9 Early Signs of Eating Disorders: A Guide for Primary Care Providers 

For many people, their primary care provider (PCP) is the clinician that they have the longest standing relationship with, and possibly the only clinician that they see regularly. This provider knows their patient’s baseline, therefore, they are more apt to notice deviations and bring them to the patient’s attention. If it is out of the PCP’s scope, then they are equipped to make a referral to a specialist(s) for the condition. In this resource, we review 9 early signs of eating disorders that primary care providers can be on the lookout for.

This article is for any provider that wants to increase their identification and diagnosis of eating disorders. You don’t have to be an eating disorder specialist to be eating disorder informed.

1. Drastic or unusual weight changes

This goes for children or adults. For a child, a yellow flag would be any sort of deviation downward from their growth curve. Even if this deviation is not a sharp, blatant decrease, and more of a gradual decline, it can still be representative of an eating disorder, as it is not typical for a child to exhibit a downward trend while growing. Typically, we see the opposite. During puberty it is not uncommon for a child to jump up to a higher percentile on their growth curve and have that become their new normal. 

We talked about a yellow flag, now let’s talk about a potential  red flag. This would be a child having a sharp drop off on their growth curve. For example, if a child has grown around the 75th percentile, and all of a sudden they began charting at the 30th percentile. 

For adults, I’d recommend to also be aware of these same weight trends, even if the weight loss is in the name of health or does not appear to be affecting the patient on the surface. It doesn’t hurt to ask more questions: Can you tell me what a typical day of eating looks like for you? What is your relationship with food? Do you ever experience feelings of guilt or shame after eating? How do you feel about your body?

2. Extreme increase in movement

As a healthcare provider, it can be awesome to hear that your patient who you have been encouraging to increase movement for years, now has suddenly gone from the occasional stroll to doing an intense HIIT class everyday. This could be driven by a genuine desire and enjoyment to engage in more movement. But it can also be a hallmark sign of an eating disorder: compulsive and/or compensatory exercise. This can be teased apart by asking more questions like:Tell me about your exercise routine. What type of movement are you doing and for what duration? How do you fuel for your workouts? How does this type of movement make you feel? What sparked the sudden change in your movement? How do they feel if you have to miss a workout?

3. Loss of menses

While there are other conditions that can cause cessation of menstruation, hypothalamic amenorrhea can be caused by low body weight or low body fat.

4. New or worsening anxiety, depression or other mental health concerns 

These conditions can happen for a multitude of reasons, but it can be critical to observe if any of these changes correlate with weight fluctuations or changes in eating habits. Mental health concerns may develop or worsen with the onset of an eating disorder. Something else to keep in mind is if someone is underweight or undernourished, their psych-related medications are not likely to be as effective, thus having a compounding impact on their mental health. 

5. Lightheadedness or passing out 

Could be related to low food intake or dehydration.

6. GI disturbances 

Changes in bowel habits, abdominal pain, early satiety, nausea, bloating, gas, and vomiting are all commonly associated with eating disorders. For example, an individual with anorexia nervosa may have slowed digestion which can manifest in the following symptoms: abdominal discomfort, bloating, gas, constipation or abnormal bowel movements.

7. Parotid gland swelling

 Repeated purging can cause these glands to swell. Although not observed in all patients who engage in self-induced vomiting, this can be a hallmark sign of purging.

8. Small lacerations or scars on back of hand

This is also known as “Russell’s sign” and can be an indicator of self-induced vomiting.

9. Increased picky eating 

It can be normal for people, especially children, to be picky eaters. But if you notice the food repertoire is getting smaller and smaller, start to ask questions. If this is paired with weight loss or a weight plateau in a growing child or adolescent, this may warrant a referral to an eating disorder dietitian, as these may be signs of ARFID (Avoidant Restrictive Food Intake Disorder) or anorexia.

Final Thoughts On Spotting Early Signs of Eating Disorders

Thank you for reading this resource on spotting the early signs of eating disorders, a guide for primary care providers. We urge that you stay curious. Keep asking questions! And…

The trust that a patient can develop with a PCP that they have known for years or even decades is irreplaceable. Likewise, the knowledge and insight that a PCP can develop about a patient throughout this length of time is invaluable. This creates a very special window of opportunity for a PCP to spot an eating disorder and make a referral to an eating disorder specialist. 

If you are a PCP reading this, please reach out to Courage to Nourish if feel like you might have a patient that would benefit from our services or want to know more! We enjoy working with PCPs and other providers in creating collaborative treatment plans that are specific to eating disorder recovery.

About Us

Courage to Nourish is a group of eating disorder specialized dietitians. We have in person locations in Alexandria, Virginia, Columbia, Maryland. and College Park, Maryland. We offer virtual services across the state of Virginia, Washington DC, Pennsylvania, and Colorado and Georgia. We offer individual nutrition therapy. As well as support groups.