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Educational Use Only: The content of this blog is for informational or educational purposes only and is not intended as individualised dietetic advice for individuals with an eating disorder. Dietitians and other health professionals are encouraged to use clinical judgement when viewing this content.
Mellisa Ashley is a Senior Clinical Dietitian, Accredited Practicing Dietitian and a Credentialed Eating Disorder Dietitian working in a specialist eating disorders service in Sydney.
Eating disorders are serious, complex mental health conditions that affect people across all ages, genders, body sizes, cultures, and backgrounds. Despite their prevalence, eating disorders often go under‑recognised in healthcare settings — including dietetic practice.
In this article, we explore how common eating disorders are in Australia, why they often go unnoticed, and the key behavioural, physical, and psychological red flags all health professionals should be attentive to.
The prevalence of eating disorders in Australia is significant; an estimated 1.1 million Australians, or 4.5% of the population, are currently affected by an eating disorder.1 Alarmingly, the annual incidence of eating disorders is now double that of stroke,1 and prevalence among young people aged 10–19 years has nearly doubled since 2012.1
Eating disorders also have the highest mortality rate of all psychiatric disorders.2 Despite these figures, eating disorders are often still undetected in healthcare settings.
Eating disorders are frequently missed in healthcare settings, including general practice, dietetic practice and other allied health services. This under-recognition can arise from several factors. One is the persistence of stereotyped expectations surrounding how individuals present with an eating disorder, despite increased awareness.
In many cases, individuals may not explicitly present to health professionals with concerns about weight, eating, or body image — instead seeking support for concerns that appear unrelated, allowing eating disorder psychopathology to remain hidden.
Eating disorders are still incorrectly associated with young, underweight women — a stereotype that stigmatises many living with this condition. Eating disorders affect people of all genders, body weights, neurotypes, sexual orientations, ages, socioeconomic status, and cultural backgrounds.3
In general practice, early detection may be overlooked when an individual presents for reasons that do not directly involve weight, nutritional concerns, or growth in children and adolescents. Individuals may seek advice from their general practitioner for “unrelated complaints”,4 such as psychological concerns (e.g. stress, depression, anxiety), or interpersonal, workplace, or school stressors (including school refusal). Some may present with perceived “unrelated” physical complaints such as fatigue, dizziness, headaches, or gastrointestinal issues, menstrual irregularities, or fertility concerns.5
In dietetic settings, clients may seek support for “other” nutritional concerns. These may include iron deficiency anaemia, gastrointestinal symptoms, concerns related to medically-prescribed diets, for weight loss, or self‑imposed dietary restrictions. In these instances, eating disorder psychopathology may remain subtle or undisclosed.
Conditions such as type 1 diabetes or polycystic ovary syndrome (PCOS) involve monitoring of food intake and weight as part of clinical management which may obscure early eating disorder behaviours. There is an increasing prevalence of disordered eating and eating disorders among individuals diagnosed with type 1 diabetes.6
Many individuals value aspects of their eating disorder; aligning traits and behaviours with who they are, and viewing them as acceptable instead of concerning. Therefore, individuals living with eating disorders may minimise any concerns related to health, weight, nutrition, and psychosocial factors, and may feel ambivalent about recovery or avoid treatment altogether.7
Restrictive eating, fasting, compulsive exercise, or body‑focused behaviours may be normalised, or even encouraged within certain sporting, cultural, or religious settings, potentially delaying accurate recognition of an eating disorder.
Health professionals in general practice may be underprepared to identify symptoms of an eating disorder8 and to respond in a sensitive, timely, and affirming manner, further delaying diagnosis and treatment. Historically, up to 97% of the health workforce have reported insufficient training to confidently identify and manage individuals with eating disorders.8
Stigma, shame, fear, denial of the illness, and an inability to perceive the severity of their illness may also delay timely diagnosis and treatment for an eating disorder.4,9 Furthermore, previous negative experiences when accessing care from health professionals, such as weight stigma, has also resulted in delayed diagnosis, care, and treatment.
Additionally, general practice appointments tend to be short and may not allow for in-depth exploration of an individual’s thoughts, feelings, and beliefs regarding food and body.
Geographical factors, limited access to specialist services (in regional and rural areas), and financial barriers such as cost can all potentially delay access to care.9
For all NSW health professionals, eating disorders are core business. Given their prevalence and severity, eating disorder care must be recognised as a standard, expected, and accessible component of healthcare service provision — not just a niche specialty. It is a collective responsibility to recognise the warning signs early and intervene when necessary.
Early detection and intervention are strongly associated with:
Despite this, around 70% of individuals with an eating disorder report being inappropriately linked to a health professional for treatment.12,13
Eating disorder red flags often span behavioural, physical, psychological, and language-based cues. Many are subtle and best identified through pattern recognition rather than isolated symptoms.
This is not an exhaustive list, and there may be individuals who may experience eating disorders, disordered eating, and/or a negative relationship with food and not exhibit many of these signs. That does not mean their concerns should not be taken seriously, nor should they be dismissed.
It is important to note, normal blood results do not rule out an eating disorder, particularly in the early stages of illness.
These may be more challenging to detect because of an individual's secrecy or shame surrounding their behaviours.14,15
Be alert to self-talk involving:
All Accredited Practising Dietitians (APDs) play an essential role in identifying and screening individuals with eating disorders and sub-clinical eating disorder behaviours. APDs, who have obtained further knowledge and skills via additional training, and with ongoing clinical experience and engagement in clinical supervision with an experienced supervisor are best equipped to manage more complex cases and treat individuals with an eating disorder as part of a multidisciplinary team, alongside medical and mental health professionals.
Health services where care of a person with an eating disorder is core business, must include Dietitians as an essential part of the multidisciplinary care team within community and inpatient services.
Knowing the limits of one’s professional and personal scope is essential. When a presentation exceeds your training, knowledge, or confidence, seeking further support through supervision or professional pathways is vital.
If an eating disorder is suspected, use a curious, empathetic, and patient‑centred approach and consider employing a validated screening tool, such as the SCOFF16 or IOI-S17, to assist with early identification.
Share any concerns transparently and without judgement. Avoid language that is dismissive, invalidating, or implies blame or shame. Support referral pathways to a GP, mental health practitioner, or eating disorder service for assessment, a formal diagnosis, and coordinated care.
Health professionals can recommend the InsideOut eClinic where appropriate, which provides free, evidence‑based CBT digital therapies and tools for those experiencing eating disorder symptoms.
For general practitioners, the InsideOut GP Hub and Practice Manager Toolkit provide valuable support in recognising the signs of eating disorders. The Hub is a practical, evidence-based digital decision-support tool designed to assist GPs in early detection, guide accurate diagnosis, and inform treatment planning that aligns with the stage of illness and the unique needs of each patient.
If you have concerns about yourself or someone you support, reaching out to a GP or eating disorder service is an important first step.
Immediate referral to an emergency department is warranted if there are signs of potential medical or psychological instability18,19, including:
It is important to note that individuals in living in a larger body are at an increased risk of disordered eating compared with the general population. These individuals are more likely to misuse weight-control practices such as fasting, purging, and diet pills, placing them at an increased risk of medical instability.20
Eating disorders are core business for all health professionals, including dietitians. Every dietitian has a role in recognising risk, responding appropriately, and supporting access and timely care.
For many clinicians, further education and supervision can enhance confidence and competence when working with more complex eating disorder presentations.21
This may include:
Further trainings and accreditations can be explored via the links below:
Eating disorders require a shared, whole‑of‑healthcare response. When health professionals recognise early warning signs, respond compassionately, and work within multidisciplinary pathways, outcomes can be significantly improved.
For dietitians specifically, ongoing collective advocacy efforts from key members of the Eating Disorders Interest Group (EDIG), Dietitians Australia, and the EDIG leadership committee have successfully re-positioned the role of the dietitian within the eating disorders care team for the NEDC National Framework for eating disorder training.22
Dietitians are now formally recognised as a core member of the treating team, alongside medical and mental health professionals, as a minimum standard. This recognition highlights the essential contribution dietitians make to eating disorder care and the positive impact they have on treatment quality and outcomes for individuals.
Making eating disorder care core business for dietitians goes beyond best practice; it’s a critical step toward earlier intervention, more effective treatment, and better recovery outcomes for those who need it most.
Butterfly National Helpline: 1800 334 673
Beyond Blue: 1300 22 4636
Lifeline: 13 11 14
Men’s Line Australia: 1300 78 99 78
Kids Helpline: 1800 55 1800
Educational Use Only: The content of this blog is for informational or educational purposes only and is not intended as individualised dietetic advice for individuals with an eating disorder. Dietitians and other health professionals are encouraged to use clinical judgement when viewing this content.
References: