Eating Disorders: What Practitioners Can Do Webinar

This webinar looks at how eating disorders can present in nutrition practice and what practitioners need to know to recognise risk, understand severity, work within their scope and refer appropriately. Hosted by Hosted by Ella Kaur (Practitioner Lead, Registered Nutritionist and Nutritional Therapy Practitioner) with guest speaker Emma Dawson (BSc Hons, CNHC Registered Nutritional Therapist, mBANT), who has a special interest in eating disorders and endometriosis.

Key Points Discussed

What eating disorders are

Eating disorders are characterised by disturbances in eating behaviour, including restriction, bingeing, purging and compulsive exercise. They are commonly driven by body image, concerns about shape and size, and distress or a need for control around food.

Why eating disorders are clinically high-risk

Eating disorders can be life-threatening. Anorexia nervosa has the highest mortality rate of all psychiatric disorders. Serious risks include:

Suicide and self-harm
Cardiac complications (notably in bulimia nervosa)
Refeeding syndrome
Renal and liver impairment

Who is at risk

Eating disorders are not limited to one group:

Risk is highest during adolescence and young adulthood.
Risk increases during times of body shape change, including perimenopause and menopause.
They affect people of all genders and identities, with higher reported risk in LGBTQ+ and trans communities.
Neurodiversity plays a role: autism is more associated with restrictive presentations, and ADHD is linked to binge eating.
Research and risk awareness are more limited in racially minoritised communities.

Types of eating disorders and clinical recognition

The DSM-5 provides the diagnostic framework, but people may have disordered eating without a formal diagnosis.

OSFED (other specified feeding or eating disorders): The most common presentation.
Binge eating disorder: Recurrent binge episodes with loss of control, without purging or compensatory behaviours.
Bulimia nervosa: Bingeing with compensatory behaviours, including fasting and excessive exercise.
ARFID: Not driven by weight or shape. It is tied to sensory sensitivity, fear of food or concerns about choking, and is the type most linked to neurodivergence.
Anorexia nervosa and atypical anorexia: Restriction with an intense fear of weight gain and body image disturbance. Atypical anorexia can occur at a BMI that doesn't look 'dangerous', yet is equally serious.

Restrictive diet approaches can increase the risk of orthorexia, so the necessity of any restrictive protocol should be questioned.

Clinical signs in practice

Binge eating: Missed meals, cycles of restriction and bingeing, guilt and shame around food, depression, anxiety and mood swings. Physical consequences include blood glucose dysregulation, GI distress and fatigue.
Bulimia nervosa: Dental erosion, a sore throat and GORD-like symptoms, secrecy or hiding food, low mood, anxiety, irritability or anger, and weight fluctuations despite apparently regular eating.
Atypical anorexia: Severe restriction, fear of weight gain, rigid food rules and excessive exercise. Physical signs include cold extremities, fatigue, hair loss, fainting or dizziness, constipation, delayed gastric emptying and gastritis.

Scope, recognition and referral for nutritional therapists

Eating disorders can be hidden within health goals and masked by therapeutic nutrition protocols.
Nutritional therapists may be the first to identify an issue, through rigid food rules or a heightened fear of weight gain.
Recommended actions include clinical supervision, seeking advice from professional associations, and working collaboratively with multidisciplinary teams, the GP and specialist support.

BMI and body image

BMI is useful for screening and risk assessment, tracking recovery and informing NHS processes.
It has limitations: it doesn't assess behaviours, body composition or individual differences, and the evidence behind it has limitations regarding race, gender and age.
Body image is the perception of body weight and shape, plus broader appearance-related concerns. Practitioners are encouraged to reflect on their own assumptions and challenge bias.

Blood glucose dysregulation and eating disorders

Cycles of restriction and bingeing can contribute to low blood glucose, strong hunger, shifts in insulin and glucose, and cravings, which reinforce disordered eating patterns.

Key Takeaways

Treat eating disorders as serious, high-risk conditions with significant medical and mental health risk, including suicide, self-harm and cardiac complications.
Recognition must be broad: eating disorders occur across all body sizes, genders and identities, and neurodiversity and life-stage changes can increase risk.
Work within scope and refer appropriately, using supervision, multidisciplinary collaboration and GP/specialist pathways, especially when signs of severity appear.

Conclusion

This webinar provides a practical, clinical overview of eating disorders in nutrition practice. It covers definitions, risk factors, recognition of the different disorder types (including atypical anorexia and ARFID), and the importance of scope, supervision and referral. It also emphasises that restriction can worsen symptoms, and that practitioners should stay alert to signs of severe medical risk in clinic.

This webinar is fully approved by BANT® and accredited for CPD hours.