When someone loses a lot of weight, people may congratulate them without realising that something serious could be happening. A parent might notice their teenager pushing food around a plate, a friend may see someone avoiding meals, or a family member may become concerned about constant exercise and an increasing fear of putting on weight.
It is easy to assume that the person is simply dieting or trying to look slimmer. But anorexia nervosa is much more complicated than that. It is a serious eating disorder that affects both physical health and mental wellbeing. Behind the behaviour may be anxiety, a need for control, low self-esteem or an overwhelming fear of gaining weight.
As a community pharmacist, I believe it is important to recognise the warning signs early. The sooner someone receives appropriate help, the better their chances of recovery.
It is not simply about being thin
Anorexia nervosa involves restricting food intake, often alongside an intense fear of gaining weight and a distorted perception of body shape or weight. A person may believe they are overweight even when they are dangerously underweight.
However, anorexia cannot be identified by appearance alone. People can develop eating disorders at different body sizes, and you cannot reliably judge someone’s physical or mental health simply by looking at them. The NHS explains the range of behavioural and physical signs associated with anorexia in its guide to anorexia symptoms.
Although it can affect anyone, anorexia often begins during adolescence or early adulthood. It can also develop later in life, including in people who have previously had no difficulties with food or body image. It affects men and boys as well as women and girls, although their struggles may be overlooked because eating disorders are sometimes wrongly regarded as a female problem.
There is rarely one single cause. Genetic vulnerability, psychological difficulties, social pressures and life experiences may all contribute. Social media can add to the pressure by promoting unrealistic body ideals, comparing appearances and presenting restrictive eating as a sign of discipline or success. But it is important not to blame one factor, or assume that every person with anorexia has the same experience.
The warning signs may be easy to miss
Changes in eating habits can initially appear harmless. Someone may say they have already eaten, become increasingly particular about food, cut meals into tiny pieces or avoid eating with family and friends. They may remove entire food groups, count calories obsessively, weigh themselves repeatedly or exercise even when exhausted or unwell.
Some people become secretive about eating. Others become anxious or distressed when a meal does not go according to plan. A person may insist they are fine despite losing a significant amount of weight.
Physical signs can include feeling cold all the time, dizziness, weakness, persistent tiredness, constipation, abdominal discomfort, dry skin and hair loss. In women who have not reached menopause, periods may stop; in younger people, growth and puberty can be affected.
These symptoms should not be dismissed as the inevitable consequences of dieting. Severe restriction can lead to malnutrition, low blood pressure, a slow heart rate, hormonal changes and disturbances in the body’s salts and minerals. In serious cases, the heart and other organs can be affected.
A person does not need to look extremely thin before their health is at risk.
What can families and friends do?
Recognising a problem is one thing; knowing how to approach it is another. Telling someone to “just eat more” or commenting repeatedly on their weight is unlikely to help. The fear and distress surrounding food can feel very real to the person, even when others cannot understand it.
A calmer approach is to describe what you have noticed without criticism. For example, you might say, “I’ve noticed you’ve been struggling with meals lately, and I’m worried about how you’re feeling. Is there anything you’d like to talk about?”
Try to listen rather than argue about calories, appearance or whether someone is too thin. Avoid praising weight loss, even if it appears to have been intentional. Instead, focus on their wellbeing, energy, mood and how difficult things seem to have become.
Family members should also remember that anorexia is not simply a choice or a failure of willpower. Blaming the person, or blaming parents, can make it harder for everyone to seek help. Recovery often requires patience, professional support and a coordinated approach.
The role of the community pharmacist
A pharmacy may be one of the places where concerns first emerge. A pharmacist might notice repeated requests for laxatives, questions about appetite suppressants, excessive interest in weight-loss products or a person who appears increasingly unwell.
Laxatives and diuretics do not provide a safe way to control body weight. Laxatives mainly affect bowel movements, while diuretics increase fluid loss; neither reverses the effects of inadequate nutrition. Misuse can cause dehydration and dangerous electrolyte disturbances.
If a customer raises concerns about restrictive eating, the pharmacist’s role is not to diagnose anorexia from a brief conversation. It is to listen without judgement, explain why the symptoms need assessment and encourage prompt contact with a GP. Where appropriate, the pharmacist can help the person understand how to access specialist eating-disorder support.
The NICE guideline on eating disorders advises that suspected eating disorders should be assessed and referred promptly. A person’s BMI or the length of time they have been unwell should not be used on its own to decide whether they deserve treatment.
That is an important message: someone should not have to become severely underweight before their concerns are taken seriously.
Can anorexia be treated?
Yes. Recovery is possible, although it can take time and progress may not be straightforward. Treatment generally combines psychological therapy, nutritional support and monitoring of physical health. The approach depends on the person’s age, circumstances, medical condition and individual needs.
For adults, recommended psychological treatments include eating-disorder-focused cognitive behavioural therapy and other specialist therapies. For children and young people, family-based treatment may be offered where appropriate. The aim is not simply to restore weight, but also to address the thoughts, fears and behaviours that maintain the illness and to support a healthier relationship with food.
Weight restoration can be an essential part of recovery because the brain and body need adequate nutrition to function properly. Medication alone is not an adequate treatment for anorexia. In severe cases, hospital care may be necessary to manage medical complications safely.
The NHS provides further information about treatment for anorexia nervosa.
When should someone seek urgent help?
If you suspect that you or someone you care about may have anorexia, contact a GP as soon as possible, even if you are uncertain. Do not wait for further weight loss or assume that the person will recover without help.
Seek urgent medical assessment if there is fainting, severe weakness, dehydration, significant palpitations or a rapid deterioration in health. If someone collapses, has chest pain, is confused or appears seriously unwell, call emergency services.
In the UK, Beat, the eating-disorder charity, offers information and support through beateatingdisorders.org.uk. Its support can be useful for people experiencing an eating disorder and for families who are trying to understand what to do next.
Anorexia is not a vanity problem, and it is not something that can be solved by telling someone to eat a bigger meal. It is a serious illness that deserves compassion, proper medical assessment and specialist care.
Sometimes, the most helpful thing we can do is notice the change, ask a kind question and help someone take that first step towards support.
Until next time, look after yourself.
This article is for general health information and is not intended to replace individual medical advice.
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