Eating Disorders: The Warning Signs

Eating disorders almost never start dramatically. They start as discipline: you cut one food group, add 20 minutes of cardio, and people tell you that you look great. The line between control and disorder gets crossed quietly, so it helps to know in advance what to look for — in yourself and in the people you train with.

Strict diet versus disorder

A strict diet has an end date and a target: 8 to 12 weeks, a deficit of 300 to 500 kcal a day, 0.3 to 0.7 kg lost per week, then back to maintenance. A disorder has no end. The target moves every time you hit it, so 80 kg becomes 76, then 73, then just a bit more.

The second test is flexibility. If a family dinner, a 3-day trip or an unplanned pizza sends you into panic, the problem is no longer the food — it is how much room food takes up in your head. Rough marker: if you think about food, weight and calories for more than 3 hours a day, that is not a nutrition plan, that is a load.

Behavioural signs around food

• Weighing yourself 3 to 5 times a day, or refusing the scale entirely while constantly checking the mirror and waist measurement.
• A banned-foods list that keeps growing: it starts with one group, and 3 months later there are 15.
• Skipping 1 to 2 meals a day, then an uncontrolled 2000 kcal or more in one sitting at night.
• Eating only in private, and turning down 2 out of 3 social invitations a week that involve food.
• Compensating: vomiting, laxatives, diuretics, or fasting the entire next day after a bad meal. Vomiting 2 or more times a week is a threshold clinicians take seriously.
• Rituals: cutting food into tiny pieces, pushing it around the plate for 30 minutes, chewing 20 times per bite, a meal that stretches to an hour.

Signs in the gym

• Training as punishment rather than as a plan — an extra 45 to 90 minutes of cardio because I ate too much.
• 7 sessions a week with no rest day at all for more than 6 weeks.
• Training with a fever, through an injury, or after a sleepless night, because one day off feels impossible.
• Strength dropping: a squat that moved 100 kg for 3 sets of 5 six weeks ago now grinds at 80 kg, and 3 sets of 8 need 4 minutes of rest instead of 2.
• Being unable to skip a session even when a coach or training partner directly suggests it.

Performance loss matters because it is objective. If you drop 10 to 15 percent of your strength on the main lifts over 6 to 8 weeks while sleeping 7 to 8 hours, intake is too low — regardless of what the mirror shows.

Physical signs

• Losing more than 5 percent of body weight in 4 weeks without a plan (at 80 kg that is 4 kg).
• Three menstrual cycles missed in a row; in men, a drop in libido and morning erections.
• Permanently cold hands and feet, resting heart rate below 45 with dizziness on standing up.
• Hair thinning, brittle nails, fine soft hair appearing on the forearms and face.
• Swollen glands under the jaw, eroded enamel and sensitive teeth — typical of vomiting.
• Constipation, bloating, and food that feels like it sits in the stomach for hours.
• Stress fractures in the foot or shin without any real jump in running volume.

What the minimum actually looks like

To keep functioning on 3 to 4 sessions a week, the reference points are: 1.6 to 2.2 g of protein per kilogram of body weight, at least 3 g of carbohydrate per kilogram on training days (for a 75 kg person that is 225 g), and fat no lower than 0.8 g per kilogram, because sex hormones fall below that. If you have been under 1500 kcal a day for months while training 4 times a week, that is not a plan — it is a debt the body pays somewhere, in bone, hormones or mood.

What to say to someone at the gym

Describe behaviour, not bodies. No comment about appearance helps, praise included, because both confirm that the body is the measure of worth.

I have noticed you have been staying an extra 40 minutes on the treadmill for about a month, and you have stopped coming to lunch with us. How are you doing?

Expect denial the first time — that is the rule, not the exception. Do not argue about numbers. Say you are around, and come back to it in 2 weeks. If the person is a minor, involve a parent straight away.

When to see a doctor

Same day, urgent: fainting, chest pain, an irregular heartbeat, resting pulse under 40, muscle cramps with weakness, vomiting blood.

Within a few days: losing more than 10 percent of body weight in 3 months, a body mass index under 18.5, three missed cycles in a row, any vomiting or laxative use for weight control, binge episodes once a week or more for longer than 3 months.

Book a routine appointment if: food has occupied most of your day for more than 6 months, or you have stopped going out because of it.

Expect blood counts, electrolytes (potassium, sodium, magnesium), an ECG, thyroid hormones and, if needed, a bone density scan. Bring specific numbers: how many kilograms, over how many weeks, daily intake, sessions per week. It cuts the conversation in half.

The short version

• A diet has an end date and tolerates exceptions; a disorder moves the target and tolerates none.
• The earliest signals are behavioural: secret eating, a growing banned list, weighing 3 to 5 times a day, cardio as punishment.
• Losing 10 to 15 percent of strength over 6 to 8 weeks with normal sleep means intake is too low.
• More than 5 percent body weight lost in 4 weeks, 3 missed cycles, or a pulse under 45 with dizziness all warrant a check-up.
• When you talk to someone, name the behaviour, stay available, and expect denial on the first attempt.