Box 8 Warning signs and clinical considerations for eating disorders among people of higher weight

Warning signs and clinical considerations for eating disorders among people of higher weight include:

 Recent body weight fluctuations (increases or decreases) [124].

 Requests for weight loss interventions [118].

 Dietary changes or severe dietary restrictions for medical (e.g., coeliac disease, allergy) or non-medical reasons (e.g., sport, veganism) [125, 126].

 Presence of food insecurity [127].

 Using food consumption or restriction to help regulate emotions [128].

 Increases in or driven/compulsive exercise, especially where there are musculo-skeletal injuries limiting active exercise [124].

 Body image concerns, especially where size and shape are influencing self-esteem (overvaluation) [124].

 Depression, anxiety or substance misuse [depression/anxiety especially predictive of eating disorders in adolescent girls, not as much as in boys; [129].

 Loss of menstruation or fertility in women (not due to fluctuations with puberty onset or menopause) [124].

 Muscle building behaviours in males or females (i.e., intense weight training, use of sports/protein supplements, anabolic steroid use) [125, 130].

 Risk for or diagnosis of type 2 diabetes (e.g., impaired glucose tolerance, signs of metabolic syndrome) [131].

 Insulin misuse in diabetes (type 1 or 2) [132, 133].

 Participation in elite sports or aesthetic-based industries [125, 134, 135].

 Presentation with nutritional (e.g., iron) deficiency/ies [124].