrition that help them to survive by preventing weight loss. They can have many or all the other physical and mental symptoms associated with disordered eating and malnutrition, though: digestive complaints, low energy/somnolence, lower than expected levels of sex hormones, amenorrhea, osteopenia, muscle wasting, hair loss, anxiety, mood changes, increases in compulsive or rigid thinking, etc.1
Screening for Eating Disorders
So, if we can’t tell whether someone has an eating disorder based on their weight, how can we catch these devastating mental health disorders earlier to prevent years of suffering? In the health care setting, we need more routine screening of patients across ages, genders, racial and ethnic groups, and body sizes.
- For adult health care providers, the NC Center of Excellence for Eating Disorders has created a free online version of the SBIRT-ED screening tool, which can be found here: https://eatingdisorderscreener.org/
- For pediatricians, the AAP has suggested screening questions in their guidelines for Identification and Management of Eating Disorders in Children and Adolescents: https://publications.aap.org/pediatrics/article/147/1/e2020040279/33504/Identification-and-Management-of-Eating-Disorders
Are you struggling with an eating disorder or disordered eating?
Lutz, Alexander & Associates Nutrition Therapy is a team of experienced Registered Dietitians specializing in eating disorders in Raleigh, Durham, Chapel Hill, Cary and Wake Forest, NC. We understand eating disorders and how often people struggle alone. We are in network with Blue Cross Blue Shield of NC and Aetna.
We’re here to help! Contact us today.
- Vo, M., Golden, N. Medical complications and management of atypical anorexia nervosa. J Eat Disord 10, 196 (2022). https://doi.org/10.1186/s40337-022-00720-9