Adam J. Sagot, D.O., FAPA
Chief Medical Officer
Preferred Behavioral Health Group
A teenager skips dinner and says they already ate. A college student trains for hours after consuming very little. A parent notices shrinking portions, oversized clothing, increasing irritability, and mounting anxiety around meals. These moments often appear subtle, but do not let them go unaddressed as they may represent the early stages of a psychiatric illness.
National Eating Disorders Awareness Week, observed in late February, calls attention to a group of serious mental health conditions that affect both adolescents and adults. The American Psychiatric Association, the American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry all recognize that these illnesses are common, complex, and potentially life threatening. NAMI and Mental Health America continue to emphasize that eating disorders carry among the highest mortality rates of any psychiatric condition, driven by both medical complications and suicide.
The term “eating disorder” does not describe one single problem. It encompasses a range of unhealthy relationships with food and body image. For some individuals, disordered eating often centers on severe restrictions and fear of weight gain. For others, it involves recurrent episodes of consuming large amounts of food followed by attempts to compensate, sometimes by forcing them to vomit. Some struggle primarily with binge eating without purging. Others avoid large categories of food because of fear, anxiety, or sensory sensitivity. Increasingly, we are also seeing unhealthy reliance on weight loss medications, including off label use of GLP 1 agonists, in ways that mask or reinforce disordered eating patterns.
These behaviors do not arise in a vacuum. Eating disorders often serve a psychological function. For some, controlling food intake becomes a way to exert control when other areas of life feel chaotic. For others, disordered eating may develop in the aftermath of trauma. In some cases, it is intertwined with depression, anxiety, obsessive thinking, or other medical and psychiatric conditions. Body image dissatisfaction, social comparison, and cultural pressures frequently amplify vulnerability. There is rarely a single cause. Biological predisposition, environmental stressors, and psychological coping patterns intersect.
Physical signs still matter. Rapid weight loss, failure to grow as expected, dizziness, cold intolerance, menstrual changes, and fatigue signal physiologic strain. In individuals who induce vomiting, clinicians may observe Russell’s sign, redness or callusing over the knuckles from repeated contact with the teeth. Dental enamel erosion, electrolyte disturbances, bradycardia, and cardiac rhythm abnormalities can develop silently. These are not cosmetic issues. They reflect systemic compromise.
Treatment works best when it is coordinated. Current recommendations support multidisciplinary care that integrates medical monitoring, psychiatric oversight, psychotherapy, and nutritional rehabilitation. For adolescents, family-based treatment has strong evidence and actively engages caregivers in restoring nutrition. Registered dietitians with eating disorder expertise are essential. Communication among providers is not optional, it is critical.
Nutritional restoration requires vigilance. Refeeding syndrome is a well-documented risk in malnourished patients. Rapid shifts in insulin and electrolytes, particularly phosphate, can precipitate cardiac and neurologic complications. Careful reintroduction, or titration, of caloric intake, frequent laboratory monitoring, and close clinical observation reduce risk. In medically unstable patients, inpatient or residential treatment may be necessary before outpatient therapy is safe.
Families should resist the urge to wait for clarity. Significant weight change, behavioral rigidity around food, or medical symptoms more than justify asking the question or seeking out a medical consultation. Early intervention improves outcomes and reduces chronicity.
Awareness week should sharpen our clinical lens and our sense of urgency. Eating disorders are complex, biologically influenced, and treatable illnesses. They demand coordinated care, sustained follow-through, and informed advocacy from the families and communities who recognize the warning signs first.