My name is Johanna Kandel and I am the CEO + Founder of the National Alliance for Eating Disorders (formerly The Alliance for Eating Disorders Awareness), the leading national nonprofit organization providing education, referrals, and support for all individuals experiencing all types of eating disorders. As someone of lived experience, creating conversations and providing help and support has become my life’s passion.

Eating disorders are complex, biopsychosocial illnesses that are characterized by a disturbance in an individual’s thoughts, feelings, and behaviors around food, eating, exercise, and/or body shape and size. Some common types of eating disorders include: Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge Eating Disorder (BED), Other Specified Feeding or Eating Disorder (OSFED), Avoidant/Restrictive Food Intake Disorder (ARFID), and Pica.

Binge Eating Disorder (BED) is a restrictive eating disorder that is characterized by recurrent episodes of binge eating, without the use of compensatory behaviors. The binge eating episodes typically occur in a rapid manner, when the individual is not hungry and often until they are extremely full. There is a sense of lack of control over eating, where the individual feels that they cannot stop eating or control what/how much they are eating.

The main difference between stress - or emotional - eating and Binge Eating Disorder is the interference of and impairment on an individual’s daily life. Stress/emotional eating

Yes. Eating disorders can affect the whole body - including an individual’s menstrual cycle.

Eating disorders can lead to the cessation, delay, or irregularity of an individual’s period. Amenorrhea (cessation of menstruation) occurs most commonly when the body is in a state of "relative energy insufficiency," which is present in many eating disorders. This will cause disruptions in the hormone cycles that regulate menses which leads to amenorrhea or irregular cycles. Among individuals that menstruate: 84% of those with anorexia nervosa will have amenorrhea between 40% - 64% of those with bulimia nervosa will experience amenorrhea or experience infrequent and irregular periods. 10.4% of those with Binge Eating Disorder will experience amenorrhea and 33.7% will experience oligomenorrhea.

It’s important to seek professional help for an eating disorder - you are not meant to do this alone! With the support of a team (if you are able to get one), you can safely learn how to nourish yourself without restrictions (leaning into an intuitive eating/all foods fit approach) and avoid any and all calorie compensation behaviors. This will allow your body to heal and get to a healthy weight which will stimulate resumption of menstruation. Please know that no

Amenorrhea is the cessation or absence of an individual’s menstrual period. There are two types of amenorrhea: primary and secondary. Primary amenorrhea refers to a delay in starting an individual’s period for the first time, while secondary amenorrhea refers to the absence of three or more consecutive periods in an individual who has menstruated before.

BMI has never been and will never be an accurate tool for determining health. An individual can be malnourished - and experience issues with menstruation - at all body weights, shapes, and sizes. When the body is experiencing relative energy insufficiency is when you start experiencing menstrual irregularities. That being said, there is no BMI cutoff at which menses stops or resumes. It depends on the individual and practitioners use menses as a marker of health so target weights in females are often marked by the resumption of menses.

Yes, eating disorders can affect fertility, including infertility, miscarriages, premature deliveries, low birth weight infants, and other complications both during and after pregnancy. For example, mestruating individuals experiencing binge eating disorder are at an increased risk of having a miscarriage. Good news is that with recovery from their eating disorders, many individuals that choose to have children, are able to conceive.

Reach out to the National Alliance for Eating Disorders. The Alliance is the leading national nonprofit organization providing education, referrals, and support for all individuals experiencing all types of eating disorders. The Alliance provides comprehensive services, including: Free referrals for all levels of eating disorders treatment (from outpatient therapists and dietitians to acute medical stabilization) through both our therapist-staffed helpline (866-662-1235) and findEDhelp website/apps. Free, weekly, therapist-led support groups for individuals (ages 18+) experiencing eating disorders and for loved ones. CLICK HERE for more information about our support groups.

It can be hard to determine appropriate options on your own. That’s why reaching out for help and support is so important (and such a brave step!)! You can call The Alliance and we can help connect you to places and people that can help determine which level of care would be appropriate. This is based on a multitude of factors including, but not limited to, frequency and intensity of eating disorder behaviors, psychiatric comorbidities, and the need for medical stabilization.

When talking about eating disorders, we recommend staying away from specifics – specific eating disorder behaviors, numbers (including weight and calories), foods, medications, etc. It’s also important to remember that eating disorders do not discriminate. They can affect anyone, regardless of age, gender, wealth, job status, sexual orientation, ability, neurodiversity, body shape/size, race, or ethnicity. You cannot tell someone has an eating disorder just by looking at them.