Disordered eating is a huge problem & not just because it can lead to an eating disorder

On 29 May, the Federal Government announced a $70 million package to fund research and treatment of eating disorders and childhood mental health. On 28 May, the Victorian Government announced plans to begin construction on Victoria’s first public residential eating disorder treatment centre.

This funding is both welcomed and warranted. A 2012 report by Deloitte Access Economics projected that by 2022, over one million Australians would have an eating disorder. And this estimate was made prior to the pandemic, which we suspect has increased this number.

Largely ignored, however, is a related health issue that affects many more times this number of people – disordered eating. Although most of the concern around disordered eating has focused on its connection to eating disorders, disordered eating can cause real harm even it if doesn’t turn into an eating disorder.

Mostly considered a problem for young women, disordered eating affects a broad range of people of different genders and ages.

We need to de-normalise and raise awareness about disordered eating behaviours; teach and encourage normal, positive eating; and provide early intervention for those experiencing disordered eating.

What is disordered eating & how is it different from an eating disorder?

It is estimated that four per cent of Australians are living with an eating disorder in any given year, but the rate for disordered eating behaviours is much higher. An Australian study, for example, found that 32 per cent of Australian adolescents engaged in disordered eating behaviours within any given year. 

A recent systematic review and meta-analysis of disordered eating in children and adolescents around the world used the SCOFF questionnaire to measure disordered eating. SCOFF, which stands for Sick, Control, One, Fat, Food, is a widely used screening tool to clarify suspicion that an eating disorder might exist. It consists of five questions:

• S – Do you make yourself Sick because you feel uncomfortably full?
• C – Do you worry you have lost Control over how much you eat?
• O – Have you recently lost more than One stone (6.35 kg) in a three-month period?
• F – Do you believe yourself to be Fat when others say you are too thin?
• F – Would you say Food dominates your life?

The study considered two or more “yes” responses to be disordered eating.

But disordered eating can include a wide array of disordered food-related behaviours. The Butterfly Foundation, a charitable organisation focused on eating disorders and body image, lists as examples:

• fasting or chronic restrained eating
• skipping meals
• binge eating
• self-induced vomiting
• restrictive dieting
• unbalanced eating (for example, restricting a major food group such as ‘fatty’ foods or carbohydrates)
• laxative, diuretic, or enema misuse
• steroid or creatine use
• using diet pills.

Eating disorders, as compared to disordered eating behaviours, are characterised by severe and persistent disturbance in eating behaviours and associated distressing thoughts and emotions. Eating disorders are diagnosed based on signs, symptoms, and eating habits. Assessments and tests usually include a physical exam and a psychological evaluation, with diagnostic criteria based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Types of eating disorders include:

• anorexia nervosa
• bulimia nervosa
• binge eating disorder
• avoidant restrictive food intake disorder
• other specified feeding and eating disorder
• pica
• rumination disorder.

Disordered eating is a problem for boys & men, & older women, too

Disordered eating is not a problem just for girls and young women, although rates are highest for this group. 

Boys and men also struggle with disordered eating. For boys and men, disordered eating is often about trying to appear more muscular rather than being thin. 

Older women also struggle with disordered eating. A U.S. study with women aged 25-45 found that 31 per cent of women without a history of anorexia or binge eating reported having purged to control weight, and 75 per cent of women reported that their concerns about shape and weight interfered with their happiness.

Disordered eating may, or may not, lead to an eating disorder

Whereas eating disorders are almost always preceded by disordered eating, much disordered eating never progresses to an eating disorder. Most disordered eating leads to more disordered eating.

Disordered eating causes real harm

There is evidence that disordered eating negatively affects almost all aspects of people’s lives, both in the short and longer-term. Most of this research has been carried out with adolescents and young people. 

A survey of young adult women in Australia over nine years, for example, found that those with disordered eating had worse physical and mental health compared to those without disordered eating each of the four years the survey was administered.

A study with adolescents in Iran found that, compared to adolescents without disordered eating, those with disordered eating had worse:

• physical functioning (for example, found it hard to run, do sport or exercise)
• emotional functioning (for example, felt afraid or scared; had trouble sleeping)
• social functioning (for example, had trouble getting along with peers, were teased)
• school functioning (for example, had trouble keeping up with schoolwork, found it hard to concentrate).

Another study that followed Australian adolescents for 10 years into adulthood found that those with disordered eating in adolescence were much more likely to have depressive and anxiety symptoms, and substance misuse, in young adulthood.

Finally, a U.S. study found that young women with disordered eating behaviours in late adolescence had worse educational attainment and personal income, and were less likely to own a home in early adulthood, than young women without disordered eating behaviours.

What can be done

First, we must de-normalise disordered eating behaviours. Things like excluding certain food groups, skipping meals, and labelling foods as ‘good’ or ‘bad’ are not normal or healthy eating behaviours and should not be presented as such. 

Instead, we should encourage normal, positive eating behaviours. Normal eating includes:

• eating when you’re hungry
• choosing foods you like
• eating until you feel satisfied
• eating flexibly and regularly
• including a variety of foods
• enjoying eating.

We must teach young people what normal, positive eating looks like. This starts within families – both in how they talk about their own eating and bodies, and that of others. It extends to friends and the wider in-person and virtual communities.

Finally, we must make early intervention for those suffering from disordered eating behaviours accessible and non-stigmatising.