3 Sneaky Signs of Eating Disorders That Clinicians Often Miss
Insights from a Seasoned Eating Disorder Therapist
Eating disorders are complex and don’t always look the way mainstream narratives or even traditional clinical training might describe them. As an eating disorder therapist who has worked with teens, families, and individuals for over a decade, I often witness how eating disorders fly under the radar—even in professional spaces—due to deeply ingrained societal biases and misconceptions.
This is particularly true when clinicians overlook certain "non-stereotypical" presentations, especially in individuals in larger bodies, marginalized communities, or those with symptoms that deviate from the traditional DSM checklist. Eating disorders do not only impact thin, white, young women; they affect people of every size, age, gender, race, and socioeconomic background.
Clinicians, even with the best intentions, can sometimes miss the subtler signs of disordered eating or full-fledged eating disorders when they aren’t looking through a trauma-informed, fat-positive, and social justice oriented lens. Identifying eating disorders early can be life-saving, so staying attuned to these less-obvious signs is critical.
Here are three sneaky signs of eating disorders that clinicians can miss and how we can do better in recognizing and addressing them.
1. Weight Loss Praised as “Health” or “Discipline”
One of the most pervasive and harmful assumptions in our society—and sometimes even in clinical settings—is that weight loss is inherently positive. This belief can cause significant harm, as it often leads eating disorder behaviors to go unnoticed, misinterpreted, or even celebrated.
When someone in a larger body comes into a clinician’s office and has lost weight, there is often a rush to congratulate them or frame the weight loss as a sign of “health improvement.” This praise can reinforce eating disorder behaviors, perpetuate internalized weight stigma, and delay appropriate care.
For example:
A teen restricts their food intake, skips meals, and exercises compulsively, but because they remain in a larger body or have a history of being in a higher weight range, the weight loss is viewed as “progress.”
A client reports feeling cold all the time, lightheaded, or experiencing hair loss, yet the underlying eating disorder is missed because their weight is within a “normal” range or only slightly decreased.
An adult client discloses disordered eating behaviors but minimizes them by stating, “But I’ve lost weight and feel so much better.” The clinician focuses on the weight loss instead of the potential harm happening underneath.
Why This Happens:
Weight bias is deeply embedded in our culture and often in clinical training. Many healthcare professionals are taught to focus on weight as a metric of health, which can lead to missed diagnoses of eating disorders in individuals who don’t meet the “thin ideal.”
What to Do Instead:
Recognize that eating disorders can exist at any weight. Weight loss or thinness is not a reliable indicator of health or disorder.
Focus on behaviors, symptoms, and emotional experiences rather than weight.
Ask: How did you achieve this weight loss? What does a typical day of eating look like for you? How is your energy and mood? Do you have any fear around food? How about weight gain?
Adopt a weight-neutral, fat-positive lens and avoid congratulating weight loss. Instead, explore what else might be happening in your client’s life.
By reframing the conversation away from weight, clinicians can uncover harmful patterns that might otherwise be missed and create a safer space for clients to share the full truth.
2. “Clean Eating” or Wellness Preoccupation Framed as a Lifestyle Choice
The rise of “clean eating,” wellness culture, and “healthy” lifestyle trends has made disordered eating increasingly easy to hide. Orthorexia, though not officially in the DSM, refers to an obsessive focus on “healthy” or “clean” eating to the detriment of one’s mental, emotional, and physical health.
On the surface, individuals engaging in these behaviors may appear “committed to wellness,” but beneath this facade can lie rigid rules, anxiety, and shame surrounding food. Clinicians sometimes fail to identify these patterns as disordered because they align with culturally approved ideals around health and morality.
Signs clinicians might miss include:
A client spends excessive time thinking about food, ingredients, or labeling foods as “good” or “bad.”
Anxiety arises when “clean” or “safe” foods are unavailable, leading to food avoidance or social isolation.
A fixation on exercise or “earning” food, even when the body is fatigued or in pain.
For example, a client might describe eliminating entire food groups (e.g., carbs, sugar, or fat) and frame it as a health decision rather than disordered eating. Similarly, someone who compulsively tracks their calories, macros, or uses fitness apps might be praised for their “discipline” rather than questioned about the emotional toll of these behaviors.
Why This Happens:
Wellness culture blurs the line between health and harm, making it harder to recognize disordered eating. Additionally, clinicians might hold unconscious biases that reinforce “health” as a moral ideal.
What to Do Instead:
Explore your client’s relationship with food and movement. Ask: How flexible are you with eating? How much time do you spend thinking about food or exercise? How do you feel if you deviate from your plan?
Educate yourself on orthorexia and the ways in which wellness culture can disguise harmful eating behaviors.
Validate that balance and flexibility are core components of true well-being.
By asking these questions and looking beneath the “health” framing, clinicians can help clients recognize when their pursuit of wellness has become harmful.
3. Frequent GI Issues or “Mysterious” Physical Complaints
Another sneaky sign of an eating disorder that clinicians can miss is the presence of frequent gastrointestinal (GI) issues or vague physical complaints. Symptoms like bloating, constipation, nausea, acid reflux, or abdominal pain can often be attributed to IBS, stress, or other medical conditions without a deeper exploration of disordered eating behaviors.
What’s often missed is that these physical complaints can result from:
Chronic food restriction or irregular eating patterns.
Binge eating episodes followed by shame and physical discomfort.
Laxative misuse or purging behaviors that disrupt the body’s natural processes.
Anxiety and somatic symptoms related to body image or food fears.
For example, a teen presenting with bloating and constipation might be referred to a GI specialist, but underlying food restriction or fear of eating is never addressed. Similarly, adults experiencing reflux after binge episodes may focus solely on treating the physical symptom, ignoring the disordered eating at its root.
Why This Happens:
Physical symptoms are often viewed in isolation, without considering the broader context of eating behaviors, stress, or body image concerns.
What to Do Instead:
Ask about your client’s eating patterns when they describe GI issues. Questions like, “Do you ever skip meals? Are there foods you avoid? What happens when you eat?” can uncover disordered behaviors.
Recognize that GI issues and physical symptoms are common in eating disorders due to the disruption of normal digestion and metabolism.
Take a holistic approach to care by screening for eating disorders whenever a client reports unexplained or chronic physical complaints. Always make to refer out to specialists to rule out medical issues.
By connecting the dots between physical symptoms and disordered eating, clinicians can provide more comprehensive care and help clients address the root cause of their discomfort.
Final Thoughts….
Eating disorders are sneaky, and they rarely look like the thin, white body we’ve been conditioned to associate with these illnesses. They hide in praised weight loss, wellness trends, and chronic physical complaints, especially in individuals in larger bodies who are often dismissed or stigmatized by medical and mental health systems.
As clinicians, we have an ethical and clinical responsibility to adopt a fat-positive, weight-inclusive lens that challenges our assumptions about health, weight, and eating. By looking beyond appearances and stereotypes, we can recognize these sneaky signs of eating disorders, validate our clients’ struggles, and connect them to the compassionate care they deserve.
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