Excerpt from The Parent’s Guide to Eating Disorders
by Marcia Herrin, EdD, MPH, RD and Nancy Matsumoto
To find out more about this helpful book click here.

So far, we have described what a full-blown eating disorder looks like. It should also be clear to you now that eating disorders are most effectively and easily treated when they are caught early. This is a bigger challenge than recognizing a child in the midst of a crisis. How do you know if your child is at risk for an eating disorder? Here we offer you a series of checklists of early warning signs. By offering this exhaustive list of early warning symptoms, our aim is to outline the range of tip-off behaviors, attitudes, and symptoms to watch for. By using your own intuition, knowing your child well, being observant, and trusting your instincts, you can transform the process of early detection from an art into more of a science.

The first checklist contains symptoms found in all eating disorders. If you check more than eight items on any of these lists, you likely have a serious problem on your hands that warrants your attention and a visit to the doctor. If you check between five and eight items, some preventive strategies are in order. Keep an eye on your child and make sure these symptoms do not increase in number. If your child exhibits only a few of these symptoms and yet you feel uneasy, you should, at the very least, share your concerns with your child’s doctor, who can help you sort through the situation.

What Are the Early Warning Signs of an Eating Disorder?

  • Obvious changes in weight, both up and down
  • Going through puberty early, or being bigger or taller than average size (this can lead a child to become overly body conscious)
  • Going on a diet
  • Pickiness in food choices, fear of fat in food
  • Sudden interest in nutrition and healthy eating
  • Interest in food labels, especially fat grams and calories
  • Deciding to become vegetarian
  • Avoiding desserts
  • Skipping meals, especially breakfast
  • Drinking excessive amounts of water, diet soda, coffee, or other noncaloric drinks
  • Frequently complaining of feeling full or bloated, or having constipation, diarrhea, stomach pain, nausea, and vomiting
  • Lying about food intake
  • Seeming distressed and guilty about eating
  • Spending a lot of time worrying about size and shape
  • A newfound interest in sports, or exercising in addition to sports practice
  • A drive to excel in sports
  • Involvement in “thinness-demand sports” such as dance, ballet, gymnastics, figure skating
  • Involvement in sports with weight classes such as wrestling, some martial arts
  • Involvement in sports in which weight can affect performance, such as running, cross-country skiing
  • A tendency to be a perfectionist
  • Low self-esteem
  • Development of moodiness, seems less happy in general

The next three checklists specifically cover anorexia, bulimia, and binge-eating disorder individually. Where the preponderance of your checks fall in these last three checklists will help you to determine which type of eating disorder your child may have.

What Are the Early Warning Signs of Anorexia?

  • When regular well-child assessments show failure to gain weight or weight loss
  • Denying obvious thinness or weight loss
  • Complaints of being cold all the time, or wearing lots of layers of clothing
  • Hands and feet are cold to the touch much of the time and may be bluish in color
  • Evidence of increased hair loss; more hair on the pillow or in     brushes. Hair looks thinner and drier
  • Lanugo hair on face or body (similar to body hair found on newborns)
  • Crying without producing tears (due to dehydration)
  • Yellowish skin tone due to elevated levels of carotene (caused by eating excessive amounts of vegetables and/or poor liver function)
  • Complaints of dizziness
  • Fainting
  • Restricting fluids
  • Preparing food for others, but not eating it

What Are the Early Warning Signs of Bulimia?

  • Finding evidence that the child has obtained laxatives, diuretics, or diet pills
  • Complaints on a regular basis of “stomach flu” or that certain foods “don’t sit right”
  • Complaints of heartburn-type symptoms (very rare in children without an eating disorder), chronic sore throat, hoarseness, difficulty swallowing
  • Puffy face or swollen cheeks
  • Redness or calluses on the back of hands
  • Redness around the mouth from exposure to stomach acid
  • Small red blood spots around the eyes, or bloodshot eyes (resulting from the pressure of self-induced vomiting)
  • Dental exam reveals large number of cavities when previously your child has always had good dental reports

(See also next checklist.)

What Are the Early Warning Signs of Binge-Eating Disorder?

The following can also be signs of bingeing behaviors that are associated with bulimia

  • On and off weight-loss diets
  • Out-of-control eating, wants to control eating, promises to control eating, but can’t
  • Eats when not hungry
  • Often complains of being too full
  • Eats rapidly
  • Eats a lot when sad, mad, or depressed
  • Secretive eating
  • Food missing from kitchen or refrigerator would have been expected