Somewhere in between dieting and eating disorders is disordered eating, which can include behaviors such as regularly skipped or erratically timed meals, over-exercising or binge eating but doesn’t yet amount to an illness. 

More than 1 in 5 youth worldwide engage in these concerning behaviors, especially girls, older teens and young people with a higher body mass index. Studies suggest they’re also common among adults—much more so than diagnosable eating disorders, and equally unhealthy. 

Cedars-Sinai experts emphasize caution for the more than half of Americans who diet every year.

“Disordered eating is sneaky,” stressed Albert Abayev, a clinical registered dietitian in the Cedars-Sinai Weight Management and Metabolic Health Center. “It often starts small, like skipping a meal or exercising more, and feels harmless at first, but it can become debilitating.”

Read: How to Talk to a Loved One About an Eating Disorder

Creating rigid rituals or rules for eating and exercise—such as a daily four-hour treadmill run or obsessing about drinking the exact same smoothie or eating a certain vegetable—is a red flag, experts warn.

Extreme diets that severely limit calories or entire food groups are particularly unsafe, especially without medical supervision. They raise the risk of developing a full-fledged eating disorder by as much as 18 times among women and girls.  

Such diets can cause early signs of malnutrition and hormonal changes, including dizziness, hair thinning, slower metabolism, and irregular or missed periods. Look out for sudden, sharp loss of weight, muscle mass or bone mass, cautioned Cedars-Sinai primary care doctor Lauren DeDecker, MD.

“The body tries to preserve itself when you’re not nourishing it properly,” she explained.

Similarly, be cautious with unprescribed weight loss medications. Occasional use of diet pills and laxatives to lose weight—characteristic of disordered eating—has been found to forecast eating disorder diagnoses by as much as 258% (for pills) and 177% (for laxatives).

Fixating on calories and the number on the scale can also quickly eat away at the time you have for things you value. Pay attention if you’re no longer able to show up for work, your responsibilities or your community because of food. Is your fear of eating something “bad”—cake at an engagement party, for example—getting in the way of spending time with friends and family? 

“If you’re isolating and food is dominating most of your thoughts throughout the day, that’s not normal,” DeDecker said.

Read: Anemia: A Barrier to Women’s Health

Reset by committing to eating three meals a day of whole foods, Abayev suggested. Time your meals so you do not go too long without eating. 

Skipping critical nutrients sets you up to feel hungrier and crave sugar and snacks, which can then lead to more disordered eating, including bingeing until you feel sick or undereating to shed pounds. 

“Your body needs consistent energy,” Abayev said. 

Try setting an alarm and tracking your food intake to help you eat regularly.

Some people who have a low appetite lightly graze all day or skip lunch without realizing it. Others avoid eating until the evening because they’re too depressed to get out of bed.

Intentional and repeated food restriction or purging requires digging into the root causes to get back on track.

Food journaling may help you be more aware of your habits, including what sets off restricting what you eat or eating for reasons other than hunger—such as anxiety, stress, sadness, low self-esteem or a need for control—according to health agencies. 

“Since disordered eating is often tied to emotions, it can creep up unnoticed and feel like the only way to cope,” Abayev said.

Read: Promoting a Positive Body Image in Children

Food is our most enduring relationship—and for many, the most complicated.

“You’re going to be eating for the rest of your life: You have to find a way that’s sustainable,” Abayev said. 

He encourages reframing food as fuel. If you don’t get enough, you’re likely to get stuck in a loop of chronic exhaustion. Instead, balance your plate with plenty of protein and fiber, focusing on adding nutrients to round it out.

Be mindful of the role each ingredient plays. Protein repairs our bodies. Carbohydrates—mainly complex carbs such as fruits, vegetables, legumes and whole grains—give us energy. Healthy fats can help you feel full and absorb vitamins.

“The key with nutrition is not to be on a diet, but to really learn how to eat,” Abayev said.

Experts recommend working with a registered dietitian for your specific nutrition needs and goals, as well as to build healthier eating attitudes.

Guilt and shame are common culprits of self-punishing dietary behaviors, such as vomiting or excessive exercise to rid yourself of unwanted calories or “bad” foods. But all foods have a place—whether it’s for nutrition, taste, culture or joy—Abayev said.

Extreme methods to overpower these instinctive needs will likely make you feel out of control in the long run.

Read: What Is Intuitive Eating? A Nutritionist Explains

Disordered eating behaviors, left unattended, are strong predictors of a life-threatening future eating disorder such as anorexia or bulimia.

Even sooner, food restriction or purging can throw off your body’s balance of electrolytes such as calcium, potassium and sodium. Too-high and too-low concentrations are tied to arrhythmias and cardiac arrest. 

Visit your primary care doctor if you are concerned about your diet or feel out of control, DeDecker suggested, especially if you’re undereating, vomiting or using laxatives after meals. Your doctor will check for bone loss and nutritional deficiencies and, if needed, refer you to a dietitian, therapist or psychiatrist who specializes in eating disorders. 

“You deserve to feel good, both in your body and in your mind,” she said.