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What You Don't Know <em>Can</em> Hurt You!

Eating disorders are very "behind closed doors" afflictions. I can't tell you how many times a parent has told me, "I had no idea." And frequently that "aha" moment comes at a startlingly late stage of the illness' progression.
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Most of us have probably heard the old adage, You can't be too thin or too rich... But one of them is dead[ly] wrong. And, while we're at it, what you don't know can hurt you.

Did you know that... eating disorders have the highest mortality rate of any mental disorder [1]... 20 million women and 10 million men will suffer from an eating disorder at some point in their life in the U.S. alone [2]... early intervention is key to treating eating disorders, yet many cases go undetected?

I can admit that when I stepped in as president and CEO of the National Eating Disorders Association, there was a lot that I had to learn about eating disorders. And as a parent, I can say that I had no idea that my child was struggling with an eating disorder.

Eating disorders are very "behind closed doors" afflictions. I can't tell you how many times a parent has told me, "I had no idea." And frequently that "aha" moment comes at a startlingly late stage of the illness' progression.

The truth is, most people are under-informed or misinformed about eating disorders. And that's a serious problem. To help remedy that issue, the 28th annual National Eating Disorders Awareness Week campaign Feb. 22-28 is themed I Had No Idea...

I had no idea... that over-exercising can lead to an eating disorder... that 35 percent of "normal" dieters progress to pathological dieting and that, of those, 20-25 percent progress to full-blown eating disorders [3]... that an eating disorder can kill you or lead to permanent physical damage... that [I, my daughter, son, sister, brother, friend] had a problem.

I had no idea... that the perfect images I see every day are digital illusions... that eating disorders don't discriminate... that my passion had become a problem... that bullying can trigger disordered eating... that my quest for health was making me sick... that eating disorders are often misdiagnosed or overlooked... that eating disorders aren't just "a phase."

While there is hope and recovery is possible -- particularly with early intervention -- many people may suffer from the long-term effects of these illnesses. And many people (including doctors) just don't recognize the signs! Misconceptions about eating disorders are rife and too often prohibit those in need from seeking treatment.

So what are the signs? Here are 10 things to look for

1. Drastic weight loss.
2. Preoccupation with counting calories.
3. The need to weigh yourself several times a day.
4. Excessive exercise.
5. Binge eating or purging.
6. Food rituals, like taking tiny bites, skipping food groups or re-arranging food on the plate.
7. Avoiding meals or only wanting to eat alone.
8. Taking laxatives or diuretics.
9. Smoking to curb appetite.
10. Persistent view of yourself as fat that worsens despite weight loss.

And now what do you do? One low-pressure, first step is a reputable online screening tool like the one developed by Screening for Mental Health, Inc. It's free, anonymous and takes just minutes to answer a series of questions developed by treatment professionals in the eating disorders field, which are designed to indicate whether clinical help is needed. There are two screenings available, one for college students -- a particularly vulnerable demographic for the development of eating disorders -- and a standard screening for other adult populations. If indicated, participants will receive referral information to local agencies for personal evaluation by a medical professional and treatment.

As with many of life's obstacles, knowing (and admitting) there's a problem, understanding the challenges and taking that first step are the only path to living a healthy, happy and fulfilling life.

During NEDAwareness Week, thousands of people come together in communities across the country, hosting events to raise awareness about body image and bring national attention to the severity of eating disorders, which are bio-psycho-social illnesses, not lifestyle choices. To learn more and get in the know, visit

Lynn Grefe
President & CEO
National Eating Disorders Association


[1] American Journal of Psychiatry, Vol. 152 (7), July 1995, p. 1073-1074, Sullivan, Patrick F.

[2] Wade, T. D., Keski-Rahkonen A., & Hudson J. (2011). Epidemiology of eating disorders. In M. Tsuang and M. Tohen (Eds.), Textbook in Psychiatric Epidemiology (3rd ed.) (pp. 343-360). New York: Wiley.

[3] Shisslak, C. M., Crago, M., & Estes, L. S. (1995). The spectrum of eating disturbances. International Journal of Eating Disorders, 18(3), 209-219.

[4] Dr. Craig Johnson, Ph.D., FAED, CEDS, Chief Clinical Officer, Eating Recovery Center, Denver, Colo., and a board member emeritus of the National Eating Disorders Association.

If you or someone you know needs help, call the National Eating Disorders Association's Helpline at 800-931-2237 or visit