* Content Note on Lived Experience *
Before we go further, I want to acknowledge that in this article I share some of my own lived experience with disordered eating. While I don’t go into graphic detail, please take care while reading and pause or close the window if you need to.
It’s also important to say: sharing lived experience is not something every practitioner needs to do. Many excellent clinicians choose not to, and their work is no less valid or powerful. Personally, I share parts of my story because it helps to reduce stigma, to show that recovery is possible, and to remind us that the eating spectrum is not just theory - it’s something I’ve walked through myself, and it definitely shapes the way I practice today.
As naturopaths, herbalists, and holistic practitioners, many of us see clients who are quietly struggling with food. But here’s the tricky thing: they rarely walk in and say, “I think I have an eating disorder!”
Instead, they show up with gut issues, fatigue, hormonal symptoms, or weight / body image concerns. If we’re not careful, the way we respond can either help them move toward healing, or unintentionally push them further into disordered eating.
The truth is, disordered eating is far more common than diagnosed eating disorders. According to the National Eating Disorders Collaboration (NEDC), disordered eating behaviours - things like restrictive dieting, compulsive exercise, and binge eating - occur on a continuum and affect a much larger proportion of the population than clinical eating disorders (NEDC, 2019). Research suggests that while around 10% of Australians will experience a diagnosable eating disorder in their lifetime, many more engage in disordered eating behaviours - with studies showing rates as high as 60% of adolescent girls and nearly 30% of adolescent boys reporting behaviours like dieting, bingeing, or purging at some point (NEDC, 2019).
International studies show similar trends, with dieting and disordered eating behaviours affecting a large proportion of adults as well (Neumark-Sztainer et al., 2006). Disordered eating symptoms have risen sharply in recent decades. Between the late 1990s and mid-2000s, the prevalence of weekly binge eating more than doubled, while strict dieting and purging behaviours increased nearly fourfold, alongside declines in quality of life (Preti et al., 2009).
This all means that most of our clients are not in a happy, healthy place with their eating, food, and bodies, and it's only a minority that have diagnosed eating disorders. Many folks are sitting in that messy middle zone. And this is exactly where practitioners can either cause harm or provide vital support.
Understanding The Eating Spectrum
At the far left of the spectrum sits Intuitive Eating (IE), an evidence-based framework created by dietitians Evelyn Tribole and Elyse Resch. It goes beyond “normal” eating by actively rejecting diet culture (which I'm SO here for) and reconnecting people to their hunger, fullness, satisfaction, and values. Intuitive Eating is flexible, compassionate, and protective against disordered eating. Here's a summary:
- IE is a structured, evidence-based model created by Tribole & Resch (1995).
- Goes deeper than normal eating: it’s about actively attuning to internal cues (hunger, fullness, satisfaction, emotions).
- Explicitly rejects diet culture - and the systems that uphold it, including patriarchy, racism, and weight stigma - along with external food rules.
- Includes 10 principles (e.g. honouring hunger, challenging the food police, respecting fullness, coping with emotions without food).
- Often used therapeutically in recovery from chronic dieting or disordered eating.
- E.g. You notice gentle hunger and decide to eat lunch. You choose tuna pasta because it sounds satisfying, and stop when you feel comfortably full. You don’t label the food as “good” or “bad.”
Next is what I simply refer to as "Normal" Eating - a term coined by Ellyn Satter. This is balanced, adequate, and relaxed eating without much thought or fuss. When I think of the poster child for normal eating, I think of, well, a child! Someone around age 3-4, who is responding purely to their innate bodily cues - but aren't actively resisting diet culture on account of not knowing it exists yet (imagine!). Folks eat three meals a day (give or take), sometimes more, sometimes less, sometimes dessert, sometimes not. It’s “good enough” eating - flexible and socially integrated, but not necessarily deeply attuned like Intuitive Eating. The TL;DR?
- A concept from Ellyn Satter (1983).
- Food is balanced, flexible, and socially integrated.
- It’s about eating 3 meals a day (give or take), sometimes snacking, sometimes having dessert, sometimes eating more, sometimes less.
- There’s no obsession with rules, but also not necessarily deep body-awareness.
- It’s “good enough” eating - adequate, varied, and relaxed.
- E.g. You eat toast and eggs for breakfast, a sandwich for lunch, pasta for dinner. Sometimes you overeat at a birthday party, sometimes you skip a meal when busy. Overall, it balances out.
Sitting in the messy middle is Disordered Eating, which is extremely common in our diet-obsessed culture. It includes dieting, rigid food rules, guilt, shame, and body preoccupation. It often grows out of social pressures to change our bodies, the rise of “clean eating,” and wellness trends that disguise restriction as health. Even though these behaviours may not reach diagnostic thresholds, they can significantly harm physical, psychological, and I would add, spiritual wellbeing. Many naturopathic clients will be here, often without recognising the problem themselves.
Many of us were exposed to disordered patterns from childhood - parents passing their dieting mentality onto their kids, kids who were started on Weight Watchers at age 12 by a parent, “almond mums”. These parents are also products of diet culture themselves.
Dieting is one of the strongest predictors of disordered eating. While often marketed as a “healthy lifestyle,” research shows that dieting increases the risk of eating disorders such as anorexia nervosa, bulimia nervosa, and binge eating disorder.
- Driven by dieting, food rules, and/or weight preoccupation
- Behaviours include chronic dieting/restrictive eating, fasting (including sustained and strict intermittent fasting and repeated "juice feasts"), binge–restrict cycles, compulsive exercise, or frequent detoxes/cleanses.
- Eating often comes with guilt, shame, and rigid control rather than flexibility.
- GI symptoms (bloating, reflux, constipation) often linked to under-fuelling or anxiety about food.
- Normalised in our culture (“clean eating,” intermittent fasting, juice cleanses), sometimes even by medical professionals (in the case of over-prescribing GLP-1 medications), which makes it harder to recognise as harmful.
- Strong predictor of eating disorder development if left unaddressed.
Even when behaviours don’t meet diagnostic criteria for an eating disorder, disordered eating can still damage physical health, mental wellbeing, relationships, and self-esteem. It’s so normalised in our culture that people often don’t see it as a problem, until it intensifies and pushes them further along the spectrum toward a clinical eating disorder.
Just before diagnosable eating disorders is the category of Subclinical Eating Disorders. These clients experience significant distress and impairment, but don’t meet all the DSM criteria for a diagnosis. Because of this, they often slip through the cracks of healthcare. They may think they’re “not sick enough” to deserve support (to use the words of the wonderful Dr. Jennifer Gaudiani), yet their suffering is real and serious. Plus, not everyone with an eating disorder can access a formal diagnosis.
It’s vital to remember: you don’t need a diagnosis to deserve help. If eating is rigid, chaotic, or tied up in shame, support is warranted. How I've seen this show up in practice:
- A client bingeing 2-3 times a month (rather than the diagnostic threshold of once a week) but feeling intense guilt and distress.
- Someone who restricts food heavily but doesn’t meet BMI cut-offs for anorexia - yet is still physically and psychologically unwell. AAN is something I educate GPs on as it’s the most common form of anorexia yet is called “atypical”, which is just a joke at this point. But I digress..
- A client who purges occasionally, but not “frequently enough” to meet criteria for bulimia nervosa.
- A person whose obsessive “clean eating” causes major social isolation and stress, but doesn’t tick enough boxes for an official diagnosis.
- Clients who cycle between dieting and overeating but describe it as “just bad habits” or “no willpower.” This always breaks my heart as often these are some of the most accomplished, disciplined people I have ever met.
As you can see, these are not “mild” problems. They’re significant struggles that impact health, relationships, and quality of life, and they deserve support.
At the far right end of the spectrum are clinically diagnosable eating disorders such as anorexia nervosa, bulimia nervosa, binge eating disorder, ARFID, and OSFED/EDNOS. These conditions meet strict diagnostic criteria and usually require medical, psychological, and dietetic care in a multidisciplinary setting.
What this looks like in clinic:
- Client presents with clear symptoms of anorexia, bulimia, binge eating disorder, ARFID, or OSFED
- Eating behaviours dominate daily life, health, and identity.
- Possible medical instability (amenorrhoea, electrolyte disturbances, fainting or dizziness, rapid weight loss).
- May not identify with the label “eating disorder,” but the severity is evident.
- Needs urgent referral to GP/ED-specialist psychologist/dietitian.
I won’t go into much more detail in this article, but it’s important to remember: by the time a client is here, their eating disorder is rarely just about food. It’s a serious mental health condition with significant medical risks. And urgent, specialised support is needed.
Most clients in naturopathic and herbal practice won’t identify with the words “eating disorder.” They’re often sitting in the disordered or subclinical zones - and this is where practitioners need to tread most carefully.
My lived experience Across the Eating Spectrum
Childhood to Age 15: Normal eating
As a kid, I was a pretty normal eater. Meals were regular, food was social, and I didn’t think too much about it.
15-16: The spark of “health”
Like many science-orientated teenagers, I started flicking through the Body + Soul lift-out in the Sunday Mail. That’s when I first became interested in nutrition - adding more dairy in the form of cheese because I’d read it was “healthy”, despite cheese never being a real staple in our household as my mum is Asian. It was innocent enough, but it planted a seed. I was a sensitive, anxious kid who was pushed hard to succeed academically, so I started running through the bushland I lived close to for stress relief. To the surprise of myself and most other people who knew me as a total nerd, this won me cross country and athletics age champion titles in senior year. I saw the benefits of focussing more on my diet and exercise for health and performance, and it was exciting.
University Years (18-20): Stress, wellness, and healthism
My first degree was veterinary science. Although I don't directly use that degree today, it taught me loads about mainstream medicine which I still respect deeply. Vet school was a medical degree and it was intense - full-time study plus part-time jobs. Around this time, I discovered Buddhism and yoga and became part of a vegetarian community. There were beautiful parts of this - community, meditation, compassion. But it also opened the door to orthorexia.
Keep in mind that it was the early 2000s: the age of “skinny is everything,” clean eating, and the emerging wellness industry. A good friend at uni went vego with me and we attended Buddhist courses together. On the surface it looked healthy, but beneath it was the beginning of rigid, rule-bound eating.
Age 20: Triathlon and the descent into disordered eating
By 20, I was all in - triathlons, long-distance running, even a half Ironman in my final year of vet school. My boyfriend at the time was into raw veganism, fasting, and juice cleanses, and I followed suit.
Looking back I was clearly in disordered eating - if not a diagnosable eating disorder. Knowing what I know now, I would likely have been diagnosed as having atypical anorexia (AAN) with orthorexia mixed in for good measure. My intake was low, my training was extreme, and my stress levels through the roof. My periods stopped for nearly a year, which is never a good thing. I injured myself constantly. Despite eating so little, I actually gained weight due to cortisol dominance and my body adapting to semi-starvation. Which as you might guess, only made me restrict harder.
Age 25: Dietetics through a disordered lens
Ironically, I started my Masters in Nutrition and Dietetics at 25, motivated by an unhealthy obsession with food and a secret hope of learning the “tricks” to finally lose weight! It was very much diet culture disguised as professional ambition. The fat-phobia reinforced throughout this degree didn't help me heal from my disordered eating, although I did learn some nutritional science that started me questioning my limited and haphazard food choices. Not really enough to change, though.
Age 26-27: The turning point
About a year after I graduated as a dietitian (and spent my first year selling weight loss in a colonic hydrotherapy clinic - I knoooow), everything shifted. I stumbled across Rick Kausman’s If Not Dieting, Then What? and later, the work of Evelyn Tribole and Elyse Resch. For the first time, I saw my own behaviours clearly: this wasn’t health, it was harm. And it wasn't serving me the way I had hoped for so long that it would.
I began therapy, connected with non-diet dietitians, and was inspired by their courage and fire. I also discovered feminism and started seeing diet culture as part of a larger system of oppression. I got angry - and that anger fuelled change. I stopped over-exercising, broadened my diet, and began the long process of healing.
Late 20s: Relearning nourishment
At 29 I became pregnant, and my body made its needs very clear. My iron levels plummeted. I remember making this liver pâté, tasting it, and nearly blacking out from how intensely my body wanted more. That was the moment I dropped veganism. Pregnancy and early motherhood were what finally taught me to nourish myself deeply, instead of restrict and punish.
30s: Building strength, not shrinking
In my early 30s, a personal trainer friend introduced me to strength training. For the first time, the focus wasn’t on shrinking my body, but on building it up: strength, vitality, energy. This was a revelation.
Throughout my 30s, I continued my own psychotherapy and immersed myself in various counselling modalities, eating disorder and chronic dieting trainings. I began working with clients, bringing my lived experience into practice. And I finally learned what it meant to be an intuitive eater: flexible, values-aligned, and actively pushing back against diet culture.
Why share this?
Because I’ve lived at every point along the spectrum. From “normal” eating to full-blown orthorexia, to recovery and intuitive eating. That journey is why I care so much about helping other practitioners recognise the messy middle, and why I believe we can do better than simply repeating diet culture under the guise of wellness.
In Part 2 of this series, I’ll show you the five red flags to look for in clinic - signs that your client’s gut complaints, fatigue, or diet goals may actually be disordered eating in disguise.
If you’d like to go deeper into this work - learning the screening tools, referral know-how, and naturopathic approaches that actually support recovery without fuelling diet culture - join me in my upcoming course, Disordered Eating for Naturopaths.
Let’s change how naturopathy does eating disorder care! You can pop your name on the waitlist here.
With love and anti-diet fire,
Casey
These are good starting places when identifying and starting to heal your relationship with food, eating and your body, and also refer to the facts and frameworks I referred to throughout this article.
- NEDC (National Eating Disorders Collaboration). (2019). Disordered eating fact sheet. https://nedc.com.au
- Butterfly Foundation. Australia’s national ED support service with resources for individuals and professionals. https://butterfly.org.au
- Kausman, R. (2004). If Not Dieting, Then What? Sydney: Allen & Unwin.
- Tribole, E., & Resch, E. (2020). Intuitive Eating: A Revolutionary Anti-Diet Approach (4th ed.). St. Martin’s Press.
- Bacon, L., & Aphramor, L. (2011). Weight science: Evaluating the evidence for a paradigm shift. Nutrition Journal, 10(9). https://doi.org/10.1186/1475-2891-10-9
National Eating Disorders Collaboration. (2019). Eating disorders in Australia: Prevalence and risk factors. Retrieved from https://nedc.com.au
Neumark-Sztainer, D., Wall, M., Guo, J., Story, M., Haines, J., & Eisenberg, M. (2006). Obesity, disordered eating, and eating disorders in a longitudinal study of adolescents: How do dieters fare 5 years later? Journal of the American Dietetic Association, 106(4), 559–568. https://doi.org/10.1016/j.jada.2006.01.003
Preti, A., de Girolamo, G., Vilagut, G., Alonso, J., de Graaf, R., Bruffaerts, R., ... & Morosini, P. (2009). The epidemiology of eating disorders in six European countries: Results of the ESEMeD–WMH project. Journal of Psychiatric Research, 43(14), 1125–1132. https://doi.org/10.1016/j.jpsychires.2009.04.003







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