5 Red Flags of Disordered Eating (And How Not to Cause Harm)

This article is part 2 of a mini-series on disordered eating in naturopathic practice. Over three parts, we’ll explore the eating spectrum, the red flags you need to know, and how to avoid accidentally fuelling diet culture in clinic.

Whether you’re a naturopath, herbalist, or other holistic practitioner, this series will start giving you the frameworks to support clients safely and effectively - without causing harm.

Through a naturopathic lens, this is Primum non nocere (First, do no harm) and Tolle totum (Treat the whole person). We’re not here to police plates; we’re here to restore healthy relationships with appetite, body, food... and essentially, oneself.
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The 5 Red Flags (and how to respond)

I’ve spent years trying to capture what disordered eating looks like in real life. The problem was, my lists kept getting longer and longer: the client who avoids carbs after 6pm, won’t eat until 11am, keeps boxes of weight loss supplements stashed away, cooks high-calorie meals for everyone else but won’t touch them, body-checks every time they pass a mirror, or spends 75% of their waking hours thinking about food and weight.

The truth is, disordered eating shows up in endless ways. And when I focused on every possible detail, it was easy to miss the bigger picture.

So instead of a looooong checklist, I now group these patterns into five broad families. I won’t list every symptom under each, but if you know the gist of these five, you’ll be much better equipped to spot disordered eating in practice... without losing sight of the person in front of you.

So here are my five red flags, in no particular order of importance:

1. Constant Dieting & Food Rules

Clients bouncing from keto to intermittent fasting to sugar detoxes, each one promising to be the fix. They may cut out whole food groups (no carbs, no dairy, no gluten) without a medical reason, or cling to timing rules like “I can’t eat after 6pm” or “I only eat within an 8-hour window.” Yes, I'm looking at you, intentional intermittent fasting!

Some refuse “processed” foods at all costs, keep cupboards stacked with detox teas or fat-burning supplements, or religiously weigh out portions even of nutrient-dense foods. And when those rules inevitably get broken? Cue guilt, shame, or a frantic plan to “make up for it” with more restriction, exercise, or fasting.

Red flag: “Willpower” often masks shame, fear, and a desperate attempt to feel in control. On the surface it can look disciplined or “healthy,” but underneath it’s anxiety in disguise.

The numbers: Dieting isn’t harmless. About 35% of “normal dieters” progress to disordered eating, and of those, 20-25% develop a clinical eating disorder (National Eating Disorders Collaboration [NEDC], 2019). This makes dieting the single strongest predictor of eating disorder onset, not a path to long-term health (Mann et al., 2007; Bacon & Aphramor, 2011).

Practitioner reframe: Instead of praising their “discipline,” I suggest you could ask some open, compassionate questions about the net effect of these rules on their quality of life:
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• “How do these food rules affect your energy and mood?”
• “What happens socially or with your family life when these rules are in play?”
• “Do you notice how you feel about yourself when you break a rule?”

These kinds of questions shift the frame from “good vs bad eating” to “what helps vs what harms.”

Protective framework: This is where Intuitive Eating Principle 1 - Reject the Diet Mentality is so powerful. Naming dieting for what it is (a false promise with real risks) can help clients unhook from the belief that the next diet will fix everything.

Naturopathic principles: Primum non nocere (First, Do No Harm) and Praevenire (Prevention). Dieting is not benign. Our job is to stop adding fuel to the fire with more restrictive protocols, and to prevent progression along the spectrum - from “wellness” dieting into full-blown disordered eating or eating disorders. Prevention means protecting clients from harm by not prescribing interventions we know don’t work, and by helping them build sustainable, flexible relationships with food.

2. Food & Body Preoccupation

Instead of food and body quietly taking their place in the ecosystem of a person’s life, they start behaving like invasive species. They spread, crowding out joy, connection, and the ability to hear the body’s other voices - hunger, play, rest, intimacy.

​Clients log every macro, body-check in every mirror or shop window, weigh daily (or multiple times), scroll “fitspo,” compare photos, refuse meals they didn’t plan, or skip social events because the menu isn’t controllable. Or if they do decide to go out and eat socially, they'll spend the day before and/or after "making up" for it - saving calories beforehand so as to appear "normal" when in the company of others, or planning a long run or power walk after the meal to burn the calories off.

​Some keep “fear foods” out of the house, measure their worth by watch metrics, or spend hours planning “perfect” days of eating.
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Red flag: Preoccupation crowds out life. When attention is glued to food/shape, flexibility, connection, and joy shrink. This is a risk state for escalation.

Practitioner reframe (what to ask):

• “Roughly how much time/brain space does food/body take on a typical day?”
• “If you got even 30% of that time back, what would it go to?”
• “What happens to your mood, sleep, or relationships when tracking ramps up?”

Protective frameworks:

• IE Principle 7 - Cope with Emotions with Kindness and Principle 8 - Respect Your Body. These pivot from control to care, and from appearance to function/values.
• Micro-experiments: a scale holiday, social media feed hygiene (unfollow triggering accounts), mirror neutrality drills (describe, don’t judge), and a time audit of “life stolen by food/body thoughts.”

Naturopathic principles:

• Scientia Critica (Critical Thinking, or Doctor as Learner): Preoccupation is often rewarded in wellness culture (“you’re so dedicated!”), even by us practitioners if we’re not careful. Critical thinking means resisting the urge to applaud obsession, and instead asking, “What is actually happening when the client tracks less or deletes the fitness app for a week?”. Let outcomes (not ideology) guide learning.
• Tolle Causam - Treat the Cause: Preoccupation is a signal, not the root. Address upstream drivers like stigma, perfectionism, underfuelling, sleep, or anxiety. In my upcoming course Body as Earth: A Root-Cause Approach to Disordered Eating for Naturopaths, we break down the nervous system/food obsession loop, and how herbs and gentle nutrition can help without feeding the fire.
• Praevenire - Prevention: Preoccupation is a risk state. Protect against escalation by de-emphasising weight goals, promoting flexible structure, and keeping space for joy and connection.

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3. Weight Cycling & Body Dissatisfaction

Clients arrive with wardrobes in three different sizes, or they “won’t buy new clothes until they’re back to goal weight.” They drop kilos on the latest detox or practitioner-only program, regain it, blame themselves, then repeat the cycle. Sometimes they say “this time will be different” while signing up for the same punishment in a shinier package.

Red flag: Shame and guilt dominate. Behaviours swing between extremes, with self-worth hanging on the scale.

The numbers:

• 80-95% of dieters regain weight within 1-5 years (Mann et al., 2007; Bacon & Aphramor, 2011). Weight cycling is the norm for yo-yo dieters, not the execption.
• Weight cycling is not benign: a 2025 Vanderbilt study (>83 000 adults) found it increased risk of heart failure by 50%, and raised diabetes, fatty liver disease, and sleep apnoea risk by ~30%, compared to stable higher weights (Silver et al., 2025).

Practitioner reframe: Normalise weight regain as physiology, not failure. Ask:

• “How has focusing on weight cycling affected your mood, sleep, or energy?”
• “What would it be like to measure health by stamina, digestion, or joy - instead of the scale?”
• Sometimes I'll ask the client if they'd like to map out a timeline of all the diets they've tried and how much weight was lost, then regained. This can be eye-opening, but be sure to reassure them that this is not proof that they are failed, but rather that the diets failed them.

Naturopathic principles:

• Primum non nocere - Do No Harm: Stop prescribing more restrictive protocols; they fuel the cycle and worsen risk.
• Tolle Causam - Treat the Cause: Look at stigma, stress, chronic sleep disruption, and metabolic adaptation. The problem isn’t willpower, it’s biology plus oppression.
• Prevention: Protect clients from being funnelled into another cycle by focusing on behaviours that enhance wellbeing.

​Aligned Intuitive Eating principles:

• #1 Reject Diet Culture
• #8 Respect Your Body
• #10 Honour Your Health with Gentle Nutrition

👉 We unpack the physiology of weight cycling and how to communicate this to clients without triggering shame in my upcoming course, Body as Earth: A Root-Cause Approach to Disordered Eating for Naturopaths.

4. Physical or Emotional Distress Around Eating

Clients come in convinced they have IBS, SIBO, or a long list of intolerances - and they might. But often they'll request restrictive elimination diets to address these issues. They describe bloating, reflux, constipation, fatigue, or say they feel “out of control” with food. Some also report menstrual changes: painful, heavier, or irregular periods, PMS that feels unbearable, or cycles going missing entirely.

Red flag: These symptoms can trace back to underfuelling, erratic eating, and stress, rather than mysterious intolerances.

What the evidence shows:

• Gut dysregulation from undernutrition: Low energy intake slows gastric emptying and bowel motility, leading to constipation, reflux, and early satiety (Gaudiani, 2018). Delayed gastric emptying is common in restrictive eating disorders and often improves with nutritional rehabilitation (Quigley, 2019).
• Functional gastrointestinal disorders (FGIDs): People with eating disorders are far more likely to meet criteria for IBS, functional dyspepsia, and chronic constipation (Evans & Garcia, 2017). Up to 90% of those with anorexia nervosa report GI symptoms (Norris et al., 2016). And it’s not just one-sided - studies show a substantial proportion of people with FGIDs also meet criteria for disordered eating or eating disorders, suggesting a strong bidirectional link between gut distress and disrupted eating patterns (Becker et al., 2022).
• Erratic eating patterns: Skipping meals or fasting all day then eating large amounts at night places strain on the digestive system, worsening reflux, bloating, and pain (Becker et al., 2022). You’ll also see echoes of this in your intermittent fasting clients - especially the OMAD (one-meal-a-day) crowd. On the flip side, constant grazing (eating stretched out over many hours) can throw off the migrating motor complex (MMC), raising the risk of SIBO and other digestive issues.​
• Stress and the gut–brain axis: Hypervigilance around food cranks up sympathetic tone, which literally switches digestion off. Result: cramps, nausea, bloating, and that classic “food just sits there” feeling (Becker et al., 2022).
• Microbiome changes: Restriction and cutting whole food groups reduce fermentable fibres and microbial diversity, which worsens bloating and visceral hypersensitivity (Becker et al., 2022).
• Hormonal impacts: Around 58% of women with EDs report menstrual irregularities (Basu & Golden, 2023). Dysfunction shows up across all ED types, not just restrictive anorexia (Pinheiro et al., 2007).
• Menstrual distress: Women with eating disorders report more PMS pain, mood changes, and bloating than controls (Klatzkin et al., 2024).
• Bone and endocrine consequences: Prolonged undernourishment alters HPO-axis signalling, raises cortisol, and reduces bone density (Gaudiani, 2018). Even subclinical restriction can worsen PMS, throw cycles off, and set up stress fractures down the track.

Practitioner reframe: Instead of reflexively prescribing another elimination, get curious:

• “Could these symptoms be the body’s response to not enough food?”
• “Do your gut issues flare more in high-stress times?”
• “Have menstrual cycles shifted since food restriction started?”

Naturopathic principles:

• Vis medicatrix naturae - The Healing Power of Nature: Adequacy and rhythm first. Then, herbal allies like Matricaria chamomilla (calming, carminative), Althaea officinalis (soothing, demulcent), and Gentiana lutea (bitter, supportive of digestion) can be helpful, depending on the client's constitution.
• Tolle Totum - Treat the Whole Person: Gut symptoms aren’t “just the gut.” They connect to nervous system dysregulation, hormones, microbiome shifts, and undernourishment.
• Prevention: Avoid quick-fix eliminations that reinforce fear. Protect gut and hormonal health by restoring adequacy, rhythm, and safety.

Aligned Intuitive Eating principles:

• #3 Make Peace with Food
• #4 Discover the Satisfaction Factor
• #10 Honour Your Health with Gentle Nutrition

​👉 In Body as Earth: A Root-Cause Approach to Disordered Eating for Naturopaths, we dive deeper into supporting gut, cycle, and hormonal health without fuelling restriction - including which herbs soothe, all without moralising food.

5. Overlap with Mental Health Concerns

Food and body control often double as coping strategies. Clients may weigh every lettuce leaf, binge to numb stress, or cling to “clean eating” as proof of worth. ADHD and OCD traits often show up here, as does perfectionism.

Red flag: Eating behaviours are welded to identity, safety, or self-worth.

The evidence: EDs co-occur at high rates with anxiety, OCD, ADHD, and trauma. Early intervention matters: research shows that recovery improves dramatically when treatment is accessed sooner (Treasure et al., 2020; Flynn et al., 2020).

Practitioner reframe: Validate food as a coping tool before offering alternatives. Ask: “It makes sense food has been your anchor - what else could help you steady yourself?”

Naturopathic principles:

• Tolle totum - Treat the Whole Person: See the physical, emotional, social, and cultural layers.
• Docere - Doctor as Teacher: Model inclusive language, and empower body trust.
• Critical Thinking / Doctor as Learner: Too often in wellness spaces, practitioners either (a) collapse everything into “nutrition” - as if protein could cure trauma - or (b) back away completely - “oh, that’s mental health, nothing I can do, out of my scope.” Both extremes do harm. 

Critical thinking here means staying curious and nuanced. Ask: “What role is food playing for this person right now? Comfort? Control? Safety?” Then decide what’s yours to support (gentle nourishment, herbs for sleep, nervous system grounding) and what needs a referral (trauma therapy, psych support).

It’s also about recognising the systems at play. If a client with ADHD is struggling with food routines, that’s executive function - not laziness, and certainly not "a lack of connection". If someone binge-eats after trauma triggers, that’s their nervous system doing its best to self-soothe. Your scope isn’t to “fix” trauma, but you can make the terrain safer: stabilise blood sugar, protect sleep, support digestion, and model body respect.

👉 In my course we dig into how to avoid both overstepping and underserving. We map where your role ends and referral begins, all without abandoning the client. Because “critical thinking” isn’t about being the smartest in the room. It’s about staying teachable, curious, and willing to be part of a larger healthcare team.

​Aligned Intuitive Eating principles: #2 Honour Your Hunger, #5 Feel Your Fullness, #7 Cope with Emotions with Kindness.

Differentiating Red Flags from Other Illnesses

One of the challenges in practice is that the red flags of disordered eating don’t exist in isolation. Many of the same symptoms can appear in other health conditions. For example:

• Cold intolerance may suggest hypothyroidism or iron deficiency, not just restrictive eating.
• Amenorrhoea or irregular cycles could be related to PCOS, thyroid dysfunction, stress, or other endocrine conditions.
• Low mood, anxiety, or fatigue may be part of depression, trauma histories, or chronic illness.
• GI complaints overlap heavily with IBS, SIBO, coeliac disease, and other functional gut disorders.

So how do you tell the difference? Context is key. Disordered eating red flags cluster together and are linked with food and body concerns. A client presenting with bloating and reflux plus rigid food rules, body preoccupation, and weight cycling is telling a different story than someone with identical gut symptoms but no disordered eating patterns.

This is where critical thinking and thorough assessment come in. A careful history - exploring eating behaviours, body image, dieting history, and mental health - helps you tease apart whether these symptoms are primarily medical, primarily behavioural, or (most often) both.

👉 In my course we dig into this in detail: how to differentiate between comorbidities like hypothyroidism or depression, and when to refer for labs versus when to focus on eating behaviours and psychological supports.
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What To Do When You Spot Red Flags

If you’re seeing yourself in this, here are five places to start. I go into much more detail in my course, with scripts, screening tools, and case studies you can practice with. For now, these steps will get you started safely.
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1. Hold space without judgment. Clients are often drenched in shame. Phrases like “That sounds really hard” or “You’re not alone in this” can be more therapeutic than any supplement or food plan.
2. Stay within scope - but don’t shrink yourself. You’re not here to treat trauma or diagnose DSM disorders. But you are qualified to observe, screen, and flag concerns. And those observations can be the missing piece that helps a GP or psychologist take a client seriously - I feel like at least once a week I'm flagging what looks like an ED in a client referred to me by a GP for something else entirely (usually IBS, diabetes, or weight concern).
3. Support what you can. Herbs for digestion or sleep, nervous system regulation, gentle nourishment frameworks. Be the safe, consistent presence who doesn’t prescribe shame.
4. Refer early. Research shows recovery outcomes are significantly better with early referral (Treasure et al., 2020). Build your network of GPs, psychologists, and HAES-aligned dietitians, and frame referral as “adding to the team,” not “I can’t help you.”
5. Keep learning. Frameworks like Intuitive Eating and HAES are protective; mindful eating can help with awareness but isn’t enough on its own. Staying updated keeps you from unconsciously fuelling diet culture.

👉 In my upcoming course (waitlist now open!) we zoom right into each of these: how to document, what language to use, and how to communicate with other professionals so your concerns get heard. But start here, and you’ll already be protecting clients from a lot of harm.

Key takeaway: Spotting red flags isn’t about thinking, "shit, this is out of my depth!", retreating or ignoring. It’s about holding space, supporting rhythms and safety, and knowing when to refer. We need more practitioners like you to take the reins! Done well, you can prevent escalation, reduce shame, and make a huge positive difference to the lives of your clients.

Next Steps

So there you have it: five red flag families and some first steps to respond without causing harm. These aren’t the whole map - more like trail markers to keep you oriented while you’re still learning the terrain.

In my course we go much deeper: into scripts, referral letters, case studies, and the nuts-and-bolts of working alongside psychs and GPs. But if you start with these basics, you’re already waaaay ahead of the average naturopath in terms of keeping clients safe.

✨ In the next episode, we’ll turn the spotlight back on ourselves as practitioners. I’ll unpack the ways naturopaths sometimes accidentally fuel disordered eating - and what to do instead. And yes, we're going to talk in depth about Metabolic Balance.


✨ Want to bring this into your own practice?
👉Download my free practitioner guide: Working with Clients with Disordered Eating for Naturopaths - packed with weight-neutral care tips.
🌿 When you sign up, you’ll also join the waitlist for Body as Earth: A Root-Cause Approach to Disordered Eating for Naturopaths and receive supportive emails to help you integrate Intuitive Eating and naturopathic principles into your practice.

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Thanks for being here and for doing this work that really matters. Remember: you don’t have to be a dietitian, GP, or psychologist to support clients with disordered eating... but you do need the right frameworks to avoid harm.

Until next time, take care of yourself, nourish your own body, and don’t forget: nuance is the new rebellion!

With warmth,
Casey 
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References

Bacon, L., & Aphramor, L. (2011). Weight science: Evaluating the evidence for a paradigm shift. Nutrition Journal, 10(1), 9. https://doi.org/10.1186/1475-2891-10-9

Basu, S., & Golden, N. H. (2023). The connection between menstrual status and restrictive eating remains essential to the diagnosis, treatment, and outcomes of eating disorders. Journal of Reproductive Endocrinology & Infertility, 8(2).

Becker, K. R., et al. (2022). The overlap between eating disorders and gastrointestinal disorders. Practical Gastroenterology, 46(8), 33–47.

Evans, M. M., & Garcia, K. (2017, November). The intersection of eating disorders and functional gastrointestinal disorders. Academy for Eating Disorders International Conference, Prague, Czech Republic. [Conference presentation].

Flynn, M., et al. (2020). Assessing the impact of First Episode Rapid Early Intervention for Eating Disorders (FREED). European Eating Disorders Review, 28(6), 1–10.

Gaudiani, J. L. (2018). Sick enough: A guide to the medical complications of eating disorders. Routledge.
Klatzkin, R. R., et al. (2024). Menstrual cycle–related symptomatology in women with eating disorders. Archives of Women’s Mental Health, 27(3), 451–463. https://doi.org/10.1007/s00737-024-01542-1

Mann, T., Tomiyama, A. J., Westling, E., Lew, A. M., Samuels, B., & Chatman, J. (2007). Medicare’s search for effective obesity treatments: Diets are not the answer. American Psychologist, 62(3), 220–233.

National Eating Disorders Collaboration. (2019). Disordered eating and dieting (Fact sheet). https://nedc.com.au

Norris, M. L., et al. (2016). Gastrointestinal complications associated with anorexia nervosa: A systematic review. International Journal of Eating Disorders, 49(3), 216–237.

Pinheiro, A. P., et al. (2007). Patterns of menstrual dysfunction in eating disorder patients. International Journal of Eating Disorders, 40(5), 424–434.

Quigley, E. M. M. (2019). Gastric emptying and upper gastrointestinal symptoms in anorexia nervosa. In Encyclopedia of Gastroenterology (pp. 1–8).

Silver, H. J., et al. (2025). Weight trajectory impacts risk for cardiometabolic diseases. The Journal of Clinical Endocrinology & Metabolism. Advance online publication.
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Treasure, J., et al. (2020). Early intervention for eating disorders. European Eating Disorders Review, 28(6), 1–10.