How our desire to control our weight, diet and body is gradually changing our relationship with food

– and where does the line between „healthy eating“ and problematic eating behaviour lie?

There are also some significant statistics behind this topic: a recent review estimates the lifetime prevalence of eating disorders to be approximately 2-5% of the population, whilst a new meta-analysis of children and young people has found a global point prevalence of around 5.23% – approximately 1 in 20.

When does looking after your health turn into a battle against food and your own body?

A dietitian’s perspective on eating disorders, diets, weight stigma and the era of „quick weight loss“

In recent years, we’ve been talking more and more about healthy eating. We talk about calories, protein, carbohydrates, sugar, fats, „inflammatory“ foods, gluten, dairy products, seed oils, fasting, detox, low-carb, keto, intermittent fasting, GLP-1 medications, Ozempic, Wegovy and Mounjaro. At first glance, all this seems to be about an interest in health.

But as a dietitian, I find myself asking another question more and more often:

When does the desire to eat „properly“ cease to be about looking after our health and start to turn into control, fear and punishment?

Because there’s a huge difference between „I want to eat a more balanced diet“ and „I’m afraid to eat this food“. And sometimes that difference isn’t obvious from the outside.

An eating disorder does not always manifest as someone who is very underweight

This is one of the most important things I want to say as a dietitian. When we hear the term „eating disorder“, many people automatically picture anorexia and someone with an extremely low body weight. The reality is much more complex.

Eating disorders include anorexia nervosa, bulimia nervosa, binge-eating disorder, ARFID and other eating disorders, and a person with an eating disorder may have underweight, normal or overweight.

A recent medical review estimates the lifetime prevalence of eating disorders to be approximately 2-5%, as these are linked not only to diet and weight, but also to significant mental and physical consequences.

And when it comes to children and young people, the picture is even more worrying.

A meta-analysis published in 2025 included 16 studies and over 77,000 children and young people from 12 countries. The estimated global point prevalence of eating disorders is 5.23% – approximately 1 in every 20. This does not mean that one in five people has a clinically diagnosed eating disorder.

But it means something very important:

Problematic attitudes towards food and the body are far more widespread than we often realise.

And there’s also a huge grey area

Between a clinically diagnosed eating disorder and a completely relaxed attitude towards food, there is a vast spectrum of behaviours that may appear „healthy“ but can become a problem.

For example:

• fear of certain foods;
• constant calorie counting;
• feelings of guilt after eating;
• compensatory fasting after „overindulging“;
• excessive physical exertion with the aim of „burning off“ what one has eaten;
• continuous weighing;
• avoiding social occasions because of the food;
• classifying foods as „clean“ and „dirty“;
• the inability to eat without knowing the calorie content;
• obsessive monitoring of macronutrients;
• fear of putting on weight;
• constantly starting a new regime;
• the feeling that one „bad“ choice has ruined the whole day.

This may not meet the diagnostic criteria for an eating disorder.

But Our attitude towards food is no longer relaxed.

And that is important.

When „healthy eating“ becomes unhealthy

In my practice, I see people who don’t eat „unhealthily“.

In fact, they have gone to the other extreme.

Their diet is so strictly controlled that:

• every meal must be „right“;
• Every meal should be planned;
• any deviation causes anxiety;
• the restaurant is becoming a problem;
• the festive season becomes a trial;
• a birthday turns into a calorie count;
• and food gradually ceases to be just food.

We need to be careful here.

Discipline does not automatically lead to good health.

Conversely, flexibility does not mean a lack of discipline.

Healthy eating should be possible in real life too.

And what happens when we’re constantly talking about „less“?

Fewer calories.

Fewer carbohydrates.

Less sugar.

Less fat.

Less weight.

A smaller body.

A reduced appetite.

Less food.

At some point, a person may start to believe that the less he eats, the healthier he is.

But that simply isn’t true.

Health isn’t just measured by how little you can eat.

Weight stigma also matters

Here’s a topic which, in my view, we don’t discuss enough – weight stigma.

This refers to the stigma, discrimination and negative attitudes towards people because of their body weight or size.

And it doesn’t just come from the internet.

It may come from:

• family;
• partner;
• friends;
• school;
• working environment;
• social media;
• medical professionals;
• even from the person themselves towards their own body.

More than 40% of adults in US studies report having experienced some form of weight stigma. Research links weight stigma to disordered eating, avoidance of physical activity, poorer mental health and avoidance of medical care.

This is particularly important because a person might start changing their diet not because they want to look after their health, but because:

is afraid of being rejected.

And these are two completely different motivations.

„I need to lose weight“ versus „I want to look after my health“

This may seem like a minor linguistic difference.

But it isn’t.

„I need to lose weight because my body is ugly.“

и

„I want to improve my metabolic health.“

are not the same thing.

In the first case, the engine may be shame.

In the second – care.

And the role of a good dietitian is not simply to prescribe a diet.

It is to understand why the person wants to change their diet.

And then came social media

We have never been exposed to so much information about food.

And we have never been exposed to so many conflicting messages.

One day:

„Dairy products are inflammatory.“

Next:

„Coffee messes with your hormones.“

Then:

„Seed oils are toxic.“

Next:

„Carbohydrates are the cause of insulin resistance.“

Then:

„Don’t eat after 6 pm.“

Next:

„Eat only within an eight-hour window.“

And finally:

„This one meal will balance your hormones.“

The problem isn’t that people are interested in their health.

The problem arises when health becomes an endless list of fears.

And then GLP-1 medicines came along

Ozempic, Wegovy, Mounjaro and other GLP-1-based therapies have changed the conversation about weight.

Here, too, we must be extremely careful.

As a dietitian, I wouldn’t say:

„These medicines are bad.“

That would be scientifically unfounded.

They have proven medical benefits for certain patients with type 2 diabetes and/or who are overweight, and can be extremely helpful as part of medical treatment.

But the fact that a particular treatment works for a specific medical condition, It does not mean that everyone has to use it for the sake of their appearance.

And, more importantly:

The medication does not eliminate the need to understand a person’s relationship with food.

What do we know about GLP-1 medicines and eating disorders?

We need to be honest here:

We still don’t know enough.

Preliminary evidence suggests that GLP-1 receptor agonists may reduce binge-eating episodes in some people.

However, the data is limited.

The National Association for Eating Disorders notes that there are few studies available, which often have small sample sizes and short durations, whilst the long-term psychological and behavioural consequences for people with eating disorders remain understudied.

A more recent international Delphi study involving multidisciplinary experts and people with lived experience reached a consensus on a number of recommendations regarding the use of GLP-1 medicines in eating disorders, but the authors emphasise that the evidence base remains limited and inconsistent.

This means that the question should not be:

„Do GLP-1 medicines cause eating disorders?“

At this stage, we do not have sufficient evidence to draw such a simple conclusion.

A better question is:

„How can we use these medicines safely in someone who has, or is at risk of, problematic eating behaviour?“

There is another major risk: that the medicine could become a tool for control

If a person has a history of:

• restrictive eating;
• binge eating;
• compensatory behaviour;
• an obsessive fear of putting on weight;
• body checking;
• excessive exercise;
• skipping meals;
• severe anxiety about food;

It is not enough simply to say:

„Here’s an injection that will curb your appetite.“

We need to ask some more questions.

What does this person eat?

Is he getting enough energy?

Is he getting enough protein?

What’s happening with his relationship with food?

Are there any binge episodes?

Is there any compensatory behaviour?

Is there a fear of certain foods?

How is his mental state changing?

Is there a medical risk?

This is the place where Medicine, dietetics and psychology must work together.

Particularly important for people who are overweight

One of the most dangerous misconceptions is:

„If a person is overweight, they cannot possibly have an eating disorder.“

That is incorrect.

In a systematic review and meta-analysis from 2025, comprising 85 studies and over 94,000 adults seeking treatment for overweight or obesity, the pooled prevalence of binge-eating disorder, as identified through clinical interviews, was approximately 14%.

This is a very good reason to stop judging eating habits based on appearance.

You can’t tell if someone has an eating disorder from a photo.

And how many people actually seek help?

And here we have a problem.

A recent systematic review and meta-analysis from 2025 found that approximately 30% of people with an eating disorder report some form of help-seeking, and around 32% report seeking formal treatment from a healthcare professional for their eating disorder.

In other words, a significant proportion of people never manage to get the right help.

There are many reasons:

• shame;
• fear of judgement;
• the belief that „I’m not thin enough to have an eating disorder“;
• lack of recognition;
• a shortage of specialist services;
• normalisation of behaviour;
• fear of putting on weight;
• the feeling that controlling one’s diet is „healthy“.

As a dietitian, I don’t want to tell you to stop taking an interest in food

On the contrary.

I want you to understand food better.

But there is a huge difference between nutrition literacy и obsession with nutrition.

It’s useful to know what protein is.

Knowing how much protein you need – that’s useful.

Being able to choose a balanced diet – that’s good for you.

But if you can’t eat a meal without checking the label…

if you feel guilty after dessert…

if you skip dinner because you’ve eaten too much at lunch…

if you train as a form of punishment…

if your thoughts about food take up a huge part of your day…

In that case, perhaps the question is no longer:

„How healthily do I eat?“

A:

„How much freedom do I have when it comes to food?“

Healthy eating must have a place in our lives

In real life, there are:

Birthdays.

Holidays.

Travel.

Restaurants.

Pizza with friends.

Chocolate.

A cake.

Breakfast at the hotel.

Food we simply love.

And that doesn’t mean we’ve „broken ranks“.

That means we are human beings.

Is there scope for weight loss?

Of course.

Weight loss may be medically important for certain people.

There are situations in which weight loss can improve metabolic parameters, symptoms, physical function and quality of life.

But The method matters.

If we want to lose weight:

• develop a fear of food;
• we lose our social life;
• let’s start making up for it;
• we are constantly punishing ourselves;
• we become obsessed with the scales;
• lose muscle mass;
• develop an eating disorder;

In that case, we cannot automatically describe the process as „healthy“.

As a dietitian, what would I like to see more of?

No more fear of food.

And more education.

No:

„Don’t eat that.“

A:

„Let’s find out why.“

No:

„This food is toxic.“

A:

„What does the evidence show?“

No:

„You need to lose weight.“

A:

„What happens to your metabolic health and how can we improve it?“

No:

„Just have a bit more willpower.“

A:

„What lies behind your behaviour?“

No:

„Here’s a diet for you.“

A:

„Let’s build skills that you can use for the rest of your life.“

And perhaps the most important question

The next time you see someone talking about:

• calories;
• diet;
• Ozempic;
• Wegovy;
• Mounjaro;
• fasting;
• „clean eating“;
• prohibited foods;
• „bad“ carbohydrates;
• „detox“;
• or „the perfect body“…

Let’s not just ask:

„Does it work?“

Let’s also ask:

„How much does it cost?“

Because health isn’t just a number on the scales.

It’s not the size of the clothes.

It’s not about how few calories you can eat.

And it’s not about how much you can curb your appetite.

Health also encompasses our relationship with food, our bodies, physical activity and ourselves.

And if a „healthy“ strategy robs us of our freedom to live a normal life, perhaps it is time to rethink what health actually means.