Eating Disorder Specialist :
Every January, millions of people in the UK and France embark on a new diet. Calorie counting, intermittent fasting, cutting out carbs, tracking every meal in an app. Most will abandon their regime within weeks. A small but significant number will not — and for them, what started as a decision to "eat more healthily" or "lose a few kilos" may quietly cross a line into something far more serious.
As a nutritionist specialising in eating disorders, I see this progression regularly in my London clinic. It rarely announces itself dramatically. It creeps in, disguised as discipline, willpower, and self-improvement. Which is precisely what makes it so dangerous — and so easy to miss.
What is the difference between dieting and disordered eating?
A diet, in its simplest sense, is a conscious decision to modify what you eat — to lose weight, manage a health condition, or simply feel better. It is time-limited, flexible, and does not dominate every waking thought.
Disordered eating, by contrast, sits on a spectrum. It involves patterns of eating that are irregular, rigid, or distressing — but which may not yet meet the clinical threshold for a diagnosed eating disorder. Think of it as the grey zone: not "normal" eating, but not yet a full disorder either. It includes behaviours such as chronic restrained eating, skipping meals regularly, obsessive calorie counting, rigid food rules, and intense guilt after eating "forbidden" foods.
The critical question is not what someone is eating, but how they relate to food, their body, and their sense of self-worth.
The statistics that matter
The numbers are sobering. A large cohort study found that females who dieted moderately were five times more likely to develop an eating disorder than those who did not diet at all — and those who practised extreme dietary restriction were 18 times more likely to develop one (Patton et al., BMJ, 1999 — a landmark study whose conclusions remain foundational to eating disorder research today).
A 2023 meta-analysis published in JAMA Pediatrics (López-Gil et al.) found significant rates of disordered eating among children and adolescents globally, highlighting how early these patterns can take root. Meanwhile, a major 2025 review published in the International Journal of Eating Disorders (Hoek, 2025) confirmed that eating disorder prevalence continues to rise — and importantly, that menopausal transition in midlife can be as significant a trigger for the development of eating disorders as puberty is in adolescence.
This is something that rarely makes headlines, but which I encounter regularly in clinical practice.
Eating disorders currently affect around 10% of the population in France and the UK. They carry the second highest mortality rate of any psychiatric illness, behind only opiate addiction.
The turning point: when dieting stops being about food
One of the most important things I tell patients — and their families — is this: an eating disorder is not really about food. Food is the arena. The disorder is about control, identity, anxiety, and self-worth.
The shift from dieting to disordered eating tends to happen when:
The rules become inflexible. A diet that began with "I'll eat less sugar" becomes "I cannot eat anything that is not on my approved list." Flexibility disappears. Meals with friends become a source of dread. Restaurants feel threatening.
The goal posts keep moving. The target is never reached — because the real issue was never the weight.
Food thoughts become intrusive. The person spends hours each day thinking about what they have eaten, what they will eat, how to compensate for what they ate. Concentration at work or school deteriorates. Food occupies the mental space that used to belong to other things.
Self-worth becomes conditional. "I was good today" means they ate less. "I was bad" means they ate normally. The entire sense of self-esteem is now contingent on what — and how much — went on the plate.
The body's signals are ignored or overridden. Hunger becomes something to be managed, defeated, or ashamed of, rather than listened to.
The specific warning signs to watch for
Whether you are concerned about yourself or someone close to you, the following signs suggest the line from dieting into an eating disorder may have been crossed.
Behavioural signs:
- Systematically avoiding social situations involving food (restaurants, family meals, dinner parties)
- Needing to go to the bathroom immediately after eating
- Exercising compulsively, even when exhausted or injured, to "compensate" for food consumed
- Weighing oneself multiple times a day
- Cutting food into tiny pieces, rearranging food on the plate without eating it, or eating in ritualistic ways
- Eating only alone, or hiding food and wrappers
Physical signs:
- Unexplained and significant weight loss or gain
- Disappearance of the menstrual cycle (amenorrhea)
- Persistent fatigue and sensitivity to cold
- Digestive problems — constipation, bloating, reflux
- Hair thinning or loss
- Swollen cheeks or erosion of dental enamel (signs of purging)
Emotional signs:
- Intense anxiety or distress around mealtimes
- Irritability, low mood, or withdrawal that worsens after eating
- An increasing preoccupation with food, bodies, and weight that crowds out other interests
- Guilt or shame after eating ordinary amounts of food
- A distorted body image — seeing oneself as larger than one actually is
These signs do not all need to be present. Even a cluster of two or three, persisting over several weeks, warrants a conversation with a professional.
The particular danger of "clean eating" and wellness culture
One of the most insidious developments in recent years is the rise of what researchers now recognise as orthorexia nervosa — an obsession not with eating less, but with eating "purely." The orthorexic person does not focus on calories. They focus on the moral quality of food: organic versus non-organic, processed versus "natural," food intolerances real or imagined.
The danger of orthorexia is that it hides in plain sight. It looks, from the outside, like admirable health consciousness. Instagram celebrates it. Friends ask for advice. But behind the scenes, the person is tormented by anxiety about food contamination, feels disgust and shame when they eat anything "impure," and is progressively restricting their social life to avoid eating anything they cannot control.
Social media and wellness culture have made this pathway into disordered eating much easier to enter — and much harder for families to identify as a problem.
Why early intervention is essential
This is a point I cannot stress enough, and which I make in every consultation with families: with eating disorders, the longer you wait, the harder recovery becomes.
The brain adapts. Restrictive eating changes neurological pathways. Hunger signals become distorted. What begins as a choice becomes, over time, a compulsion. The 2024 year-in-review published in Eating Disorders: The Journal of Treatment & Prevention noted that standardised mortality ratios in adolescents with anorexia nervosa now exceed 21 — meaning the risk of death in this group is more than 21 times higher than in the general population of the same age.
Early intervention — before the disorder is fully entrenched — consistently produces better outcomes. If you are reading this and recognising something in yourself or someone you care about, do not wait until things are "bad enough." In my experience, there is no such thing as too early to seek advice. If it turns out you were worried about nothing, a professional will reassure you. If your concern is valid, you will have acted at the moment it matters most.
A note from my clinical experience: the French perspective
Having trained in France and practised in London for many years, I am often struck by a cultural difference that is rarely discussed. French culture has, historically, maintained a healthier relationship with food than the Anglo-American world — meals are social, pleasure is expected, and the notion of a "diet" carries less cultural prestige than it does in the UK or the US.
And yet, the French are not immune. The pressure of social media, the influence of English-language wellness content, and the same underlying psychological vulnerabilities exist everywhere. What differs is often how quickly families and friends notice — and how quickly they seek help. In France, the general practitioner tends to be the first port of call. In the UK, GPs are often the gatekeepers to specialist care under the NHS, which can mean long waits. In both countries, a specialist nutritionist who works alongside psychologists and psychiatrists can provide an important bridge — particularly in the early stages, before a formal clinical diagnosis has been made.
When to seek help — and where to start
If you are concerned about your own relationship with food, or that of someone close to you, the first step is always to speak to a professional.
If you would like specialist nutritional support — whether you are in the early stages of concern or already in recovery — I offer consultations at my London clinic and online. I work alongside psychiatrists and psychologists to provide integrated care, and I am registered on the French Embassy's official list of practitioners in London (liste de notoriété), offering consultations in both English and French.
You can contact me here.
Frequently Asked Questions
Can a diet trigger an eating disorder even if I never intended to develop one? Yes. Research is clear that dieting — particularly restrictive dieting — is one of the strongest risk factors for the development of an eating disorder, regardless of intention. The disorder often begins with what feels like a reasonable, moderate decision to eat less.
Is it an eating disorder if my weight is still "normal"? Absolutely. Weight is not the primary diagnostic criterion for most eating disorders. "Atypical anorexia nervosa," for example, involves all the psychological and behavioural features of anorexia — restriction, distorted body image, intense fear of weight gain — in people whose weight remains within a "normal" BMI range. These cases are increasingly recognised in clinical settings and are no less serious.
How is an eating disorder different from just being very health-conscious? The key distinction is distress, rigidity, and impairment. Someone who eats healthily does so flexibly — they can adapt when circumstances change, they enjoy meals socially, and their self-esteem does not depend on what they ate today. When healthy eating becomes a source of anxiety, isolation, or self-punishment, it has moved into disordered territory.
At what age can an eating disorder develop? At any age. While adolescence and early adulthood are the most common onset periods, research published in 2025 in the International Journal of Eating Disorders confirmed that midlife transitions — particularly perimenopause — can trigger eating disorders in women who have never struggled with them before. Eating disorders in older adults and in men are significantly underdiagnosed.
What should I say to someone I think has an eating disorder? Choose a quiet, private moment outside of mealtimes. Express concern without criticism or judgment — focus on what you have observed, not on their weight or what they are eating. Avoid phrases like "you just need to eat more" or "you look fine." Instead, say something like: "I've noticed you seem stressed around food lately, and I care about you. Would you be willing to talk to someone about it?" Your role is to open a door, not to push them through it.
Francine Joyce is a London nutritionist (French diététicienne) specialising in eating disorders, digestive health, and weight management. She works with patients in English and French, in person and online. She is a member of the FFAB (French Federation of Anorexia Bulimia) and a regular contributor to BBC, France Info, and France Culture.
Contact Francine | Back to Eating Disorders
Sources:
- Patton G.C. et al., "Onset of adolescent eating disorders: population based cohort study over 3 years," BMJ, 1999
- López-Gil J.F. et al., "Global Proportion of Disordered Eating in Children and Adolescents," JAMA Pediatrics, 2023
- Hoek H.W., "The Incidence and Prevalence of Eating Disorders Between 1975 and 2024," International Journal of Eating Disorders, 2025
- Quadflieg N. et al., cited in "Updates in the treatment of eating disorders in 2024," Eating Disorders: The Journal of Treatment & Prevention, 2025
- National Eating Disorders Association (NEDA), Risk Factors, 2023
- NICE Guideline NG69, Eating Disorders: Recognition and Treatment (reviewed 2024–2025)
- Beat Eating Disorders: beateatingdisorders.org.uk
