Eating Disorders Are Rare — Disordered Eating Is Common

Eating disorders are seemingly everywhere. If you’ve spent any time in your life browsing popular magazines, watching films, or even reading this column, you might assume that virtually everyone has been diagnosed with one of the eight eating disorders currently listed in the DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition). In fact, those diagnoses affect only an estimated 1-3% of the American population. That doesn’t make these illnesses any less grave, nor the millions who suffer from them any less worthy of support. It only means that eating disorders are rare. Disordered eating, on the other hand, is very common.

Statistically speaking, the term “disordered eating” applies to somewhere between 50% and 75% of people. But while most people have at least some knowledge of anorexia and bulimia, there is virtually no general understanding of disordered eating, the issue that has a significantly wider-ranging impact.

“Disordered eating” is a term that gets tossed into a lot of different conversations, and it wears a lot of different hats. A doctor may use it when examining a patient whose health status they’re unsure of. Someone in eating disorder recovery may refer to their “disordered eating” because they’d prefer not to be defined as an anorectic or a bulimic (quite understandably). And then there are those who have never been treated or even screened for an eating disorder, but whose relationship to food is somehow off: They feel some anxiety when choosing what to eat. They spend an inordinate amount of time considering the content of the food. They try to stick to certain food rules and feel bad when they break them. Indeed, anyone who has ever been on a diet has almost certainly engaged in what clinicians would define as disordered eating.

“It’s a hell of a lot more prevalent than we think it is,” says Melainie Rogers, MS, RDN, CDN, CEDRD, the founder of Balance, an NYC-based eating disorder treatment centre. “If we’re going to be technical about it, I would say the vast majority of women especially — but also men — in New York City, probably have disordered eating.” Rogers and her staff use the term for any eating that isn’t neutral, but doesn’t meet diagnostic criteria for an eating disorder. Rogers defines neutral or normalised eating as eating with “an absence of anxiety. There’s an absence of counting calories and fats. There’s an absence of cutting out certain macronutrients — so, you’re not leaving out bread, for example, or pasta, or anything that’s white.”

It’s telling that Rogers defines normal eating by what it isn’t (restrictive, rule-based, anxiety-provoking). But it’s logical as well, because most of us do not eat with a total absence of emotional attachment and most of us do not see food as a neutral entity. The majority of American adults, teenagers, and even children under the age of 10 have repeatedly changed their eating patterns in an attempt to lose weight. You probably don’t need empirical evidence to guess that most of those people have psychological and emotional reasons for wanting to lose weight, but if you do, there’s plenty of it.

“When people go on these diets — unless it’s for a medical purpose — it can start to get a little bit obsessive,” Rogers says. For some, it’s just a temporary obsession and one that fades away when they quit the diet. For others, she says, “there’s the potential for those diets to be a gateway into disordered eating.”

Complicating the matter further is how “dieting” has become taboo as a term and a concept. As a practice, it’s as common as it ever was — it’s simply been rebranded as “clean eating” or “whole eating” or any other term that defines health as restriction. Belief-based dietary choices, like veganism — which was once considered both niche and entirely different from traditional dieting — have gained more mainstream popularity. Similarly, the gluten-free trend has been widely adopted by those who have no medical reason to avoid the protein but simply believe that gluten is bad, period. Disordered eating now has so many monikers to hide behind.

Thus it seems safe to say that most people will (at the very least) dabble with disordered eating over the course of their lifetime. But here’s the very tricky caveat: While disordered eating is a common problem, it’s not always a big, bad, life-altering problem. “To me, ‘disordered eating’ is a term that is so broad that it basically ends up meaning nothing at all,” says Kelsey Osgood, author of How To Disappear Completely: On Modern Anorexia, a memoir and historical study of the disease in popular culture. “Saying someone has disordered eating habits could mean she/he refuses to eat anything blue — probably not going to ruin your quality of life — or it could mean that he/she is borderline eating disordered — might ruin your life.”

While Osgood doesn’t treat patients herself, she points out that if you’re going by strictly clinical definitions, you could argue that someone who eats only Halal meat has disordered eating — when, of course, that’s not necessarily true or false. Context is everything, she says. “If someone is described as having disordered habits, I tend to assume this means they live with their habits, these habits aren't compromising their health severely and irrevocably, and they manage to hold down a job and have meaningful relationships — in spite of never eating anything red or being vegan or whatever,” Osgood says.

Kate Rosenblatt, MA, LPC, LMHC, the clinical director at Balance, echoes this sentiment. “One way we hear patients try to piece it out is by asking, Is this negatively impacting a lot of areas of my life? Am I not going out to dinner with friends anymore because we’re not going to restaurants where I feel comfortable eating?” She urges people to simply ask themselves if their eating habits are harming their health, relationships or happiness. Answering those queries can make the severity of the problem quite clear.

If there is any silver lining to the prevalence of subclinical disordered eating, it’s that there’s no reason for it to be some deep and shameful secret. Those in ED recovery may feel like failures if they find themselves, years later, stressing slightly over food, exercise or appearance. But succumbing to that feeling of failure may be more harmful than simply reminding themselves that, unfortunately, everyone does this sometimes — and, fortunately, most people survive. Osgood herself wrote about this experience when she got engaged and was suddenly barraged with wedding diets and bridal bootcamp classes. After establishing that she wasn’t in danger of relapse, Osgood was able to recognise that she will have easy days and hard days and perhaps disordered days — and those days don’t have to derail her. She wrote: “I can look at myself in the [mirror] with mild dissatisfaction (it’s never going to be perfect, after all), and then move along with the rest of my life.”

Again, those who’ve been diagnosed with eating disorders make up only a small percentage of the population. But the ubiquity of disordered eating could make it easier for someone with a life-threatening problem to brush it off as no big deal. As Rogers points out, “The vast majority of our clients come in thinking their problem is a lot less serious than it actually is.” Some of those people are buried deep in denial — but others simply have no idea. They really do believe that weekend bingeing is normal or that gluten is poison. That’s why Rogers thinks it’s important to name disordered eating when you see it.

“It has a little bit of an impact — it has a bit of a punch to it,” she says, adding that the term “disordered eating” tends to cut through all the other diet jargon. “I’m hoping that it might actually pull people up and make them realise, ‘Oh my god, I thought this was healthy, but actually this could be disordered.’” Only then is it possible to assess just how disordered.

It’s already too easy to skirt around these problems and pretend they aren’t there. Disordered eating may not be rare and it may not (necessarily) be a crisis. On an individual level, it is certainly not as dangerous as an eating disorder. But it is a societal ill that most of us will catch at one point or another, and it won’t be cured by ignoring it or muddling its name. Let’s start by calling it what it is: Dieting, restricting, cleansing — all these are synonyms for disordered eating. If we can’t at least call it by its right name, then there’s no question about it. We have a real problem.