By age 23, I’d tried every diet imaginable. I cut carbs for 10 months. I went vegan. I did days-long juice cleanses. To many others, this may have just seemed like dabbling in “healthy eating,” but then, at a routine doctor’s appointment, I was encouraged to see a dietitian. That’s when I learned the term “disordered eating.”

According to registered dietitian Sam Tryon, disordered eating describes a set of behaviors aimed at weight control, such as obsessively counting calories, restricting nutrients such as sugar, and skipping meals. While it can be used to cover a spectrum of dieting behaviors and diagnosed eating disorders, disordered eating itself is not a diagnosis.

Disordered eating often goes unrecognized because the very behaviors that constitute it have been normalized by society. For example, there’s a tendency in disordered eating to take a staunchly moralistic, “good vs. bad” approach to food. But this behavior is often viewed culturally as just “healthy eating.”

Due to the normalized nature of disordered eating, it’s difficult to know exactly how prevalent it is. But in a 2008 survey sponsored by the University of North Carolina at Chapel Hill and SELF magazine, 65 percent of the 4,023 female respondents reported disordered eating behaviors.

Disordered eating can still have a serious impact on a person’s well-being, especially in the long term. Read on to learn how to recognize red flags of disordered eating and the best ways to seek help.

Symptoms of disordered eating aren’t constrained to eating habits — they also encompass emotional issues and long-term health outcomes.

It’s important to remember that even if someone shows some of the signs or symptoms on this list, that’s not necessarily enough to warrant concern. Speak up only if you notice a pattern of these behaviors or if it’s clear someone is experiencing an emotional toll.

Physical symptoms

  • skipping meals
  • compulsively eating
  • bingeing and purging
  • frequent dieting
  • obsessively counting calories
  • exercising excessively to compensate for eating
  • using diet pills or laxatives
  • menstrual irregularity
  • performing food rituals
  • frequent weight fluctuations
  • digestion issues
  • feeling dizzy or exhausted
  • fainting

Emotional signs

  • feeling a loss of control around food
  • feeling guilty/ashamed about eating
  • tying self-worth to size or weight
  • obsessing over body image/the way you look
  • avoiding social engagements that include food
  • self-esteem issues

Long-term effects

The subtle nature of disordered eating means it often goes unrecognized — including by the person experiencing it — until the signs and effects have gotten serious.

Some of the possible long-term effects are:

  • depression
  • substance misuse
  • social isolation
  • malnutrition
  • premature osteoporosis
  • anemia
  • low white blood cell count (increased risk for infection)
  • kidney/organ damage
  • low heart rate
  • suicidal thoughts
  • death

As is common with people who experience disordered eating, it took a long time for anyone (including myself) to notice something was wrong. I didn’t fit the stereotype of a thin white woman, and many of the ways I controlled my eating were normalized by the weight loss industry.

1. There is a “look” to eating disorders

When it comes to disordered eating, Tryon works with people of all sizes, weights, and genders. However, because of the perception that disordered eating affects only white and/or thin women, other demographics are less likely to be treated or diagnosed.

A 2000 survey of more than 7,000 women found that black women were as likely as white women to experience binge eating and vomiting. And a small 2006 study found that doctors were less likely to diagnose an eating disorder in a black patient than in a white patient with the same symptoms.

2. It’s a matter of vanity

It’s imperative to bust the myth that people who struggle with disordered eating do this out of vanity. Tryon emphasizes that weight loss can seem like the goal, but in reality, many people are just trying to heal issues of self-worth.

3. It’s normal behavior

Even though extreme dieting and exercising are somewhat common in our culture, that does not mean these behaviors aren’t disordered. In Tryon’s experience, it’s not actually healthy to be hyper-vigilant when it comes to food and exercise.

Normal eating can be defined as a mixed and balanced diet that contains enough nutrients and calories to meet the body’s needs. It also emphasizes a positive attitude toward food and not deeming foods “good” or “bad.”

Simply put, your body needs fuel, and avoiding hunger cues is not normal behavior.

4. It’s not that dangerous for your health

According to Tryon, disordered eating behaviors can severely impact a person’s mental, physical, and social health. Specific effects include gastrointestinal issues and weight fluctuations — which impact the risk for heart disease and diabetes — as well as anxiety, depression, and social isolation, she says.

If you’re concerned someone in your life is struggling with disordered eating, make sure you intervene in a kind and compassionate way.

1. Speak up if you’re concerned

It’s best to reach out as early as possible, since the side effects can get worse as time goes on.

Tryon suggests sending them resources about building a healthy relationship with food or rejecting diet culture. Two recommendations are Health at Every Size by Lindo Bacon and Christy Harrison’s Food Psych Podcast.

2. Avoid alienating them

Be considerate and loving in the way you speak with this person. Tryon points out that many people are not familiar with disordered eating because it’s so normalized in society.

Try using “I” statements to explain why you’re worried, rather than accusing them of specific behaviors. It’s also important not to start the conversation in a meal setting.

Here are some example phrases you might use:

  • “I’ve noticed you pay a lot of attention to what you eat and your weight. I care about your happiness and want to make sure you’re not being too hard on yourself.”
  • “I read that carbs of all types are really important because it’s what our brains use for energy.”
  • “I read that ‘calories in and calories out’ isn’t actually how the body works. ”

3. Understand why they experience disordered eating

The start of disordered eating behaviors is often not really about weight loss.

“Remember that the person’s sense of self is likely tied up in their weight, and for them, weight loss is about more than buying a smaller size, it is about being worthy and deserving of love,” says Tryon.

4. Be patient

The first conversation might not go anywhere. It’s possible the person doesn’t know their behaviors are disordered at all, says Tryon. This can be especially true if their body is deemed “too big” by conventional standards.

If you struggle with disordered eating, know you have options to find help.

1. Confide in a loved one

Realizing you may have a problem is a huge first step! While it’s normal to feel apprehensive about sharing with loved ones, it can be a huge comfort to have an advocate through recovery.

Let them know about your struggles and how they can support you. You can also ask them to refrain from talking about calories or weight around you.

“If you are not sure how the person can help, it’s OK to let them know that too,” says Tryon.

2. Stop weighing yourself

This includes at your healthcare provider’s office. According to Tryon, “with very few exceptions, there is no reason to know your weight.”

3. Get rid of any clothes that don’t fit

Hanging on to clothes you dream about fitting into perpetuates the idea that your body isn’t good enough as it is. Buy clothes you love for the body you have. “It’s empowering to feel comfortable and confident in your clothes,” says Tryon.

4. Curate a body-positive social feed

Tryon suggests unfollowing accounts that promote restriction, “clean” eating, or body change. Also try following hashtags such as #AntiDiet, #HealthAtEverySize, and #BodyPositive.

Following these hashtags diversifies the range of bodies that appear on your feed, which can help you unlearn the cultural norm of what a body should look like.

Social circles — both online and IRL — are important in maintaining recovery. Tryon recommends surrounding yourself with people who eat without restriction and don’t talk about diets.

5. Reach out to a dietitian and/or therapist

It’s important to work with a professional because of the complicated emotions that can come up when recovering from disordered eating behaviors.

“Working to heal the person’s relationship with food involves helping the person heal their relationship with their larger sense of self,” says Tryon. “A therapist and dietitian who specialize in eating disorders will understand this complex relationship and support the person in facing these inner demons, rather than focusing strictly on changing the way the person eats.”

Tryon emphasizes finding a provider who specializes in eating disorders and being wary of anyone who says they specialize in “weight control” or “weight loss.” If there are no specialists in your area, many dietitians and therapists provide support through telehealth.

American society is inherently fatphobic and pro-diet. It’s not easy to try to rewire our brains to disregard socially accepted norms and accept ourselves as we are.

Here are some tips for developing habits that serve your well-being:

  • Avoid crash diets. This includes any diet — even those branded as “lifestyle changes” — that forces you to cut out foods that “aren’t good for you.” Unless you have an allergy or intolerance, all foods are good foods.
  • Celebrate food. Try watching food-positive shows like “Ugly Delicious” and “Salt Fat Acid Heat.”
  • Avoid commenting on body and appearance. Try complimenting yourself and your friends on other qualities that are important.
  • Prioritize your mental health. Mental health is just as important as physical health. Practicing self-care, learning about mindfulness, and going to therapy are all great for the health of your inner self.
  • Do exercise you enjoy. Find activities that aren’t focused on burning calories or changing how your body looks.

Reina Sultan (she/her) is a Lebanese-American Muslim woman working on gender and conflict issues at her nine-to-five. Her work can also be found in Huffington Post, Rewire.News, Wear Your Voice Mag, and Rantt. Follow @SultanReina on Twitter for endless hot takes and photos of her extremely cute cats.