The warning signs we congratulate

Most lists of eating disorder warning signs describe things that look like problems. Secrecy around food. Skipping meals. Distress after eating.

This piece is about the other kind — the behaviours that look, to almost everyone including the person doing them, like discipline.

Six minutes

Researchers randomised 481 college students into three groups and had them watch six minutes of short-form video. One group watched “lifestyle” content — the familiar what-I-eat-in-a-day format, depicting restrictive diets. One watched “eating only” content, where a creator eats large amounts of highly palatable food. The control group watched art videos.

Before and after, participants rated their preoccupation with weight and shape and their urges to binge, purge and exercise.

Six minutes of the lifestyle content increased weight and shape preoccupation and increased the urge to exercise, and maintained urges to binge and purge. The effect on weight and shape preoccupation was stronger in women.

The eating-only group came out more preoccupied with weight and shape too. Their urges to binge, vomit and exercise held steady rather than falling. So the effect wasn’t confined to the openly restrictive content — both kinds of food video moved people in the same direction.

The control group — the ones watching art — showed a decrease in the urge to binge eat and to exercise.

This is the only experimental, causal evidence in this whole series, and it involves six minutes of content that is not merely tolerated but algorithmically rewarded.

Exercise is the clearest example

In a multi-country study of 31,671 people with a lifetime history of an eating disorder — meaning they had met criteria for one at some point in their life — 88% reported maladaptive exercise at some point.

Maladaptive exercise is the umbrella term for exercise that has stopped being a choice: continued through injury or illness, used to compensate for eating, or impossible to skip without guilt or anxiety. 

Around 40% described exercise they felt driven to do currently, and around 35% described it as compulsive.

Prevalence was highest in anorexia nervosa but high across every diagnosis and every country studied.

Nearly nine in ten. And of all the behaviours associated with eating disorders, this is the one most likely to be described admiringly — as commitment, as dedication, as someone who never misses a session.

There is no clean line between committed and compulsive, and clinical reviews are explicit that no consensus definition exists. But the absence of a bright line is a reason to ask, not a reason to assume.

Even the compliments

This is the finding people find hardest, and it’s the oldest research here.

A study of appearance-related commentary found that the impact of both criticism and compliments — not how often they happened, but how much they landed — predicted higher body surveillance and greater body dissatisfaction. Compliments about appearance can activate the same self-monitoring that criticism does, particularly in people already prone to watching themselves.

Which puts a very ordinary clinical moment in an awkward light. “You’re looking well.” “You’ve done brilliantly.” Said warmly, meant warmly, and not necessarily neutral.

Including from us

In interviews with 38 adults with atypical anorexia nervosa about their experiences of medical care, one of the themes patients described was providers pathologising their weight — and they reported that this triggered eating disorder behaviours and relapse. Other themes were minimisation and denial of the disorder, with consequent delays in screening and care.

The authors’ own conclusion is worth quoting rather than paraphrasing: many providers “may inadvertently reinforce patients’ EDs.”

Inadvertently. Not carelessly. The mechanism is that weight-focused care and weight-focused encouragement look, from the inside, like good practice.

And the people paid to encourage it

One answer from our own survey has stayed with us. It came from a fitness professional, unprompted, when we asked what training the field needed:

“I also know of friends who have flagged concerns over body image and not wishing weigh in etc to be a part of check ins and their fitness professional has continued to request this data. I think more awareness of the potential dangers of this behaviour is needed for some fitness professionals.”

Someone said they didn’t want to be weighed. They were weighed anyway. And the person noticing it was another fitness professional, asking for training.

Others in the same survey asked for exactly what’s missing: “a course for fit pros to support ED folks in recovery with return to movement”, and “how can movement be used in a way that is supportive to the person in recovery”.

We’re building it. A training for fitness professionals and sports coaches is in development for 2027 — if that’s your field, the newsletter is where it will be announced first.

So, what do we do with this

Nothing dramatic. This isn’t a call to stop saying kind things to patients.

It’s an invitation to notice a category you may not have had a category for: the changes that arrive looking like improvement. Someone who has become very consistent about training. Someone whose diet has become very clean. Someone who has lost weight and seems pleased about it.

None of those is a diagnosis. All of them are worth a question rather than a compliment.

Nobody is asking you to police how people eat or exercise. Only to notice that some of what we routinely admire is, for some people, the illness doing its work.

You don’t have to be a specialist. You do need training — and we can help with that.

The training

Eating Disorders: What Every Professional Needs to Know is a one-day training for clinicians, therapists, dietitians and allied health professionals who don’t work in eating disorders and don’t intend to — but who want to recognise one when it’s in front of them, and know how to support a client who presents with signs and symptoms.

Saturday 28 November 2026, 10:00–16:00, at the Carmelite Centre, Dublin 2. Six hours, six CPD points (PSI). €169, or €139 for students. It runs on a Saturday, so it doesn’t cost you clinic time.

See the full programme →Eating Disorders: What Every Professional Needs to Know

Frequently Asked Questions

Can social media content directly affect eating disorder symptoms?

Yes. In a randomised experiment with 481 participants, six minutes of short-form “lifestyle” video depicting restrictive diets increased weight and shape preoccupation and increased the urge to exercise, while a control group watching art content showed a decrease in urges to binge eat and exercise.

How common is maladaptive exercise in eating disorders?

In a multi-country study of 31,671 people with a lifetime history of an eating disorder — meaning they had met criteria for one at some point in their life — 88% reported maladaptive exercise at some point. Around 40% described exercise they felt driven to do currently, and around 35% described it as compulsive.

Can complimenting someone on their appearance be harmful?

Research on appearance-related commentary found that the impact of both criticisms and compliments predicted higher body surveillance and greater body dissatisfaction. Compliments about appearance can activate self-objectification, particularly in people already prone to body monitoring.

Can healthcare providers unintentionally reinforce an eating disorder?

Yes. In interviews with 38 adults with atypical anorexia nervosa, patients described providers pathologising their weight and reported that this triggered eating disorder behaviours and relapse. The authors concluded that many providers may inadvertently reinforce patients’ eating disorders.

How do you tell committed exercise from compulsive exercise?

There is no consensus definition or established best practice for making this distinction, and clinical reviews say so explicitly. The absence of a clear threshold is a reason to ask about a patient’s relationship with exercise rather than to assume it is healthy.

Sources

• Davis et al. (2025), Appetite 211:108002. DOI: 10.1016/j.appet.2025.108002

• Watson et al. (2026), International Journal of Eating Disorders 59(1):190–204. DOI: 10.1002/eat.24563

• Calogero, Herbozo & Thompson (2009), Psychology of Women Quarterly 33(1):120–132. DOI: 10.1111/j.1471-6402.2008.01479.x

• Harrop et al. (2023), Body Image 46:48–61. DOI: 10.1016/j.bodyim.2023.04.008

• Gorrell, Drury & Schaumberg (2026), Psychiatric Clinics of North America 49(1):97–114. DOI: 10.1016/j.psc.2025.08.008