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Eating disorders are serious health conditions that affect both your physical and mental health. These conditions include problems in how you think about food, eating, weight and shape, and in your eating behaviors. These symptoms can affect your health, your emotions and your ability to function in important areas of life.

If not treated effectively, eating disorders can become long-term problems and, in some cases, can cause death. The most common eating disorders are anorexia, bulimia and binge-eating disorder.

Most eating disorders involve focusing too much on weight, body shape and food. This can lead to dangerous eating behaviors. These behaviors can seriously affect the ability to get the nutrition your body needs. Eating disorders can harm the heart, digestive system, bones, teeth and mouth. They can lead to other diseases. They're also linked with depression, anxiety, self-harm, and suicidal thoughts and behaviors.

With proper treatment, you can return to healthier eating habits and learn healthier ways to think about food and your body. You also may be able to reverse or reduce serious problems caused by the eating disorder.

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Symptoms vary, depending on the type of eating disorder. Anorexia, bulimia and binge-eating disorder are the most common eating disorders. People with eating disorders can have all different body types and sizes.

Anorexia (an-o-REK-see-uh), also called anorexia nervosa, can be a life-threatening eating disorder. It includes an unhealthy low body weight, intense fear of gaining weight, and a view of weight and shape that is not realistic. Anorexia often involves using extreme efforts to control weight and shape, which often seriously interfere with health and daily life.

Anorexia may include severely limiting calories or cutting out certain kinds of foods or food groups. It may involve other methods to lose weight, such as exercising too much, using laxatives or diet aids, or vomiting after eating. Efforts to reduce weight can cause severe health problems, even for those who continue eating throughout the day or whose weight isn't extremely low.

Bulimia (buh-LEE-me-uh), also called bulimia nervosa, is a serious, sometimes life-threatening eating disorder. Bulimia includes episodes of bingeing, commonly followed by episodes of purging. Sometimes bulimia also includes severely limiting eating for periods of time. This often leads to stronger urges to binge eat and then purge.

Bingeing involves eating food — sometimes an extremely large amount — in a short period of time. During bingeing, people feel like they have no control over their eating and that they can't stop. After eating, due to guilt, shame or an intense fear of weight gain, purging is done to get rid of calories. Purging can include vomiting, exercising too much, not eating for a period of time, or using other methods, such as taking laxatives. Some people change medicine doses, such as changing insulin amounts, to try to lose weight.

Bulimia also involves being preoccupied with weight and body shape, with severe and harsh self-judgment of personal appearance.

Binge-eating disorder

Binge-eating disorder involves eating food in a short amount of time. When bingeing, it feels like there's no control over eating. But binge eating is not followed by purging. During a binge, people may eat food faster or eat more food than planned. Even when not hungry, eating may continue long past feeling uncomfortably full.

After a binge, people often feel a great deal of guilt, disgust or shame. They may fear gaining weight. They may try to severely limit eating for periods of time. This leads to increased urges to binge, setting up an unhealthy cycle. Embarrassment can lead to eating alone to hide bingeing. A new round of bingeing commonly occurs at least once a week.

Avoidant/restrictive food intake disorder

Avoidant/restrictive food intake disorder includes extremely limited eating or not eating certain foods. The pattern of eating often doesn't meet minimum daily nutrition needs. This may lead to problems with growth, development and functioning in daily life. But people with this disorder don't have fears about gaining weight or body size. Instead, they may not be interested in eating or may avoid food with a certain color, texture, smell or taste. Or they may worry about what can happen when eating. For example, they may have a fear of choking or vomiting, or they may worry about getting stomach problems.

Avoidant/restrictive food intake disorder can be diagnosed in all ages, but it's more common in younger children. The disorder can result in major weight loss or failure to gain weight in childhood. A lack of proper nutrition can lead to major health problems.

When to see a doctor

An eating disorder can be difficult to manage or overcome by yourself. The earlier you get treatment, the more likely you'll make a full recovery. Sometimes people can have problem eating behaviors that are similar to some symptoms of an eating disorder, but the symptoms don't meet the guidelines for a diagnosis of an eating disorder. But these problem eating behaviors can still seriously affect health and well-being.

If you have problem eating behaviors that cause you distress or affect your life or health, or if you think you have an eating disorder, seek medical help.

Urging a loved one to seek treatment

Many people with eating disorders may not think they need treatment. One of the main features of many eating disorders is not realizing how severe the symptoms are. Also, guilt and shame often prevent people from getting help.

If you're worried about a friend or family member, urge the person to talk to a health care provider. Even if that person isn't ready to admit to having an issue with food, you can start the discussion by expressing concern and a desire to listen.

Red flags that may suggest an eating disorder include:

  • Skipping meals or snacks or making excuses for not eating.
  • Having a very limited diet that hasn't been prescribed by a trained medical professional.
  • Too much focus on food or healthy eating, especially if it means not participating in usual events, such as sports banquets, eating birthday cake or dining out.
  • Making own meals rather than eating what the family eats.
  • Withdrawing from usual social activities.
  • Frequent and ongoing worry or complaints about being unhealthy or overweight and talk of losing weight.
  • Frequent checking in the mirror for what are thought to be flaws.
  • Repeatedly eating large amounts of foods.
  • Using dietary supplements, laxatives or herbal products for weight loss.
  • Exercising much more than the average person. This includes not taking rest days or days off for injury or illness or refusing to attend social events or other life events because of wanting to exercise.
  • Calluses on the knuckles from reaching fingers into the mouth to cause vomiting.
  • Problems with loss of tooth enamel that may be a sign of repeated vomiting.
  • Leaving during meals or right after a meal to use the toilet.
  • Talk of depression, disgust, shame or guilt about eating habits.
  • Eating in secret.

If you're worried that you or your child may have an eating disorder, contact a health care provider to talk about your concerns. If needed, get a referral to a mental health provider with expertise in eating disorders. Or if your insurance permits it, contact an expert directly.

The exact cause of eating disorders is not known. As with other mental health conditions, there may be different causes, such as:

  • Genetics. Some people may have genes that increase their risk of developing eating disorders.
  • Biology. Biological factors, such as changes in brain chemicals, may play a role in eating disorders.

Risk factors

Anyone can develop an eating disorder. Eating disorders often start in the teen and young adult years. But they can occur at any age.

Certain factors may increase the risk of developing an eating disorder, including:

  • Family history. Eating disorders are more likely to occur in people who have parents or siblings who've had an eating disorder.
  • Other mental health issues. Trauma, anxiety, depression, obsessive-compulsive disorder and other mental health issues can increase the likelihood of an eating disorder.
  • Dieting and starvation. Frequent dieting is a risk factor for an eating disorder, especially with weight that is constantly going up and down when getting on and off new diets. There is strong evidence that many of the symptoms of an eating disorder are symptoms of starvation. Starvation affects the brain and can lead to mood changes, rigid thinking, anxiety and reduced appetite. This may cause severely limited eating or problem eating behaviors to continue and make it difficult to return to healthy eating habits.
  • A history of weight bullying. People who have been teased or bullied for their weight are more likely to develop problems with eating and eating disorders. This includes people who have been made to feel ashamed of their weight by peers, health care professionals, coaches, teachers or family members.
  • Stress. Whether it's heading off to college, moving, landing a new job, or a family or relationship issue, change can bring stress. And stress may increase the risk of an eating disorder.


Eating disorders cause a wide variety of complications, some of them life-threatening. The more severe or long lasting the eating disorder, the more likely it is that serious complications may occur. These may include:

  • Serious health problems.
  • Depression and anxiety.
  • Suicidal thoughts or behavior.
  • Problems with growth and development.
  • Social and relationship problems.
  • Substance use disorders.
  • Work and school issues.

There's no sure way to prevent eating disorders, but you can take steps to develop healthy eating habits. If you have a child, you can help your child lower the risk of developing eating disorders.

To develop healthy eating habits and lifestyle behaviors:

  • Choose a healthy diet rich in whole grains, fruits and vegetables. Limit salt, sugar, alcohol, saturated fat and trans fats. Avoid extreme dieting. If you need to lose weight, talk to your health care provider or a dietitian to create a plan that meets your needs.
  • Don't use dietary supplements, laxatives or herbal products for weight loss.
  • Get enough physical activity. Each week, get at least 150 minutes of aerobic activity, such as brisk walking. Choose activities that you enjoy, so you're more likely to do them.
  • Seek help for mental health issues, such as depression, anxiety, or issues with self-esteem and body image.

For more guidelines on food and nutrition, as well as physical activity, go to health.gov.

Talk to a health care provider if you have concerns about your eating behaviors. Getting treatment early can prevent the problem from getting worse.

Here are some ways to help your child develop healthy-eating behaviors:

  • Avoid dieting around your child. Family dining habits may influence the relationships children develop with food. Eating meals together gives you an opportunity to teach your child about the pitfalls of dieting. It also allows you to see whether your child is eating enough food and enough variety.
  • Talk to your child. There are many websites and other social media sites that promote dangerous ideas, such as viewing anorexia as a lifestyle choice rather than an eating disorder. Some sites encourage teens to start dieting. It's important to correct any wrong ideas like this. Talk to your child about the risks of making unhealthy eating choices.
  • Encourage and reinforce a healthy body image in your child, whatever their shape or size. Talk to your child about self-image and offer reassurance that body shapes can vary. Don't criticize your own body in front of your child. Messages of acceptance and respect can help build healthy self-esteem. They also can build resilience ⸺ the ability to recover quickly from difficult events. These skills can help children get through the challenging times of the teen and young adult years.
  • Ask your child's health care provider for help. At well-child visits, health care providers may be able to identify early signs of an eating disorder. They can ask children questions about their eating habits. These visits can include checks of height and weight percentiles and body mass index, which can alert you and your child's provider to any big changes.

Reach out to help

If you notice a family member or friend who seems to show signs of an eating disorder, consider talking to that person about your concern for their well-being. You may not be able to prevent an eating disorder from developing, but reaching out with compassion may encourage the person to seek treatment.

  • Feeding and eating disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5-TR. 5th ed. American Psychiatric Association; 2022. https://dsm.psychiatryonline.org. Accessed Nov. 16, 2022.
  • Hales RE, et al. Feeding and eating disorders. In: The American Psychiatric Publishing Textbook of Psychiatry. 7th ed. American Psychiatric Publishing; 2019. https://psychiatryonline.org. Accessed Nov. 10, 2022.
  • Eating disorders: About more than food. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/eating-disorders. Accessed Nov. 16, 2022.
  • Eating disorders. National Alliance on Mental Illness. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Eating-Disorders/Support. Accessed Nov. 16, 2022.
  • What are eating disorders? American Psychiatric Association. https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders. Accessed Nov. 16, 2022.
  • Treasure J, et al. Eating disorders. The Lancet. 2020; doi:10.1016/S0140-6736(20)30059-3.
  • Hay P. Current approach to eating disorders: A clinical update. Internal Medicine Journal. 2020; doi:10.1111/imj.14691.
  • Bhattacharya A, et al. Feeding and eating disorders. Handbook of Clinical Neurology. 2020; doi:10.1016/B978-0-444-64123-6.00026-6.
  • Uniacke B, et al. Eating disorders. Annals of Internal Medicine. 2022; doi:10.7326/AITC202208160.
  • Fogarty S, et al. The role of complementary and alternative medicine in the treatment of eating disorders: A systematic review. Eating Behaviors. 2016; doi:10.1016/j.eatbeh.2016.03.002.
  • Some imported dietary supplements and nonprescription drug products may harm you. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/some-imported-dietary-supplements-and-nonprescription-drug-products-may-harm-you. Accessed Nov. 16, 2022.
  • Questions and answers about FDA's initiative against contaminated weight loss products. U.S. Food and Drug Administration. https://www.fda.gov/drugs/frequently-asked-questions-popular-topics/questions-and-answers-about-fdas-initiative-against-contaminated-weight-loss-products. Accessed Nov. 16, 2022.
  • Mixing medications and dietary supplements can endanger your health. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/mixing-medications-and-dietary-supplements-can-endanger-your-health. Accessed Nov. 16, 2022.
  • Lebow JR (expert opinion). Mayo Clinic. Dec. 1, 2022.
  • 2020-2025 Dietary Guidelines for Americans. U.S. Department of Health and Human Services and U.S. Department of Agriculture. https://www.dietaryguidelines.gov. Accessed Feb. 3, 2023.
  • Long MW, et al. Cost-effectiveness of 5 public health approaches to prevent eating disorders. American Journal of Preventive Medicine. 2022; doi:10.1016/j.amepre.2022.07.005.
  • Health.gov. https://health.gov/. Accessed Feb. 7, 2023.
  • Eating disorder treatment: Know your options

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What Causes Eating Disorders?

Reviewed by Psychology Today Staff

No one fully understands what gives rise to these painful and confounding illnesses. Eating disorders likely emerge from a complex relationship between genetics, personality traits, and environmental influences such as childhood experiences, social comparison, stressful or traumatic events, and cultural beauty standards. Although the roots of disordered eating will likely remain a mystery for some time, treatment can help those suffering embark on a successful recovery.

On This Page

  • Which personality traits and attitudes are linked to eating disorders?
  • Are eating disorders genetic?
  • Do stress and trauma lead to eating disorders?
  • How do culture, media, and beauty ideals influence eating disorders?
  • How common are eating disorders?
  • Has the prevalence of eating disorders increased over time?

Eating disorders are connected to perfectionism, obsessive compulsive tendencies, and sensitivity to negative emotions. Low self-esteem and body dissatisfaction are risk factors, as well as mental health challenges such as anxiety and depression.

One of the strongest predictors of eating disorders among girls, research suggests, is the value peers place on weight and eating. This tendency is heightened in college, a community of individuals the same age with few older adults to provide broader perspective. The influence of peer perception may contribute to the proliferation of eating disorders on college campuses.

Research in twins, biological families, and adoptive families show that genetics can render people at greater risk of developing a disorder. People who have a family member with an eating disorder face a much greater risk of developing one themselves. For example, studies show that people are 7 to 12 times more likely to develop anorexia or bulimia if they have a relative with an eating disorder.

Those genetic underpinnings may also help explain why eating disorders often overlap with certain conditions, such as depression, anxiety, and obsessive compulsive disorder.

However, one’s genetic predisposition is only one piece of the puzzle. For most people, a triggering event would also be necessary to spur the development of a disorder.

Eating disorders can be spurred by life transitions as well as stressful or traumatic events. Those incidents—such as starting a new job, a sexual assault, or the death of a loved one—can lead to overwhelming and uncontrollable emotions.

Restricting food intake and regulating weight can lead people to feel a sense of control amid the chaos. And sometimes this is the only aspect of life they think they can control. In this way, a triggering event can lead to a persistent disorder.

Eating disorders are prominent in Western cultures, which place a strong emphasis on thinness, weight, and beauty. This can lead young adults, especially women, to believe that their self-worth is tied to their weight.

Exposure to images of filtered, edited, and perfected bodies leads to self-comparison—a process that occurs quickly, effortlessly, and sometimes unconsciously. Constant comparison can take a heavy toll on self-esteem and body satisfaction.

Cultural and media scripts may contribute to the development of an eating disorder. However, they cannot produce the condition on their own.

The lifetime prevalence of eating disorders among adolescents in the U.S. is 3.8 percent for women and 1.5 percent for men, according to the National Institute of Mental Health. Among adults in the U.S., the overall prevalence of binge-eating disorder is 1.2 percent, the overall prevalence of anorexia is 0.6 percent, and the overall prevalence of bulimia is 0.3 percent.

Studies that slightly expand the diagnostic criteria find higher estimates of eating disorders, such as 5 percent of adolescent girls or nearly 8 percent of individuals overall. Eating disorders can occur at any time, but they typically develop in one’s adolescence or early twenties.

Although eating disorders have existed throughout human history, they seem to be growing more widespread today. One large review study found that 3.5 percent of people suffered from an eating disorder in the years 2000 to 2006, yet nearly 8 percent suffered from one in the years 2013 to 2018.

A particularly unsettling trend is that anorexia may be increasing among children. One recent study found that anorexia had increased among 8- to 12-year-olds in the past decade, which is consistent with other research showing that the age of onset for anorexia may be decreasing.

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Eating Disorders, Essay Example

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Eating disorders affect men and women of all ages, although adolescents tend to be the age group that is more susceptible. This is because, as their bodies are changing, they may feel more pressure by society as well as peer groups to look attractive and fit in (Segal et al). Types of eating disorders include Anorexia, Bulimia and Compulsive Overeating, which can also be related to the first two. The reasons behind Eating Disorder usually stem from a reaction to low self-esteem and a negative means of coping with life and stress (Something Fishy).  Eating disorders are also often associated with an underlying psychological disorder, which may be the reason behind the eating disorder or which may develop from the Eating Disorder itself. Mental health disorders that are often associated with Eating Disorder include Anxiety, Depression, Multiple Personality Disorder, Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, BiPolar, BiPolar II, Borderline Personality Disorder, Panic Disorder and Dissociative Disorder. The longer a person suffers from ED, the more probable that they will be dealing with another mental illness, most likely Anxiety or Depression (Something Fishy). The eventual outcome of Eating Disorder can be deadly. “Some eating disorders are associated with a 10-15% mortality rate and a 20-25% suicide rate. Sometimes, anorexia, bulimia and compulsive eating may be perceived as slow suicide (Carruthers).” In order to prevent the deadly consequences of Eating Disorder and to prevent it from becoming more pervasive in society, it is necessary to recognize the correct treatment method for this disease.  Traditional treatments have focused on providing risk information to raise awareness of the consequences of Eating Disorder (Lobera et al 263). However, since Eating Disorder is a mental illness, a more effective treatment is one that offers psychological evaluation, counseling and treatment. Cognitive Behavioral Therapy is emerging as a more robust and effective method that can be used not only to treat Eating Disorder but the associated mental illnesses that may accompany it.

The Problem

Eating disorder is pervasive in society and can have deadly consequences on those that suffer from it. Many time Eating Disorder goes undetected by family members and friends because those suffering will go to great lengths to hide their problem. However, there are some signs and symptoms that can be clues that a person is suffering from some sort of eating disorder. According to Segal, these signs can include:

  • Restricting Food or Dieting: A change in eating habits that includes restricting food or excessive dieting. The person my frequently miss meals or not eat, complaining of an upset stomach or that they are not hungry. A use of diet pills or illegal drugs may also be noticed.
  • Bingeing: Sufferers may binge eat in secret, which can be hard to detect since they will usually do it late at night or in a private place. Signs of potential bingeing are empty food packages and wrappers and hidden stashes of high calorie junk food or desserts.
  • Purging: Those who suffer from bulimia will force themselves to throw up after meals to rid their body of added calories. A sign that this is occurring is when a person makes a trip to the bathroom right after eating on a regular basis, possible running water or a fan to hide the sound of their vomiting. They may also use perfume, mouthwash or breath mints regularly to disguise the smell. In addition to vomiting, laxatives or diuretics may also be used to flush unwanted calories from the body.
  • Distorted body image and altered appearance: People suffering from Eating Disorder often have a very distorted image of their own body. While they may appear thin to others, they may view themselves as fat and attempt to hide their body under loose clothing. They will also have an obsessive preoccupation with their weight, and complain of being fat even when it is obvious to others that this is not the case.

There are several possible side effects from Eating Disorders, both physical and psychological. Physical damage can be temporary or permanent, depending on the severity of the eating disorder and the length of time the person has been suffering from it.  Psychological consequences can be the development of a mental illness, especially depression and anxiety. Some sufferers of Eating Disorder will also develop a coping mechanism such as harming themselves, through cutting, self-mutilation or self-inflicted violence, or SIV (Something Fishy).

Physical consequences of Eating Disorders depend on the type of eating disorder that the person has. Anorexia nervosa can lead to a slow heart rate and low blood pressure, putting the sufferer at risk for heart failure and permanent heart damage. Malnutrition can lead to osteoporosis and dry, brittle bones. Other common complications include kidney damage due to dehydration, overall weakness, hair loss and dry skin. Bulimia nervosa, where the person constantly purges through vomiting, can have similar consequences as Anorexia but with added complications and damage to the esophagus and gastric cavity due to the frequent vomiting. In addition, tooth decay can occur because of damage caused by gastric juices. If the person also uses laxatives to purge, irregular bowel movements and constipation can occur. Peptic ulcers and pancreatitis can also common negative heath effects (National Eating Disorders Association).  If the Eating Disorder goes on for a prolonged time period, death is also a possible affect, which is why it is important to seek treatment for the individual as soon as it is determined that they are suffering from an Eating Disorder.

Once it is recognized that a loved one may be suffering from an Eating Disorder, the next step is coming up with an effective intervention in time to prevent any lasting physical damage or death. The most effective treatment to date is Cognitive-behavioral therapy, an active form of counseling that can be done in either a group or private setting (Curtis). Cognitive-behavioral therapy is used to help correct poor eating habits and prevent relapse as well as change the way the individual thinks about food, eating and their body image (Curtis).

Cognitive-behavioral therapy is considered to be one of the most effective treatments for eating disorders, but of course this depends on both the counselor administrating the therapy and the attitude of the person receiving it.  According to Fairburn (3), while patients with eating disorders “have a reputation for being difficult to treat, the great majority can be helped and many, if not most, can make a full and lasting recovery.” In the study conducted by Lobera et al, it was determined that students that took part in group cognitive-behavioral therapy sessions showed a reduced dissatisfaction with their body and a reduction in their drive to thinness. Self esteem was also improved during the group therapy sessions and eating habits were significantly improved.

“The overall effectiveness of cognitive-behavioral therapy can depend on the duration of the sessions. Cognitive-behavioral therapy is considered effective for the treatment of eating disorders. But because eating disorder behaviors can endure for a long period of time, ongoing psychological treatment is usually required for at least a year and may be needed for several years (Curtis).”

  Alternative solutions

Traditional treatments for Eating Disorders rely on educating potential sufferers, especially school aged children, of the potential damage, both psychological and physical, that can be caused by the various eating disorders .

“ Research conducted to date into the primary prevention of eating disorders (ED) has mainly considered the provision of information regarding risk factors. Consequently, there is a need to develop new methods that go a step further, promoting a change in attitudes and behavior in the  target population (Lobera et al).”

The current research has not shown that passive techniques, such as providing information, reduces the prevalence of eating disorders or improves the condition in existing patients. While education about eating disorders, the signs and symptoms and the potential health affects, is an important part of providing information to both the those that may know someone who is suffering from an eating disorder and those that are suffering from one, it is not an effective treatment by itself. It must be integrated with a deeper level of therapy that helps to improve the self-esteem and psychological issues from which the eating disorder stems.

Hospitalization has also been a treatment for those suffering from an eating disorder, especially when a complication, such as kidney failure or extreme weakness, occurs. However, treating the symptom of the eating disorder will not treat the underlying problem. Hospitalization can effectively treat the symptom only when it is combined with a psychological therapy that treats the underlying psychological problem that is causing the physical health problem.

Effectively treating eating disorders is possible using cognitive-behavioral therapy. However, the sooner a person who is suffering from an eating disorder begins treatment the more effective the treatment is likely to be. The longer a person suffers from an eating disorder, the more problems that may arise because of it, both physically and psychologically. While the deeper underlying issue may differ from patient to patient, it must be addressed in order for an eating disorder treatment to be effective. If not, the eating disorder is likely to continue. By becoming better educated about the underlying mental health issues that are typically the cause of eating disorder, both family members and friends of loved ones suffering from eating disorders and the sufferers themselves can take the steps necessary to overcome Eating Disorder and begin the road to recovery.

Works Cited

“Associated Mental Health Conditions and Addictions.” Something Fishy, 2010. Web. 19 November2010.

Carruthers, Martyn. Who Has Eating Disorders?   Soulwork Solutions, 2010. Web. 19 November 2010.

Curtis, Jeanette. “Cognitive-behavioral Therapy for Eating Disorders.” WebMD (September 16, 2009). Web. 19 November 2010.

Fairburn, Christopher G. Cognitive Behavior Therapy and Eating Disorders. New York: The Guilford Press, 2008. Print.  

“Health Consequences of Eating Disorders” National Eating Disorders Association (2005). Web. 21 November 2010.

Lobera, I.J., Lozano, P.L., Rios, P.B., Candau, J.R., Villar y Lebreros, Gregorio Sanchez, Millan, M.T.M., Gonzalez, M.T.M., Martin, L.A., Villalobos, I.J. and Sanchez, N.V. “Traditional and New Strategies in the Primary Prevention of Eating Disorders: A Comparative Study in Spanish Adolescents.” International Journal of General Medicine 3  (October 5, 2010): 263-272. Dovepress.Web. 19 November 2010.

Segal, Jeanne, Smith, Melinda, Barston, Suzanne. Helping Someone with an Eating Disorder: Advice for Parents, Family Members and Friends , 2010. Web. 19 November 2010.

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Essay on Eating Disorder

Eating disorders represent a complex intersection of psychological, physical, and social issues. They are not just about food but are serious mental health conditions. This essay aims to delve into the various aspects of eating disorders, exploring their types, causes, effects, and treatments, providing a comprehensive understanding for students and individuals keen on understanding this intricate topic.

Eating Disorders

Eating disorders are serious mental health conditions characterized by an unhealthy preoccupation with eating, exercise, and body weight or shape. They can have devastating physical and psychological consequences. The most common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder.

  • Anorexia Nervosa: Anorexia is characterized by an intense fear of gaining weight and a distorted body image, leading individuals to restrict their food intake drastically. This can result in severe malnutrition, physical health issues, and even life-threatening conditions.
  • Bulimia Nervosa: Bulimia involves recurrent episodes of binge eating, followed by behaviors aimed at compensating for the excessive calorie intake, such as purging through vomiting, excessive exercise, or laxative use. This cycle of overeating and purging can have serious health consequences.
  • Binge-Eating Disorder: Binge-eating disorder is marked by recurrent episodes of consuming large quantities of food in a short period, often without control. Unlike bulimia, individuals with this disorder do not engage in purging behaviors, which can lead to obesity and related health issues.
  • Avoidant/Restrictive Food Intake Disorder (ARFID): ARFID is characterized by highly selective eating patterns, avoiding certain foods or food groups based on sensory issues, aversions, or limited interest in food. This disorder can result in nutritional deficiencies and impaired growth in children.
  • Other Specified Feeding or Eating Disorders (OSFED): OSFED, previously known as EDNOS (Eating Disorder Not Otherwise Specified), includes a range of eating disorders that do not fit the strict criteria for anorexia, bulimia, or binge-eating disorder. It encompasses various disordered eating patterns.
  • Night Eating Syndrome: Individuals with night eating syndrome consume a significant portion of their daily caloric intake during the nighttime. They may wake up to eat, often experiencing insomnia and emotional distress.
  • Muscle Dysmorphia (Bigorexia): Muscle dysmorphia primarily affects men and is characterized by an obsessive desire to gain muscle mass and an intense fear of being inadequately muscular. It can lead to excessive exercise and supplement use.

Causes of Eating Disorders

Eating disorders are caused by a complex interplay of genetic, biological, behavioral, psychological, and social factors.

  • Genetic Factors : Family and twin studies suggest a genetic predisposition to eating disorders.
  • Psychological Factors : Low self-esteem, perfectionism, and impulsive behavior are commonly associated with eating disorders.
  • Social Factors : Cultural pressures that glorify thinness and body shaming can trigger eating disorders.

Effects of Eating Disorders

The effects of eating disorders can be severe and far-reaching.

  • Malnutrition: Eating disorders often lead to severe malnutrition, resulting in vitamin and mineral deficiencies, weakened immune system, and fragile bones.
  • Gastrointestinal Issues: Individuals with eating disorders may experience digestive problems such as constipation, bloating, and acid reflux.
  • Cardiovascular Problems: Heart complications, such as irregular heart rhythms, low blood pressure, and increased risk of heart attack, can occur.
  • Dental Issues: Frequent vomiting associated with some eating disorders can lead to dental problems, including tooth decay and erosion.
  • Hair and Skin Problems: Hair loss, brittle nails, and dry, discolored skin are common physical effects.
  • Anxiety and Depression: Eating disorders are often co-occurring with anxiety and depression, exacerbating these mental health conditions.
  • Obsessive Thoughts: Individuals with eating disorders may become obsessed with food, body size, and weight, leading to distressing and intrusive thoughts.
  • Low Self-esteem: Persistent body dissatisfaction and distorted body image contribute to low self-esteem and poor self-worth.
  • Social Isolation: Eating disorders can lead to social withdrawal, isolation, and strained relationships with friends and family.
  • Emotional Instability: Mood swings, irritability, and emotional instability are common effects of eating disorders.
  • Secrecy and Deception: Many individuals with eating disorders engage in secretive behaviors related to eating, hiding their disordered eating habits.
  • Ritualistic Eating: Rigid food rituals and routines, such as eating specific foods in specific orders, are common among those with eating disorders.
  • Excessive Exercise: Over-exercising is often seen in individuals with certain eating disorders, leading to physical strain and potential injuries.
  • Food Hoarding or Bingeing: Some may hoard food or engage in secretive binge-eating episodes, followed by guilt and shame.
  • Electrolyte Imbalance: Frequent purging behaviors (vomiting, laxative use) can disrupt electrolyte balance, leading to potentially life-threatening conditions like cardiac arrhythmias.
  • Osteoporosis: Malnutrition can result in bone density loss, increasing the risk of fractures and osteoporosis.
  • Lanugo Hair: Fine, downy hair growth on the body, known as lanugo, may develop in response to malnutrition.
  • Organ Damage: Long-term consequences of eating disorders can include damage to vital organs, such as the liver and kidneys.
  • Menstrual Irregularities: In females, eating disorders can lead to amenorrhea (absence of menstruation) or irregular menstrual cycles.
  • Fertility Problems: Reduced fertility and complications during pregnancy may occur due to hormonal imbalances and nutritional deficiencies.

Treatment of Eating Disorders

Treating eating disorders generally involves a multidisciplinary approach, including medical care, nutritional counseling, and therapy.

  • Medical Treatment : Focuses on addressing any immediate health risks.
  • Nutritional Counseling : Helps in developing a healthy relationship with food.
  • Psychotherapy : Cognitive-behavioral therapy (CBT) is particularly effective in treating eating disorders.

Coping Strategies and Support

  • Support Groups : Sharing experiences with others facing similar challenges can be comforting.
  • Healthy Lifestyle Choices : Engaging in regular physical activity and eating a balanced diet can improve mood and health.
  • Professional Help : Seeking timely professional help is crucial for recovery.

In conclusion, Eating disorders are complex conditions that require a comprehensive understanding of their causes, effects, and treatment options. Awareness and education are key in preventing these disorders and encouraging those affected to seek help. As a community, it is vital to foster an environment where body positivity is embraced, and mental health is taken seriously.

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The association between eating disorders and mental health: an umbrella review

Eng joo tan.

1 School of Public Health and Preventive Medicine, Monash University Health Economics Group (MUHEG), Monash University, Melbourne, VIC 3004 Australia

Tejeesha Raut

2 Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Burwood, VIC 3125 Australia

Long Khanh-Dao Le

Phillipa hay.

3 Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia

4 Camden and Campbelltown Hospital, SWSLHD, Campbelltown, NSW 2560 Australia

Jaithri Ananthapavan

5 Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Deakin University, Burwood, VIC 3125 Australia

Yong Yi Lee

6 School of Public Health, The University of Queensland, QLD 4006 Herston, Australia

7 Policy and Epidemiology Group, Queensland Centre for Mental Health Research, QLD 4076 Wacol, Australia

Cathrine Mihalopoulos

Associated data.

All relevant data are within the manuscript and supplementary materials.

There have been an increasing number of systematic reviews indicating the association between eating disorders (ED), including its risk factors, with mental health problems such as depression, suicide and anxiety. The objective of this study was to conduct an umbrella review of these reviews and provide a top-level synthesis of the current evidence in this area.

A systematic search was performed using four databases (MEDLINE Complete, APA PyscInfo, CINAHL Complete and EMBASE). The inclusion criteria were systematic reviews (with or without meta-analysis), published in the English language between January 2015 and November 2022. The quality of the studies was assessed using the Joanna Briggs Institute Critical Appraisal tools for use of JBI Systematic reviews.

A total of 6,537 reviews were identified, of which 18 reviews met the inclusion criteria, including 10 reviews with meta-analysis. The average quality assessment score for the included reviews was moderate. Six reviews investigated the association between ED and three specific mental health problems: (a) depression and anxiety, (b) obsessive-compulsive symptoms and (c) social anxiety. A further 3 reviews focused on the relationship between ED and attention deficit hyperactivity disorder (ADHD) while 2 reviews focused on ED and suicidal-related outcomes. The remaining 7 reviews explored the association between ED and bipolar disorders, personality disorders, and non-suicidal self-injury. Depression, social anxiety and ADHD are likely to have a stronger strength of association with ED relative to other mental health problems.

Mental health problems such as depression, social anxiety and ADHD were found to be more prevalent among people suffering from eating disorders. Further research is necessary to understand the mechanism and health impacts of potential comorbidities of ED.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40337-022-00725-4.

This review aimed to investigate the association between eating disorders (ED) and mental health problems. A review of existing systematic reviews was conducted to provide a top-level synthesis of the current evidence in this area. Our review found a total of 18 systematic reviews, which investigated the association between ED and a wide range of mental health problems. These conditions include depression and anxiety, obsessive-compulsive symptoms, attention deficit hyperactivity disorder (ADHD), social anxiety, personality disorders, suicidal-related outcomes, bipolar disorders and non-suicidal self-injury. Depression, social anxiety and ADHD are likely to have a stronger strength of association with ED relative to other mental health problems.


Eating disorders (ED) such as anorexia nervosa, bulimia nervosa and binge eating disorders lead to higher physical and psychological morbidity, disabilities, and mortality rates [ 1 ]. The prevalence of eating disorder is increasing, with the lifetime prevalence between 3.3 and 18.6% among women and between 0.8 and 6.5% among men [ 2 ]. Risk factors such as dieting and body dissatisfaction have been considered predictors of ED onset for many years [ 3 ]. Other predisposing factors of ED also include family history of EDs, having close relatives with a mental health problem, personal history of anxiety disorder, and behavioural inflexibility and sociocultural issues such as weight stigma, bullying or teasing and limited social networks [ 4 ].

Many studies have linked EDs to various mental health problems. For example, personality disorders can be found in a portion of patients with anorexia nervosa (AN) and bulimia nervosa (BN), and were encountered in the treatment of EDs [ 5 ]. Binge eating disorder (BED) has been found to impact mental health problems such as anxiety and depression which worsens health-related quality of life (HRQL) of an individual [ 6 ]. In a study of a nationally representative sample of 36,309 adults, all three EDs were associated with more than one comorbid somatic condition, which can range from lifetime mood disorders, anxiety disorders, major depressive disorder and alcohol and drug use disorders [ 7 ]. It has been widely recognized that individuals with EDs show higher rates of suicidality, which includes complete suicide, suicidal attempt, and suicidal ideation [ 8 ]. The negative perception of body image, a risk factor for ED, has also been linked to depression and obesity [ 9 ]. Individuals suffering from anorexia nervosa or bulimia nervosa also exhibit social anxiety disorders, have low self-esteem and more likely to feel nervous about their appearances in public places [ 10 – 12 ].

The significant burden of mental health problems necessitates a more comprehensive understanding of the relationship between mental health and ED. Recent evidence suggested that the burden of mental health problems has increased, with suicide as the second leading cause of death among 15–29 years and the annual global cost of depression and anxiety was estimated to be USD 1 trillion [ 13 ]. While previous studies and reviews have investigated the association between EDs and specific mental health problems such as anxiety, depression and substance use disorder, there is no existing review that provides a top-level summary of these associations by using a broader definition of mental health. Consequently, there is a lack of comparative analyses of the various mental health problems and their associations with ED. Addressing this gap in current research can assist researchers and clinicians to develop a suite of interventions that has the most impact on reducing the ED-mental health co-morbidity. In this context, an umbrella review is useful because it allows the findings of existing reviews to be compared and contrasted. Therefore, this umbrella review aims to synthesize contemporary evidence in order to better understand the relationship between eating disorders and various mental health problems across demographic and clinical factors.

This review adhered to the Joanna Brigg Institute (JBI) guidelines for umbrella reviews [ 14 ] and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards [ 15 ]. An ethics exemption for this research was approved by the Deakin University Human Research Ethics Committee (DUHREC) (ref. 202–1030). The protocol was registered with PROSPERO: International Prospective Register of Systematic Reviews (ref. CRD42021232372).

Search strategies and databases

In consultation with an experienced librarian, a literature search to identify potentially eligible publications was performed by the second author (TR) on 16 November 2020. A second literature search was performed by the first author (EJT) on 8 November 2022 to include potential studies published from 16 November 2020 onwards. Both searches were conducted via the EBSCOhost platform on four databases: MEDLINE Complete, APA PyscInfo, CINAHL Complete and EMBASE. The International Classification of Diseases version 10 (ICD-10) was used to define the mental health problems relevant to this review. For the purpose of this review, the disease category of disorders of psychological development, which included disorders related to speech, language, scholastic skills, motor function and autism were not considered. The search terms used in the study were various combinations of eating disorder keywords (e.g., “anorexi*”) and mental health keywords (e.g., “addiction”) using Boolean operators (or/and). Further details of the search terms can be found in Table S1 in the supplementary information file.

Inclusion and exclusion criteria

The aim of this umbrella review was to identify reviews of studies that investigated the association between eating disorders and mental health problems. Therefore, reviews that reported the association or consequences of EDs or ED risk factors and mental health problems such as depression, anxiety, substance use disorders were included. The inclusion criteria required studies to be systematic reviews with or without meta-analyses while scoping reviews, narrative reviews, or literatures reviews without quality assessment were excluded. For the purpose of this umbrella review, a study is considered a systematic review if it had a clearly formulated research question, reported systematic and reproducible methods to identify, select and critically appraise relevant research studies. The studies were limited to the general population although there were no age or gender restrictions on the participants. All the articles included in the study were human studies, published in the English language published in peer-reviewed journals within the last seven years i.e. from January 2015 to November 2022. Non-review studies such as cohort, prevalence, case-control or cross-sectional studies were excluded from this review. Reviews with the wrong setting, study design, outcomes or the patient population were excluded. Further details of the inclusion and exclusion criteria can be found in Table S2 in the supplementary information file.

Identification of relevant studies and data extraction

All studies from the database search results were imported into Endnote and duplicates were removed. The remaining studies were then uploaded to Covidence, an online systematic review management tool, for screening [ 16 ]. A two-stage screening process applying the inclusion and exclusion criteria was conducted: (a) title and abstract screening and (b) full-text screening. Both screening processes were done independently by two reviewers (TR, EJT) and any discrepancies were discussed and resolved by the third reviewer (LL). The following data were extracted from reviews that fulfilled the inclusion criteria: year of publication, number of included studies, type of eating disorders or risk factors of eating disorders, mental health problem, presence of meta-analysis component, study design, population description, country and effect size (if available). Data extraction was performed by TR and independently checked by EJT and LL.

Quality assessment

The bias and quality of the included reviews were assessed using the Joanna Briggs Institute Critical Appraisal tools for systematic reviews (The Joanna Briggs Institute, 2017). The purpose of this appraisal tool is to assess the methodological quality of the included studies and to determine the extent of the possibility of bias in design, conduct and analysis. The tool consists of 11 items (further details are available Table S2 in the supplementary information file) include three choices - “Yes”, “No” and “Unclear”. The total score on the scale is 11.

A total of 7,275 potentially relevant studies were identified from the database search. After duplicates were removed, 6,537 studies were available for screening. After title and abstract screening, 94 studies were progressed to full-text screening. Full-text screening resulted in 18 studies meeting the inclusion criteria and being included in the umbrella review. The PRISMA diagram shown in Fig.  1 reports the reason for exclusion for the remaining 76 studies with full-text review.

An external file that holds a picture, illustration, etc.
Object name is 40337_2022_725_Fig1_HTML.jpg

PRISMA flow diagram of included studies

Characteristics of included studies

Out of the 18 systematic reviews, ten included a meta-analysis component. There were six reviews investigating the association between ED or ED risk factors (e.g. body dissatisfaction) and three specific mental health problems: (a) depression and anxiety, (b) obsessive-compulsive symptoms and (c) social anxiety. Another three reviews focused on the relationship between ED and attention deficit hyperactivity disorder (ADHD) while two reviews focused on ED and suicidal-related outcomes. The remaining seven reviews explored the association between ED and bipolar disorders, personality disorders, and non-suicidal self-injury. Further details of the included studies are presented in Table  1 . The number of individual studies included within the reviews ranged from five to 122 studies with the majority of included studies being conducted using a cross-sectional study design. All but one review investigated the general population, including males and females, and the sample size ranged from 1,792 to 2,321,441 participants.

Summary of included reviews

SMD = standardized mean difference; OR = odds ratio

*The quality score was calculated from the total score out of 11 based on the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Systematic Reviews questionnaire

ED, depression and anxiety, obsessive compulsive symptoms and social anxiety

The evidence from two reviews [ 17 – 19 ] suggest that individuals afflicted with BED or disordered eating have a higher risk of experiencing negative mood, tension, sadness and emotional instability [ 19 ], which can further develop into depressive and anxiety symptoms [ 17 ]. However, limited evidence was found to support any link between disordered eating and obsessive-compulsive symptoms [ 17 ]. There is evidence to suggest that the relationship between anxiety and AN can be bi-directional. For example, the review by Lloyd et al. [ 18 ] demonstrated that the risk of anorexia is predicted to increase in adolescents and young adults diagnosed with an anxiety disorder. Meanwhile, Kerr-Gaffney et al. [ 11 ] conducted a systematic review and meta-analysis and found that both BN and AN were associated with social anxiety with a medium effect size of 0.71 [95% CI 0.47, 0.95; p  < 0.001] and a large effect size of 1.65 [95% CI 1.03, 2.27; p  < 0.001], respectively as estimated using the Cohen’s d statistic. The authors concluded that individuals with AN or BN have high levels of social anxiety compared to healthy controls.

Several reviews have indicated that certain ED risk factors can potentially contribute to depression. The systematic review and meta-analysis conducted by Puccio et al. [ 20 ] suggested that eating pathology is one of the risk factors for depression and vice-versa. The effect of eating pathology on depression among 18,641 females aged 6–50 years was shown to be significant with an effect size of 0.13 (95% CI: 0.09 to 0.17, p  < 0.001), which was conducted on r values [ 19 ]. A systematic review of body image dissatisfaction and depression found that in men the perception of being underweight or dissatisfaction due to low weight was observed by idealizing a larger body, whereas women perceived their body larger than it was by idealizing a lean body [ 21 ]. Both of these conditions were associated with the presence of depression or depressive symptoms although the review was unable to conclude whether more severe body image dissatisfaction increased chances of also having depressive symptoms or both conditions co-exist.

ED and attention deficit hyperactivity disorder

A systematic review conducted by Kaisari et al. [ 22 ] on disordered eating behaviour and (ADHD) among 115,418 participants (including both male and female populations) suggested that the impulsivity symptoms of ADHD were positively associated with overeating in AN and BN. Similarly, Levin & Rawana [ 23 ] explored the association between AN, BN and BED and ADHD among 74,852 participants and showed that childhood ADHD increases the risk of disordered eating or developing ED in later life. The systematic and meta-analysis of ED on ADHD by Nazar et al. [ 24 ] showed that the pooled odds ratio of diagnosing any ED in ADHD populations was 3.82 (95% CI 2.34–6.24). BN has the highest odds ratio (5.71, 95% CI 3.56–9.16) followed by AN (4.28, 95% CI 2.24–8.16) and BED (4.13, 95% CI 3.00–5.67). On the other hand, the pooled odds ratio of diagnosing ADHD in people with eating disorders was 2.57 (95% CI 1.30–5.11) [ 24 ].

ED and bipolar disorder

The systematic review by Álvarez Ruiz & Gutiérrez-Rojas [ 25 ] found that the severity of BN and BED in women was higher among patients with bipolar disorder. The evidence from their review suggested that there is a comorbidity between ED and bipolar disorder, with prevalence rate of EDs in bipolar disorder patients ranging from 5.3 to 31%. In addition, a more recent meta-analytic review of 47 studies reported the lifetime prevalence of AN, BN and BED as 3.8% (95% CI 2–6%), 7.4% (95% CI 6–10%) and 12.5% (95% CI 9.40–16.6%) among individuals with bipolar disorder, respectively [ 26 ].

ED and suicidal factors

A systematic review of 12 cross-sectional and 5 longitudinal studies on BED and suicidal factors among adolescents and adults found that BED is associated with a higher risk of suicide, including suicidal behaviours and ideation [ 8 ]. Similarly, the systematic review by Goldstein & Gvion [ 27 ], which included 36 cross-sectional studies and 2 longitudinal studies, suggested that eating disorders with purging behaviour, impulsivity and specific interpersonal features were associated with greater risk of suicidal behaviours.

ED and non-suicidal self-injury

A systematic review and meta-analysis by Cucchi et al. [ 28 ] reported that, among patients with various EDs, the prevalence of a lifetime history of non-suicidal self-injury (NSSI) was 27.3% (95% CI 23.8–31.0%) for ED, 21.8% (95% CI 18.5–25.6%) for AN, and 32.7% (95% CI 26.9–39.1%) for BN. Based on 29 studies and 6,575 participants, the review concluded that NSSI is a significant correlate of ED and prevalent among adolescents and young adults with ED.

ED and personality disorders

The systematic review and meta-analysis conducted by Farstad et al. [ 29 ] on ED and personality disorders (PD) included 14 studies and showed that pooled prevalence rates of PD ranged from 0% (95% CI: 0–4%) (for schizoid) to 30% (95% CI 0–56%) (for obsessive-compulsive) in individuals with ED. The authors concluded that increases in perfectionism, neuroticism, low extraversion, sensitivity to social rewards, avoidance motivation, negative urgency and high-self-directedness was found in the people presenting with EDs. This finding is consistent with another review that investigated the association between EDs and symptoms of borderline personality disorder [ 30 ]. The authors found that nine symptoms of borderline personality disorder were significantly elevated in patients with EDs compared to controls.

In a meta-analytic review of 59 studies, the lifetime and current prevalence of obsessive-compulsive disorder was reported to be 13.9% [95% CI 10.4–18.1%] and 8.7% [95% CI 5.8–11.8%] respectively across EDs, which included all ED subtypes [ 31 ]. Another meta-analysis review reported lifetime comorbidity rates for obsessive-compulsive disorder of 19% in AN patients and 14% in BN patients based on cross-sectional studies [ 32 ]. These rates increased to 44% in AN patients and 18.5% in BN patients when longitudinal studies were considered.

Quality of included systematic reviews

The scores achieved by the included reviews ranged from 45% (i.e. 5 out of 11 questions) to 100% (i.e. 11 out of 11 questions). On average, the reviews met 72% of the JBI criteria. The details of the score are presented in Table S3 in the supplementary information file. Overall quality was acceptable and most reviews performed well in the design of review question, inclusion criteria, search strategy and criteria used for study appraisal. The main loss of scores were from the criteria of methods to minimize errors in data extraction and assessment of publication bias.

To the best of our knowledge, this is the first umbrella review to examine the overall evidence of the association between eating disorders and mental health across the age spectrum. While previous reviews were focused on investigating the relationship between eating disorders and specific mental health problems, our review captured all relevant mental health problems, including mental disorders, personality disorders and suicide-related outcomes. The findings of this review were synthesized from contemporaneous systematic reviews (i.e. in the last 7 years) and highlighted the growing body of evidence in this area, particularly the frequency of comorbidity of ED and mental health problems. In addition, our review provides a top-level summary of the strength of the association between the various mental health problems and eating disorders, and the direction of effect where possible.

A total of 643 individual studies were reviewed by the 18 systematic reviews included in this umbrella review. The synthesis of evidence revealed that there is a significant association between ED and mental health problems in general. However, among the various mental health problems investigated, only reviews focusing on depression, social anxiety and ADHD reported an effect size or odds ratio from their respective meta-analysis. Therefore, based on quantitative evidence, the association between these three mental health problems and ED is more prominent compared to other mental health problems. There is also evidence to suggest that depression and anxiety are significantly associated with different types of EDs and their risk factors. For example, symptoms of depression and anxiety were often observed in individuals suffering from AN, BN and BED or those with ED risk factors such as body dissatisfaction [ 16 , 21 ]. Interestingly, existing research shows that childhood ADHD increased the risk of disordered eating or developing ED in later life and vice versa while the risk of ADHD in individuals with ED is increased three-fold, compared to control groups [ 24 ]. This phenomenon is particularly relevant for prevention efforts given that diagnosis of ADHD in young girls or women can be delayed or missed [ 33 ]. As such, there are potential shared benefits to be gained when addressing both conditions. Further research is required to explore the underlying mechanisms and comorbidity between EDs and mental disorders. The prevention or treatment of this comorbidity also needs to be addressed by future intervention studies.

While females continue to be disproportionately affected by ED, including through its association with other mental health problems, there is also growing evidence to indicate the adverse impacts of the ED-mental disorder comorbidity on the male population. For example, the correlation between the risk of developing eating pathology due to childhood ADHD was observed to be stronger in males compared to females [ 23 ]. Furthermore, restrictive eating behaviour has been linked to ADHD-related hyperactivity symptoms in boys although the causal pathway is still not fully understood [ 34 , 35 ] As the population group investigated by the reviews included in this study was predominantly females, the association between ED and mental health may be underestimated in males. A balanced representation of the two sexes should be considered in future studies and will lead to an improved understanding of the function of gender in this emerging comorbidity.

Our umbrella review also reported that most of the research were undertaken in high-income countries, whereas limited studies have been conducted in low- and middle-income countries. This is not surprising given that previous evidence have indicated a severe scarcity of mental health research resources in low- and middle-income countries, especially in Asian and African countries [ 36 ]. Furthermore, ED-related epidemiology research in low- and middle-income countries often focused on prevalence studies and less on comorbidity between ED and mental health problems [ 37 ]. Therefore, there is a need to address this gap in the literature and investigate the generalizability of present evidence across different regions.

One of the limitations of our umbrella review is that it did not include reviews published in languages other than English. In addition, our literature search was limited to the last 7 years, therefore, reviews published before 2015 were not considered. However, it is likely that the more recent reviews in our study have included previous evidence. Another limitation is that no recent individual studies were included. Although this omission may have an impact on the findings of our study, it is unlikely to change the overall conclusion.

Overall, there may be several clinical implications from our findings. First, there is a need to increase awareness and screening for ED in general mental health settings and broader demographics. Compared to general mental health, ED is often underdiagnosed in primary care and therefore the health burden of ED is largely hidden even though it is substantial [ 38 , 39 ]. Second, it is necessary to address the unmet need for treatment of ED. Evidence has shown that although a majority of community cases with a diagnosable ED who seek treatment received treatment for weight loss, only a small proportion received appropriate mental health care [ 40 ]. There is a need to promote supported integrated treatments such as the introduction of mood intolerance module in temperament based therapy with supports [ 41 ].

The outcome of the umbrella review suggests that eating disorders and mental health problems are significantly associated with each other. Mental health problems such as depression, anxiety, suicidal attempts are found to be more prevalent among people suffering from eating disorders. EDs also arise from impulsive behaviours, poor emotion regulation, history of childhood physical and emotional abuse, pain tolerance and interpersonal fears such as perceived burdensomeness [ 16 , 27 ]. Our findings suggest that there is a need for further research to understand the health impacts of eating disorder and mental disorder comorbidities. For instance, there is a limited assessment of risk factors of suicide in people with ED and, therefore, historical and contemporary data need to be collected in order to better understand the risk of suicide in ED. Further efforts should also be made to identify effective and cost-effective interventions for the prevention or treatment of ED and its comorbidities.


Not applicable.

Author contributions

EJT and LKDL conceptualized and designed the study. TR, EJT, LKDL contributed to the acquisition, analysis, and interpretation of data for the work, drafted the initial manuscript, and reviewed and revised the manuscript. PH, JA, YYL and CM contributed to the conception and design of the work and the acquisition, analysis, and interpretation of data for the work and critically revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

This study was funded by the National Health and Medical Research Council Ideas Grant (APP1183225). LKDL is funded by the Alfred Deakin Postdoctoral Research Fellow. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Availability of data and materials


An ethics exemption for this research was approved by the Deakin University Human Research Ethics Committee (DUHREC) (ref. 2021-030).

Dr Long Le is a Guest Editor for the collection of “Environmental Influences on Eating disorders, Disordered eating and Body Image” in Journal of Eating Disorders. All other authors do have any competing interest to declare.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Contributor Information

Eng Joo Tan, Email: [email protected] .

Long Khanh-Dao Le, Email: [email protected] .

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Your chance of acceptance, your chancing factors, extracurriculars, discussing my eating disorder in college essays – too personal or potentially impactful.

Hey guys, so here's the thing – I’ve battled with an eating disorder, and it’s been a significant part of my high school experience. Should I write about overcoming this challenge in my essays, or would it be better to choose a less sensitive subject?

Your courage in facing and overcoming such a personal challenge is commendable. When choosing an essay topic, the key is to focus on how the experience has shaped you and enabled personal growth. If you believe that your journey with an eating disorder has been a transformational part of your high school experience and has changed you in a significant way, it is worth considering as an essay topic.

However, ensure that your narrative is one of resilience and that it showcases how this experience has helped you build up your strengths, rather than solely focusing on the struggle itself. For example, avoid graphic descriptions of what you dealt with, as they may be uncomfortable for admissions officers to read, especially if they have struggled with eating disorders themselves—remember, you never know who is going to be reading your essay.

Rather, focus on how overcoming the hardship of this experience has taught you important life skills, by talking about accomplishments or formative experiences that were enabled by the abilities you developed as a result of your struggle with your eating disorder. This approach will give colleges what they are interested in in any personal statement, which is your ability to persevere and how your experiences have prepared you for the challenges of college life.

In summary, this topic is not too personal if framed correctly. If you're wondering if your approach is working, you can always check out CollegeVine's free peer essay review service, or submit it to an expert advisor for a paid review. Since they don't know you, they can provide an objective perspective that will hopefully give you a sense of how an actual admissions officer would read you essay. Good luck!

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Anorexia as Eating Disorder Essay

Introduction, prevalence of anorexia nervosa disorder, possible causes of anorexia nervosa, danger signs.

Significant amount of time has been dedicated by researchers in the study of anorexia, an eating disorder. Nonetheless, extensive data that is so far available has not been fully utilized towards combating this disorder. It is against this background that the number of anorexia patients across the world has continued to raise thereby negating available treatment methods.

Initially, the condition was restricted among western population but the very western standards of beauty have spread to other parts of the world leading to rapid spread of the disorder. This review will explore aspects of anorexia nervosa by tracing its historical background, possible causes, prevalence rate as well as treatment.

Types of eating disorders

As society continues to promote thin body mentality to be the ideal of beauty, Attia and Welsh observe that there is increasing number of people who are developing anorexia as they become more aware of their weight. [1] Most people are concerned about their body weight at some point in life. However, according to the above authors, those who develop eating disorders tend to take their concerns to the extreme.

Abnormal eating habits are a threat to a person’s well being and some extremities can cause death. Research over the past few years, has shown that there has been an increase in the number of people suffering from eating disorders especially anorexia nervosa and bulimia nervosa. The above disorders are more prevalent in young women and adolescents. Among the general population, it is estimated that about five million people will show signs of at least one type of the above disorders.

Three major types of eating disorders have been identified. The first and the most common type is anorexia nervosa. Individuals who suffer from this disorder are have a distorted view of their body image. Despite some of them being extremely underweight, they will always have feelings of being overweight. These individuals will refuse to eat but will continue to exercise compulsively with some starving themselves to death.

The second type is bulimia nervosa which until recently has always been confused with anorexia nervosa. These individuals unlike the one suffering from anorexia nervosa will consume large quantity of food although they feel guilty about it. The affected person will perform the above acts because they feel ashamed and disgusted of the binging act. Once they get rid of their stomachs’ contents, tension and negative emotions dissipate. Many scholars have dedicated their time to study anorexia. However, due to limitation in scope, the rest of the chapter will explore anorexia nervosa by tracing the historical background of the condition, reviewing prevalence of the disorder in terms of gender, culture and geographical background as well as the causes and the current treatment methods.

Understanding anorexia nervosa

According to Dare, anorexia has been associated with loss of appetite and does not occur due to physical sickness but mostly triggered by perception of the mind. [2] An individual has a similar appetite with a normal healthy person but they tend to suppress it by either eating very little or avoiding eating for a prolonged period of time. It is against this reason that psychologists view this condition as life threatening if left untreated. [3]

The motivating factor that makes the patient to lose appetite at the sight of food is their obsession to lose weight. Such people are very conscious of their body image, and they always strive to achieve the ideal slim body. The above individuals will deliberately starve themselves to maintain the ideal thin body. In addition, they adopt a strict exercising schedule motivated by their intent fear to become fat.

Historical perspective of anorexia nervosa

Knowledge about the condition came into the lime light in the late 18 th century, when two separate physicians; Charles Lesegue and William Gull researched on anorexia nervosa. The two have been regarded as pioneer researchers in this particular filed. At the initial stages, several names were put forward but, anorexia nervosa came to be widely accepted eventually.

Many other researchers such as Hilde Bruch, Arthur Crisp among other have come forward, and their works have contributed into the research by coming up with treatment plans. Despite the numerous studies into the condition, there is lack of adequate technological innovation as far as treatment is concerned. Hence, it has become a concern among contemporary physician researchers.

The development of anorexia disorder can be traced back to several cultures from ancient times. During this particular time, prolonged fasting was observed but usually it was for religious reasons. The fast was common among the Greek and Egyptian cultures, but, no evidence has been found to show the fasting was as a result of the disorder.

A close resemblance of the disorder in ancient times was that which developed among people who practiced eastern religions. As Steiner documents, some Eastern religious beliefs led to self starvation as people sought spiritual fulfillment. [4] Self starvation is regarded as one of the symptoms of anorexia nervosa today.

Although a slight similarity of ancient times self starvation can be compared with modern day anorexia nervosa, the motivating factors are very different. The ancient people practiced self starvation mainly for religious reasons, but not because they feared getting fat as it evident today.

Lack of a direct link between ancient and modern day disorder has made development of deep research in this disorder to be limited in scope. [5] The disorder has always been viewed from a social perspective, and earlier researchers have ignored the medial aspect of it.

Initially, anorexia was viewed as a social condition, that affected young women and girls from the high-class circles, and it was viewed as their fashion trend. For this reason, scholars saw the disorder as a pass time activity, which did not have any medical effects. It was not until later when the disorder was given attention by the medial experts when serious medial implications started to be discovered.

The prevalence of the disorder affects people of both gender types. It can affect individuals of any age. However, women are more predisposed to the disorder as compared to men. Statistics have identified the ratio to be one out of ten men. Scholars say the incidences of the disorder are increasing day by day, and we might have new statistical out look in the future.

The numerous studies conducted show the disorder is more prevalent among the population from the industrialized nations. Despite the industrialized nations having abundant-food supply, the population especially the females shy away from eating to maintain the slim image, which is considered to be attractive.

The disorder has been found to be common in the western countries such as United Kingdom, USA, Canada and other highly industrialized nations. Studies in the US show that 0.5 to 1 % of females in the US are likely to develop the disorder. In United Kingdom, an estimated 0.7 % to 1.2% females are at high risk of developing anorexia.

However, research of the spread of the disorders in African countries is very limited; hence it may not be easy to hypothesize prevalence rate in those areas due to limited research conducted in the past.

The results of such studies are hard to generalize across African and other minority cultures. The results of the above studies showed very minimal cases of the anorexia nervosa. Indeed, Rumney expounds that the low level of prevalence rate is a clear indication that cultural factors contribute in the development of anorexia nervosa.

Previous studies have also indicated that the disorder is common among post -puberty adults. However, in recent years, isolated cases have been identified among children as young as 7 years. [6] In addition, more recent studies have noted that the disorder is gaining momentum among pre-puberty individuals.

This information has led scholars today to agree that the disorder begins in mid and late adolescence. When the disorder develops at this age, prognosis is always better as compared to those who develop it past the age of 40 years. The disorder at rare times can affect order adults as life stresses catches up with them.

Individuals who develop the disorder do so when they start perceiving in their mind that they are overweight. When such a person begins to diet, he/she does not notice when the weight falls. They will thus continue to diet and exercise intensively, and the habit turns into an obsession.

Such people will do anything to lose weight, and the reason they undertake self starvation measures is because they see weight gain as a sign that they have failed. Eventually, if left untreated the disorder can lead to fatality as the individuals continue to lose weight beyond the required healthy weight for their age and height. Anorexia disorder prognosis is good when diagnosed at early stages.

Researchers have been interested to know what causes the anorexia nervosa disorder. Further, they have been interested to know the contributing factors that lead to the development of the disorder. However, it is difficult to determine the specific causes of the disorder, and most of the causes put forward are hypothetical. Scholars believe that anorexia nervosa can be attributed to a combination of factors, ranging from environmental, cultural, biological and psychological.

Biological causes

Researchers of anorexia disorder through numerous experiments have come across evidence, that some people could be genetically predisposed than others to develop the disorder. The probability of a person whose close family member suffered from an eating disorder, to get anorexia nervosa is higher than for a person whose family has not history of eating disorder.

Statistics has shown that the probability is 10 times higher, and more than 50 % of anorexia nervosa cases can be linked to the hereditary factor. [7] Although numerous experiments have been conducted, the researchers have failed to provide a clear explanation of how biological factors are directly related to the eating disorder.

However, research has been success as researchers have discovered specific chromosomes, which are directly linked to the disorder. The specific chromosomes identified are known to increase susceptibility to the eating disorders; anorexia nervosa and others.

Another biological factor that can be linked with the increased risk to the disorder has to do with the brain abnormal biochemical make up. The abnormal biochemical make up is related with the hypothalamic-pituitary-adrenal axis (HPA) which regulates a person mood, stress and appetite.

The gland releases certain neurotransmitters such as serotonin, norepinephrine and dopamine, which are responsible for mood regulation. When the release of the above neurotransmitters is reduced, such a person is likely to develop the disorder. The above evidence shows that abnormal biochemical make up which is biological factor can be attributed to the eating disorder.

Cultural factors

Cultural beliefs and attitude factors can also be linked to the development of anorexia nervosa disorder, and other eating disorders. The rates of the disorders vary from one race or ethnic group to the other, and the dimension or extent changes with time as cultures evolve. So many studies have concentrated their researches among people within the western culture. [8] However, extensive research needs to be done all over the world to demonstrate the spread of the disorder across all cultures.

A cultural factor that has contributed to the development of the disorder originates from the western culture, where a thin body is viewed as the ideal. This idealization, which receives much attention through the numerous mass media, has been listed as a significant cultural factor that leads to the development of the disorder.

The media are powerful tool when it comes to influencing peoples’ attitudes towards a particular topic. The media are to blame for the widespread anorexia disorder as they portray slim body as the measure of attractiveness.

Although eating disorders can be traced back in history, the massive shift to the view that slim is ideal has emerged recently as promotions of slim body increases. The evidence that today men and women are not satisfied with a big body is evident from the numerous diet articles, diet medication and the like.

A further elaboration on the aspect of culture is that which explains the role of changing cultures to the change of development of anorexia nervosa, as well as the changing prevalence.

Several proposals have been put forward to classify anorexia as cultural-change syndrome rather than a cultural specific syndrome as many tend to believe. [9] This proposal cites studies done among the immigrants which show that though the disorder is rare, it is gaining momentum, as the immigrants culture change because of interaction with the host culture.

In addition, rare cases of the disorder are being reported in less developed world since the process of industrialization brings with it changes in culture. As the world become a global village, the interaction and transfer of cultural values is inevitable; hence anorexia will be a cultural-changing syndrome in the future.

The reason why anorexia disorder is being transferred from the western to other world cultures is because the western culture has always been viewed as ideal. The media have played a great role in communication the values of the western culture to other parts of the world and hence eroding traditional values especially among the young people.

Apart from the idealization of slim body among the western culture, another cultural force which has caused the widespread occurrence of the disorder is identified. [10] In the recent decades, the role of women in society has taken a great shift.

Several feminist theorists have associated the rapid development of eating disorder with the changing roles of women in society especially in western cultures. [11] Feminists theorists have hypothesized that the pressures placed on today’s woman will increase their vulnerability to eating disorders. A historical perceptive of eating disorders to support the hypothesis, is that which shows that eating disorders among women develop, when they are presented with many opportunities.

However, the available opportunity has to be combined with absolute freedom for such a woman to develop anorexia nervosa. Lack of freedom is what makes wealthy women in Muslim cultures to shy away from self starvation since they live restricted lifestyles.

Today woman is pushed to be a high achiever; at the same time, society expects her to maintain her femininity and attractiveness. The anorexia disorders among females come about as they try to balance the demand by society to be both successful and attractive.

Psychological causes

Studies to link the development of anorexia disorder and psychological factors received much attention in the 20 th century. The early theorists focused their attention on studying how person unconscious sexuality conflicts contributed to the development of the disorder.

They also wanted to find out the link between adolescent rebellion and regression to the oral stage of development to the anorexia nervosa. Similarly, earlier psychologists also associated the disorder with the advent of object relations theory. [12] The above theory focuses on how a parent relation with an infant affects the personality development of an individual.

The modern-day psychologists have developed a theory which shows anorexia disorder to be caused by emotional disturbances. The variables of emotional, logical and stimuli come into play in an attempt to classify anorexia as an emotional disorder. According to the anorexia nervosa theory, anorexia, which resides on the emotional side of the human brain, can occur whenever the emotional elements are disturbed.

The disorder is said to develop during mental growth where one of the key points is affected. The theory postulates that the adolescence stage of growth is the most likely point, when the disorder will develop. This is because during adolescence an individual is developing a sense of self, and most of the times adolescents are not able to handle any form of criticism positively. [13]

During this search of identity stage, criticism carries a lot of weight and the person will try to distance themselves from it by manipulating the external environment to avoid further criticism. This escapism behavior suppresses the internal being and the person expresses though unconsciously the preferred emotional image.

When prolonged, exposure of the internal self to suppression will eventually lead to mental segregation presented as anorexia nervosa. Dare expounds that it is a form of mental illness that originates from emotional. Hence, an individual is always concerned with peoples perception of his/her image. [14]

Family therapists have also contributed to debate on how psychological factors associated with family relations, lead to the development of anorexia nervosa disorder. [15] The said therapists have tried to demonstrate the relationship between dysfunctional family relationships and broken down family interaction bonds, with the development of anorexia nervosa.

Individuals whose mothers are intrusive, overprotective and exhibit perfectionists’ characteristics are likely to develop anorexia disorder. In addition, if ones’ father is passive, withdraw, moody or ineffective the probability for such an individual to develop anorexia nervosa is increased.

Personality traits have also been linked with the development of the anorexia nervosa disorder. The individuals have been cited to have low self esteem, extreme fear of becoming fat and feeling of helplessness in life. [16] The individuals are usually people who are high performers in whatever sector they are in life, but their tendency of perfectionism is what compels them to develop the disorder.

Such people are always concerned with peoples’ opinion about them, and always strive to portray a perfect picture. [17] The see the tendency to control their weight as advantageous in gaining peoples approval. It is very hard to know that individuals have a problem as they tend to keep their feelings to themselves, and rarely show rebellious behavior.

Individuals who are developing anorexia nervosa disorder are likely to use weight reduction drugs during the initial stages of the obsession. Other behavioral signs have been identified by researchers. The individuals will start by cutting back on the portion of food they are used to take previously. The individuals will also exhibit an obsessive interest in exercises, and will spend every opportunity exercising.

Those with the bulimia nervosa disorder will be seen going to the bathroom right after they take any meals. [18] Those who suffer from anorexia nervosa will also avoid gathering where food is likely to be served as they do not want to be forced to eat under the circumstances. The above behaviors affect the body negatively and the patients start showing signs of poor health. The most initial symptom associated with anorexia nervosa is gradual but constant weight loss.

Initially, the weight loss is not harmful to the body especially if the patient was overweight. [19] At the later stage as the patient increases weigh losing exercises, the individual will start complaining about stomach problems accompanied by constipation diarrhea. As days goes by, the patient becomes weaker and weaker as the energy reserves are dangerously utilized by the body.

Dizziness may also be a common complaint, and at times, the patient may experience fainting episodes. If left untreated, the symptoms continue to appear which might lead to death. [20]

Eating disorders are very common problem among the population. Anorexia nervosa, which is one type of eating disorders, has become so common and if not watched more health problems are likely to arrive in the future. Researchers should put more effort to innovate on preventive and treatment measures of the condition.

Attia Evelyn, Walsh B. Timothy, 2007. “ Anorexia Nervosa”. American Journal Psychiatry 164(2007): 1805-1810.

Bell, Rudolph M. Holy anorexia . Chicago, Illinois: University of Chicago Press, 1987. Dare Chris, Isler Ivan, Russel Gerald, Treasure Janet & Dodge Liz .“Psychological

Therapies for Adults with Anorexia Nervosa.” British Journal of Psychiatry, 178 (2001): 216-221.

DeAngelis Tori, 2002. “ A Genetic Link to Anorexia”. Monitor on Psychology 33(2002), 34-37.

Halmi, Katherine A. “ The Multimodal Treatment of Eating Disorders”. World Psychiatry 4(2005): 69-73.

Kaye Walter H., Bulik Cynthia M., Thornton Laura, Barbarich Nicole, Masters Kim and the Price Foundation Collaborative Group. “Co-morbidity of Anxiety Disorders with Anorexia and Bulimia Nervosa ”. American Journal of Psychiatry 161 (2004): 2215-2221.

Mehler, Philip S. “Diagnosis and Care of Patients with Anorexia Nervosa in Primary Care Settings.” Annals of Internal Medicine 134(2001):1048-1059.

Naqvi, Syed. “Review of Child and Adolescent Psychiatry.” Focus 2 (2004):529-540. Palmer, B. “Come the Revolution. Revisiting the Management of Anorexia Nervosa.” Advances in Psychiatric Treatment 12 (2006):5-12.

  • Papadopoulos Fotios C, Ekbom Aders, Eselius Lisa & Brandt Lena. “ Excess Mortality, Causes of Death and Prognostic Factors in Anorexia Nervosa.” British Journal of Psychiatry 194 (2009): 10-17.
  • Ramsay Rosalind, Ward Anne, Treasure Janet & Russel Gerald F. M. “ Compulsary Treatment in Anorexia Nervosa. Short Term Benefits and Long Term Mortality.” British Journal of Psychiatry 175 (1999): 147-153.

Rumney, Avis. Dying to please: anorexia, treatment and recovery . Jefferson, N.C. : McFarland, 2009.

  • Steiner Hans, Mazer Cliff & Litt Iris F. “Compliance and Outcome in Anorexia Nervosa”. West J Med 153 (1990): 133-139.
  • Swain, Pamela I., Scaglius, Fernanda Baeza., Balfour, Louise., and Hany Bissada. Anorexia Nervosa And Bulimia Nervosa: New Research . New York: Nova Biomedical Books, 2006.

Wade Tracey D., Bulik Cynthia M., Neale Michael, and Kendler Keneth S. “Anorexia Nervosa and Major Depression: Shared Genetic and Environmental Risk Factors” . Am J Psychiatry 157 (2000):469-471.

  • Attia Evelyn, Walsh B. Timothy. “ Anorexia Nervosa”. American Journal of Psychiatry 164 (2007), 1805-1810.
  • Dare Chris, Isler Ivan, Russel Gerald, Treasure Janet & Dodge Liz. “PsychologicalTherapies for Adults with Anorexia Nervosa.” British Journal of Psychiatry 178 (2001): 216-221.
  • DeAngelis, Tori. “ A Genetic Link to Anorexia.” Monitor on Psychology 33 (2002), 34-37.
  • Wade Tracey D., Bulik Cynthia M., Neale Michael, and Kendler Keneth S. “Anorexia Nervosa and Major Depression: Shared Genetic and Environmental Risk Factors” . Am J Psychiatry 157 (2000), 469-471.
  • Mehler, Philip S. “Diagnosis and Care of Patients with Anorexia Nervosa in Primary Care Settings’. Annals of Internal Medicine 134(2001):1048-1059.
  • Mehler, Philip S., 2001. “Diagnosis and Care of Patients with Anorexia Nervosa in Primary Care Settings.” Annals of Internal Medicine 134(2001):1048-1059.
  • Rumney, Avis. Dying to please: anorexia, treatment and recovery . Jefferson, N.C.: McFarland, 2009.
  • Palmer, B. “Come the Revolution. Revisiting the Management of Anorexia Nervosa.” Advances in Psychiatric Treatment 12 (2006):5-12.
  • Bell, Rudolph M. Holy anorexia . Chicago, Illinois: University of Chicago Press, 1987.
  • Naqvi, Syed. “Review of Child and Adolescent Psychiatry.” Focus 2 (2004):529-540.
  • Halmi Katherine A. 2005. “ The Multimodal Treatment of Eating Disorders”. World Psychiatry 4, no. 2 (2005): 69-73.
  • Dare Chris, Isler Ivan, Russel Gerald, Treasure Janet & Dodge Liz . “Psychological Therapies for Adults with Anorexia Nervosa.” British Journal of Psychiatry 178 (2001): 216-221.
  • Attia Evelyn, Walsh B. Timothy, 2007. “ Anorexia Nervosa”. American Journal Psychiatry 164 (2007): 1805-1810.
  • Kaye Walter H., Bulik Cynthia M., Thornton Laura, Barbarich Nicole, Masters Kim and the Price Foundation Collaborative Group. “Comorbidity of Anxiety Disorders with Anorexia and Bulimia Nervosa ”. American Journal of Psychiatry 161 (2004): 2215-2221.
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How can I plan what to eat or drink when I have diabetes?

How can physical activity help manage my diabetes, what can i do to reach or maintain a healthy weight, should i quit smoking, how can i take care of my mental health, clinical trials for healthy living with diabetes.

Healthy living is a way to manage diabetes . To have a healthy lifestyle, take steps now to plan healthy meals and snacks, do physical activities, get enough sleep, and quit smoking or using tobacco products.

Healthy living may help keep your body’s blood pressure , cholesterol , and blood glucose level, also called blood sugar level, in the range your primary health care professional recommends. Your primary health care professional may be a doctor, a physician assistant, or a nurse practitioner. Healthy living may also help prevent or delay health problems  from diabetes that can affect your heart, kidneys, eyes, brain, and other parts of your body.

Making lifestyle changes can be hard, but starting with small changes and building from there may benefit your health. You may want to get help from family, loved ones, friends, and other trusted people in your community. You can also get information from your health care professionals.

What you choose to eat, how much you eat, and when you eat are parts of a meal plan. Having healthy foods and drinks can help keep your blood glucose, blood pressure, and cholesterol levels in the ranges your health care professional recommends. If you have overweight or obesity, a healthy meal plan—along with regular physical activity, getting enough sleep, and other healthy behaviors—may help you reach and maintain a healthy weight. In some cases, health care professionals may also recommend diabetes medicines that may help you lose weight, or weight-loss surgery, also called metabolic and bariatric surgery.

Choose healthy foods and drinks

There is no right or wrong way to choose healthy foods and drinks that may help manage your diabetes. Healthy meal plans for people who have diabetes may include

  • dairy or plant-based dairy products
  • nonstarchy vegetables
  • protein foods
  • whole grains

Try to choose foods that include nutrients such as vitamins, calcium , fiber , and healthy fats . Also try to choose drinks with little or no added sugar , such as tap or bottled water, low-fat or non-fat milk, and unsweetened tea, coffee, or sparkling water.

Try to plan meals and snacks that have fewer

  • foods high in saturated fat
  • foods high in sodium, a mineral found in salt
  • sugary foods , such as cookies and cakes, and sweet drinks, such as soda, juice, flavored coffee, and sports drinks

Your body turns carbohydrates , or carbs, from food into glucose, which can raise your blood glucose level. Some fruits, beans, and starchy vegetables—such as potatoes and corn—have more carbs than other foods. Keep carbs in mind when planning your meals.

You should also limit how much alcohol you drink. If you take insulin  or certain diabetes medicines , drinking alcohol can make your blood glucose level drop too low, which is called hypoglycemia . If you do drink alcohol, be sure to eat food when you drink and remember to check your blood glucose level after drinking. Talk with your health care team about your alcohol-drinking habits.

A woman in a wheelchair, chopping vegetables at a kitchen table.

Find the best times to eat or drink

Talk with your health care professional or health care team about when you should eat or drink. The best time to have meals and snacks may depend on

  • what medicines you take for diabetes
  • what your level of physical activity or your work schedule is
  • whether you have other health conditions or diseases

Ask your health care team if you should eat before, during, or after physical activity. Some diabetes medicines, such as sulfonylureas  or insulin, may make your blood glucose level drop too low during exercise or if you skip or delay a meal.

Plan how much to eat or drink

You may worry that having diabetes means giving up foods and drinks you enjoy. The good news is you can still have your favorite foods and drinks, but you might need to have them in smaller portions  or enjoy them less often.

For people who have diabetes, carb counting and the plate method are two common ways to plan how much to eat or drink. Talk with your health care professional or health care team to find a method that works for you.

Carb counting

Carbohydrate counting , or carb counting, means planning and keeping track of the amount of carbs you eat and drink in each meal or snack. Not all people with diabetes need to count carbs. However, if you take insulin, counting carbs can help you know how much insulin to take.

Plate method

The plate method helps you control portion sizes  without counting and measuring. This method divides a 9-inch plate into the following three sections to help you choose the types and amounts of foods to eat for each meal.

  • Nonstarchy vegetables—such as leafy greens, peppers, carrots, or green beans—should make up half of your plate.
  • Carb foods that are high in fiber—such as brown rice, whole grains, beans, or fruits—should make up one-quarter of your plate.
  • Protein foods—such as lean meats, fish, dairy, or tofu or other soy products—should make up one quarter of your plate.

If you are not taking insulin, you may not need to count carbs when using the plate method.

Plate method, with half of the circular plate filled with nonstarchy vegetables; one fourth of the plate showing carbohydrate foods, including fruits; and one fourth of the plate showing protein foods. A glass filled with water, or another zero-calorie drink, is on the side.

Work with your health care team to create a meal plan that works for you. You may want to have a diabetes educator  or a registered dietitian  on your team. A registered dietitian can provide medical nutrition therapy , which includes counseling to help you create and follow a meal plan. Your health care team may be able to recommend other resources, such as a healthy lifestyle coach, to help you with making changes. Ask your health care team or your insurance company if your benefits include medical nutrition therapy or other diabetes care resources.

Talk with your health care professional before taking dietary supplements

There is no clear proof that specific foods, herbs, spices, or dietary supplements —such as vitamins or minerals—can help manage diabetes. Your health care professional may ask you to take vitamins or minerals if you can’t get enough from foods. Talk with your health care professional before you take any supplements, because some may cause side effects or affect how well your diabetes medicines work.

Research shows that regular physical activity helps people manage their diabetes and stay healthy. Benefits of physical activity may include

  • lower blood glucose, blood pressure, and cholesterol levels
  • better heart health
  • healthier weight
  • better mood and sleep
  • better balance and memory

Talk with your health care professional before starting a new physical activity or changing how much physical activity you do. They may suggest types of activities based on your ability, schedule, meal plan, interests, and diabetes medicines. Your health care professional may also tell you the best times of day to be active or what to do if your blood glucose level goes out of the range recommended for you.

Two women walking outside.

Do different types of physical activity

People with diabetes can be active, even if they take insulin or use technology such as insulin pumps .

Try to do different kinds of activities . While being more active may have more health benefits, any physical activity is better than none. Start slowly with activities you enjoy. You may be able to change your level of effort and try other activities over time. Having a friend or family member join you may help you stick to your routine.

The physical activities you do may need to be different if you are age 65 or older , are pregnant , or have a disability or health condition . Physical activities may also need to be different for children and teens . Ask your health care professional or health care team about activities that are safe for you.

Aerobic activities

Aerobic activities make you breathe harder and make your heart beat faster. You can try walking, dancing, wheelchair rolling, or swimming. Most adults should try to get at least 150 minutes of moderate-intensity physical activity each week. Aim to do 30 minutes a day on most days of the week. You don’t have to do all 30 minutes at one time. You can break up physical activity into small amounts during your day and still get the benefit. 1

Strength training or resistance training

Strength training or resistance training may make your muscles and bones stronger. You can try lifting weights or doing other exercises such as wall pushups or arm raises. Try to do this kind of training two times a week. 1

Balance and stretching activities

Balance and stretching activities may help you move better and have stronger muscles and bones. You may want to try standing on one leg or stretching your legs when sitting on the floor. Try to do these kinds of activities two or three times a week. 1

Some activities that need balance may be unsafe for people with nerve damage or vision problems caused by diabetes. Ask your health care professional or health care team about activities that are safe for you.

 Group of people doing stretching exercises outdoors.

Stay safe during physical activity

Staying safe during physical activity is important. Here are some tips to keep in mind.

Drink liquids

Drinking liquids helps prevent dehydration , or the loss of too much water in your body. Drinking water is a way to stay hydrated. Sports drinks often have a lot of sugar and calories , and you don’t need them for most moderate physical activities.

Avoid low blood glucose

Check your blood glucose level before, during, and right after physical activity. Physical activity often lowers the level of glucose in your blood. Low blood glucose levels may last for hours or days after physical activity. You are most likely to have low blood glucose if you take insulin or some other diabetes medicines, such as sulfonylureas.

Ask your health care professional if you should take less insulin or eat carbs before, during, or after physical activity. Low blood glucose can be a serious medical emergency that must be treated right away. Take steps to protect yourself. You can learn how to treat low blood glucose , let other people know what to do if you need help, and use a medical alert bracelet.

Avoid high blood glucose and ketoacidosis

Taking less insulin before physical activity may help prevent low blood glucose, but it may also make you more likely to have high blood glucose. If your body does not have enough insulin, it can’t use glucose as a source of energy and will use fat instead. When your body uses fat for energy, your body makes chemicals called ketones .

High levels of ketones in your blood can lead to a condition called diabetic ketoacidosis (DKA) . DKA is a medical emergency that should be treated right away. DKA is most common in people with type 1 diabetes . Occasionally, DKA may affect people with type 2 diabetes  who have lost their ability to produce insulin. Ask your health care professional how much insulin you should take before physical activity, whether you need to test your urine for ketones, and what level of ketones is dangerous for you.

Take care of your feet

People with diabetes may have problems with their feet because high blood glucose levels can damage blood vessels and nerves. To help prevent foot problems, wear comfortable and supportive shoes and take care of your feet  before, during, and after physical activity.

A man checks his foot while a woman watches over his shoulder.

If you have diabetes, managing your weight  may bring you several health benefits. Ask your health care professional or health care team if you are at a healthy weight  or if you should try to lose weight.

If you are an adult with overweight or obesity, work with your health care team to create a weight-loss plan. Losing 5% to 7% of your current weight may help you prevent or improve some health problems  and manage your blood glucose, cholesterol, and blood pressure levels. 2 If you are worried about your child’s weight  and they have diabetes, talk with their health care professional before your child starts a new weight-loss plan.

You may be able to reach and maintain a healthy weight by

  • following a healthy meal plan
  • consuming fewer calories
  • being physically active
  • getting 7 to 8 hours of sleep each night 3

If you have type 2 diabetes, your health care professional may recommend diabetes medicines that may help you lose weight.

Online tools such as the Body Weight Planner  may help you create eating and physical activity plans. You may want to talk with your health care professional about other options for managing your weight, including joining a weight-loss program  that can provide helpful information, support, and behavioral or lifestyle counseling. These options may have a cost, so make sure to check the details of the programs.

Your health care professional may recommend weight-loss surgery  if you aren’t able to reach a healthy weight with meal planning, physical activity, and taking diabetes medicines that help with weight loss.

If you are pregnant , trying to lose weight may not be healthy. However, you should ask your health care professional whether it makes sense to monitor or limit your weight gain during pregnancy.

Both diabetes and smoking —including using tobacco products and e-cigarettes—cause your blood vessels to narrow. Both diabetes and smoking increase your risk of having a heart attack or stroke , nerve damage , kidney disease , eye disease , or amputation . Secondhand smoke can also affect the health of your family or others who live with you.

If you smoke or use other tobacco products, stop. Ask for help . You don’t have to do it alone.

Feeling stressed, sad, or angry can be common for people with diabetes. Managing diabetes or learning to cope with new information about your health can be hard. People with chronic illnesses such as diabetes may develop anxiety or other mental health conditions .

Learn healthy ways to lower your stress , and ask for help from your health care team or a mental health professional. While it may be uncomfortable to talk about your feelings, finding a health care professional whom you trust and want to talk with may help you

  • lower your feelings of stress, depression, or anxiety
  • manage problems sleeping or remembering things
  • see how diabetes affects your family, school, work, or financial situation

Ask your health care team for mental health resources for people with diabetes.

Sleeping too much or too little may raise your blood glucose levels. Your sleep habits may also affect your mental health and vice versa. People with diabetes and overweight or obesity can also have other health conditions that affect sleep, such as sleep apnea , which can raise your blood pressure and risk of heart disease.

Man with obesity looking distressed talking with a health care professional.

NIDDK conducts and supports clinical trials in many diseases and conditions, including diabetes. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.

What are clinical trials for healthy living with diabetes?

Clinical trials—and other types of clinical studies —are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help health care professionals and researchers learn more about disease and improve health care for people in the future.

Researchers are studying many aspects of healthy living for people with diabetes, such as

  • how changing when you eat may affect body weight and metabolism
  • how less access to healthy foods may affect diabetes management, other health problems, and risk of dying
  • whether low-carbohydrate meal plans can help lower blood glucose levels
  • which diabetes medicines are more likely to help people lose weight

Find out if clinical trials are right for you .

Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials.

What clinical trials for healthy living with diabetes are looking for participants?

You can view a filtered list of clinical studies on healthy living with diabetes that are federally funded, open, and recruiting at www.ClinicalTrials.gov . You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe for you. Always talk with your primary health care professional before you participate in a clinical study.

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts.

NIDDK would like to thank: Elizabeth M. Venditti, Ph.D., University of Pittsburgh School of Medicine.


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