If you’ve spent your life believing that eating disorders have a certain “look,” you’re not alone. There’s a reason the SWAG (skinny, white, affluent girl) stereotype—an unfortunate artifact of early research on patients with anorexia nervosa—is still so prevalent.
But eating disorders don’t discriminate.
Not only can people of all ages, genders and races struggle with anorexia, so can people of all weights. Unfortunately, society – and even some medical professionals – have reinforced the myth that you have to be underweight to be “sick enough” to need help with a restrictive eating disorder.
But here’s the hard, clinical truth: You can’t determine someone’s health or relationship with food by looking at their body size. Attitudes and attitudes matter, not body size.
As an eating disorder specialist, I have had many clients with average to heavier bodies come to me trapped in a cycle of severe food restriction, intense fear of weight gain, and obsessive thoughts about food. Yet they tell me, “I don’t have a problem…I just need to lose weight,” when they really have anorexia atypical.
What is anorexia nervosa? (OSFED explained)
The word “informal” is a bit of a misnomer. In clinical settings, we use it Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for the categorization of diseases. Anorexia atypical is not grouped with “typical” anorexia. falls under his umbrella OSFED (Other Specified Feeding or Eating Disorder).
Someone with anorexia atypical meets every single diagnostic criterion for anorexia nervosa — diet restriction, intense fear of weight gain and negative body image — except they don’t have an “underweight” BMI. Instead, they have BMIs in the ‘normal’, ‘overweight’ or ‘obese’ range.
The irony? There is nothing “unusual” about suffering. Research shows that the medical and psychological complications of anorexia nervosa—such as irregular heart rhythms, electrolyte imbalances, fainting, and suicidal ideation—are just as severe as those seen in underweight patients.
As an eating disorder researcher once told me, people with anorexia atypical have more body image disturbance, whereas typical anorexia can have more medical complications. However, both groups show the hallmarks of malnutrition: loss of periods, loss of bone mass, orthostatic hypotension (a sharp drop in blood pressure when one stands up), and electrolyte imbalances.
The ‘wellness’ mask: how society glorifies eating disorders on larger bodies
The most dangerous thing about anorexia nervosa is that it is often socially reinforced. When a person in a larger body begins to restrict food or exercise excessively, it is often praised. They listen:
- “You look great! What’s your secret?”
- “I wish I had your willpower.”
- “Keep up the hard work.”
For the sufferer, these “compliments” act as fuel for the eating disorder. They validate the inner voice that says hunger is a weakness and that their worth is tied to making their bodies smaller. Because they are congratulated on their symptoms, they rarely recognize that they are actually in a medical crisis.
When someone with anorexia is underweight, their health care providers tell them they need to eat more and gain weight and that weight gain is okay. Unfortunately, the opposite is true when the person is “overweight”. They get the message from the professionals they trust with their health that they eat too much and weigh too much. Again, this totally plays into their eating disorder.
Someone with anorexia atypical may pass out or have pain from low gastrointestinal motility—a common side effect of severe caloric restriction or weight loss—but it is not treated as it would be if they were underweight. Instead, they are treated as eating too much.
The Myth of “You Just Need to Lose Weight”
If what I’ve written so far describes you, but you are thinking “I will stop these behaviors once I reach my goal weight”, I want you to stop for a moment.
In the eating disorder mindset, the goalpost is always moving. “Goal weight” is a mirror. Once you get there, the eating disorder will tell you that it wasn’t enough weight or that you needed to cut back even more to make sure you don’t gain it back.
When you think you “just have to lose weight,” you’re often dealing with internalized weight bias. This is the belief that a smaller body is inherently healthier or more valuable. You may also want to avoid weight bias directed at you by others. However, if the path to a smaller body includes malnutrition, obsessive thoughts, and losing your social life, it’s not “healthy.” It’s a slow collapse of your well-being.
We should all be concerned about overly controlling, limiting, obsessive food thoughts and behaviors – in ourselves and in others. We have to draw a line there.
In our society it may seem “healthy” to be really obsessed, but if all you talk and think about is weight, body and food, that’s not a balanced healthy life. The cost to your relationships and quality of life is very high.
The physical toll is real: atypical symptoms of anorexia
Like it or not, your heart, brain and bones don’t care what the scale says — they only care if they are fed. When you restrict your intake, your body goes into a semi-starvation state.
Even if you are in a bigger body, your metabolism will slow down to conserve energy and you may experience:
- Bradycardia: Dangerously low heart rate.
- Orthostatic hypotension: Feeling dizzy or light-headed when standing up.
- Amenorrhea: Missing your menstrual cycle (yes, this can happen at any weight).
- Gastroparesis: Slowing down of the digestive system causing bloating and pain.
If you experience these things, you are not “failing” a diet. You don’t need to work more. You are experiencing the normal consequences of an eating disorder.
Research shows that medical complications from severe calorie restriction can be severe at any body weight, and has found that weight suppression itself—the difference between a person’s highest and current weight—causes the severity of symptoms.
Because thinking you’re not “sick enough” is a trap
The myth that anorexia “doesn’t happen” to larger people is extremely harmful. The most common reason people with anorexia nervosa don’t seek help is that they don’t think they are “sick enough.” They may think they’re just doing what they’re supposed to do—restricting calories and losing weight in order to be healthy. They delay seeking help until they hit a certain weight or collapse.
Eating disorders are never healthy, andyou don’t have to earn your recovery. The severity of an eating disorder is measured by the degree of your mental obsession and the impact on your life, not your BMI. If food has become your main preoccupation, if you feel guilty every time you eat, and if your “health journey” has taken away your joy – you are pretty sick right now.
How to start the healing process with a HAES dietitian
Recovery from anorexia nervosa requires a weight-inclusive approach. This means working with a team (therapist, dietitian and doctor) that understands that health is not about a specific body size and that weight loss is not a valid treatment for an eating disorder.
Some initial steps are:
- Recognize the pain: Admit that limiting mindsets and eating behaviors have become a prison.
- Look for experts: Look for providers that do not include weight, HAES (Health at Every Size)-aligned.
- Invoke the praise: Begin to recognize that external compliments on your weight loss are triggers for your eating disorder.
- Focus on re-feeding: The first step in eating disorder recovery is always consistent, adequate food — no matter what your size. Your brain can’t heal if it’s hungry.
If you’ve been told your whole life that your body is a problem that needs to be solved, it’s incredibly brave to decide to stop fighting it. You deserve space. You deserve to eat without shame. And most importantly, you deserve medical care that sees your race, not just your BMI. If you’re thinking about seeking help, don’t hesitate to reach out. Just click here to schedule a free 20-minute Discovery Call to talk about your concerns and see if we’re a good fit.
Disclaimer: All information provided here is general in nature and provided for educational purposes only. This information should not be taken as medical or other health advice related to an individual’s specific health or medical condition. You agree that use of this information is at your own risk.
Hi, I’m Carrie Dennett, MPH, RDN, a weight that includes registered dietitian, nutritionist and body image consultant. I offer compassionate, personalized care for adults of all ages, shapes, sizes and genders who want to break free from eating disorders, disordered eating or years of dieting. If you need to learn how to management of IBS symptoms with food, or improve your eating and lifestyle habits to help manage a current health concern or just supporting your overall health and wellness, helping people with that too.
Need 1-on-1 help with your nutrition, food or body image concerns? Program a free 20-minute Discovery Call let’s talk about how I can help you and explore if we’re a good fit! I am in network with Regence BCBS, FirstChoice Health and Providence Health Plan and can bill Blue Cross and/or Blue Shield insurance in many states. If I don’t get your insurance, I can help you claim compensation yourself. To learn more, explore our insurance and service areas page.
Print this post
