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by Sandeepa Soni Dietitian at BSUH

The speed, intensity and longevity of this viral pandemic has brought about much sadness, negativity and frustration. Repeated lockdowns, long periods of isolation and financial pressures for those who cannot do their day to day paid jobs can be detrimental to mental health.  It’s no wonder individuals with eating disorders have worsening symptoms and worse still people with poor metal health or low self-esteem are developing an eating disorder.

I am a Dietitian with over 16 years’ experience of working within the NHS and I am currently working with a patient with eating disorders on a hospital ward and have had experience with working with patients with anorexia nervosa and bulimia in my career. I am going to discuss some of the main eating disorders that people can suffer from, signs and symptoms and how to get help.

An eating disorder is a mental health condition where the person uses the control of food to deal with their feelings and other situations, they feel they cannot control. There are different types of eating disorders which have varying symptoms.  The causes can be due to various factors such as biological (e.g. imbalance of hormones), psychological (e.g. poor body image), environmental factors (e.g. dysfunctional family dynamic) or family/childhood trauma. There can also be many other triggers. Unfortunately, these disorders can be seen more in females and in adolescent females and can be exacerbated by the power of social media.

Anorexia-Nervosa – this is when a person is controlling their body weight by eating very little food, exercising too much or doing both.

People with anorexia generally view themselves as overweight, even if they are dangerously underweight. They become obsessed with monitoring their weight, avoid certain types of foods and severely restrict their calories. You may find these people constantly thinking about food, collecting recipes, hoarding food or have difficulty eating with family or friends.

When this is continued for a long period of time the individual living with this disease will experience thinning of their bones, infertility, brittle hair and nails and a growth of fine hair all over their body. In severe cases, anorexia can lead to heart, brain or multi-organ failure or even death.

Sadly, a patient of mine did pass away from anorexia nervosa on the hospital ward only a few months ago because of the longevity and intensity of her anorexia nervosa. The impact of this disease on the individual’s relatives and friends is awful. They often feel helpless, rejected and sadness for the person they once could relate to.

Bulimia – a cycle of binging and purging. Often the person eats excessive amounts in one sitting (binging) and then feels ashamed about eating large volumes and takes drastic action by getting rid of the food (purging).

Each binge eating episode usually continues until the person is painfully full and they feel they cannot stop eating or control how much they are eating. The person tends to binge on foods they would normally avoid and may binge in secret. To relieve the gut discomfort and guilt for eating the volume of foods, they then tend to purge. Purging may include forced vomiting, fasting, laxatives, use enema’s and excessive exercise. Rather than becoming underweight, they may keep a relatively normal weight but become influenced by body shape and avoid weight gain.

If you have a relative or friend with bulimia, this continued cycle of bingeing and purging can lead to an inflamed and sore throat, swollen salivary glands, worn tooth enamel, tooth decay, acid reflux, irritation of the gut and severe dehydration.

Binge Eating disorder (BED) – In this disorder you may find the person typically eats large portions of food in a short period of time until they are uncomfortably full. They often feel a lack of control but don’t tend to restrict calories or have purging behaviours.

They typically eat unusually large amounts of food in relatively short periods of time and feel a lack of control during binges. They tend to eat in secret, eat even if they are not hungry and have feelings of distress, disgust or guilt when thinking about their binge eating behaviour. People with binge eating disorder often are overweight or obese.

Orthorexia – not formally an eating disorder but it is on the rise and worth a mention. This is when a person is obsessed with eating ‘healthily’.  They tend to be concerned with the nutritional quality of the food or ‘purity’ of foods, rather then the quantity but to a point where they damage their own well-being.

Warning signs that somebody has an eating disorder

As people develop an eating disorder and times goes on, symptoms may worsen, and it may become more apparent they have a problem. It might be easier to spot at the moment since most, if not all meals will be eaten at home during the pandemic. If you are concerned about a family member, friend or colleague these are some of warning signs below: –

  • a large and dramatic weight loss
  • lying about the number of foods eaten, what they’ve eaten, or their weight
  • eating a large amount of food very quickly
  • frequent trips to the bathroom straight after eating
  • excessive exercise
  • avoiding eating with other people
  • eating very slowly or cutting food into small pieces
  • wearing loose or baggy clothes to hide their weight loss

General tips for supporting someone

Often the effect of somebody with an eating disorder is emotionally distressing and stirs up feelings of guilt, anger or frustration from family/friends close to the person but nobody is to blame.  A strained relationship or conflict isn’t helpful and the key is to build a bond, work together to move forward and support the person in need. Below are some ideas of what to do:

  • If you think you have an eating disorder it is not your fault
  • If you think a loved one is suffering tell them they are not to blame.
  • Understand how distressing the illness is for your loved one.
  • Read up and gain more insight into eating disorders where you can.
  • Ask your loved one how they are feeling and what they are thinking, don’t assume how they must be feeling.
  • Rather than discussing weight, body shape, food, and diets in front of the person who is suffering try and model a good relationship with your own food and exercise.
  • Tell yourself that you loved one can change and recover from this.
  • Ask your loved one how you can help them – it might be helpful to encourage them to eat regularly, have boundaries around mealtimes, having opportunities to talk about how they are feeling. If your loved one doesn’t want help, be supportive and remind them you can hear that they are distressed and how it must be difficult for them and you are there if they need you.


Where to get help?

If you think you have an eating disorder or you believe someone you know does it can be difficult to know what to do.

You may not think of it as a problem or the person you are concerned about may not realise, they have an eating disorder. It’s quite common to deny it or be secretive and defensive about unhealthy eating habits or weight issues.

If you are concerned about a family member, friend or colleague, let them know you’re worried about them and encourage them to see a GP. Don’t put off getting help because of the pandemic as these disorders can escalate and getting help early on is beneficial. Be supportive and offer to talk to them about their feelings. If it is a child or teenager, often the school nurse can be the first stage in helping.

Recovery from an eating disorder will take time and there are specialists or teams of specialists which can be accessed usually via the GP.  They may suggest talking to therapists and a medical check to see that the eating disorder hasn’t affected the persons physical health.

If you are not sure about a visit to the GP but do want support there are also some charities, helplines and guidance in the links below.

BEAT! The UK’s leading eating disorder charity. BEAT provides support online, via telephone and has some great tips for helping people with an eating disorder.

NHS support: tips for helping a loved one and this link can find help in your local area.

Mind: for better mental health. Provide online support, a helpline & face to face help

I hope you have found my article informative and thank you for taking time to read it. As well as eating disorders I have experience in irritable bowel syndrome, inflammatory bowel disease, gut health, weight management, cancer and diabetes. If you would like any advice please do not hesitate to contact me at or via Twitter @nutritionwithsandy. Also look out for my new website launching soon at