You don’t have to have a full-blown eating disorder like anorexia or bulimia to have a dangerous relationship with food – one that puts your health and even your life at risk. You, or someone you love, could be suffering from “almost anorexia.” Which involves fluctuating weight, restrictive dieting, binge eating, purging, and a negative body image. And it can lead to serious physical and psychological complications – including low heart rate and low blood pressure. As well as feelings of depression, loneliness and fatigue.

In fact, according to the experts, “almost anorexics” are just as likely to die from their restrictive eating habits as a full-blown anorexic. That’s according to Harvard psychology professor Dr. Jennifer Thomas, who wrote the book Almost Anorexic: Is My Relationship with Food a Problem? She says the issue is often ignored and left untreated, because patients don’t exhibit all of the symptoms for a medical diagnosis of anorexia. Which requires three things: Being severely underweight, having an intense fear of becoming fat, and feeling like you’re fat even when you’re skin and bones.

Dr. Thomas also says “almost anorexia” isn’t about a one-time diet before a vacation – it’s an ongoing, unhealthy obsession with food, eating, and calories. And Dr. Thomas believes that 1 in 20 people suffer from “almost anorexia.” Some signs include cutting out entire food groups, or really restrictive eating – especially if it prohibits them from eating with others. An almost-anorexic will also feel guilty for “cheating” on their food rules, or not meeting weight goals. They may also take laxatives or obsessively exercise to make up for excess calories.

If someone you care about displays an unhealthy attitude toward food, you can find helpful information and advice at nationaleatingdisorders.org.