How do you tell if someone has an eating disorder? Is it the emaciated shape of a person as illustrated by popular media? Is it the tiny frame seen in a mirror? Are these body shapes the kind you need to see in order to spot an eating disorder?
What about the people who don’t fit the “look” of an eating disorder? What about people with higher weights, who act the same as “clinically underweight” individuals with eating disorders? Are they not suffering just as much as their underweight peers?
Eating disorders cannot be spotted by looking in a mirror — research has found that eating disorder incidence and severity have nothing to do with physical weight or shape. In fact, less than six percent of people with eating disorders are classified as “underweight.”
With this in mind, we will discuss:
- why eating disorders cannot be defined by size
- what current research has found concerning weight and eating disorders
- why associating eating disorders with “the look” is dangerous
- how to really know if you or someone you know is suffering with an eating disorder
We will also briefly discuss what to do if you think you or someone you know does present with eating disorder symptoms. Research shows that the earlier an eating disorder is detected and treated, the higher the likelihood of making a full recovery.
And everyone — no matter your weight, shape or size — deserves recovery.
Why Eating Disorders Are Not Actually “About” Size
The DSM (Diagnostic and Statistical Manual of Mental Disorders) includes within it the standard guide for diagnosing eating disorders. In the DSM, no disorder relies on physical weight or shape as a significant diagnostic factor — except eating disorders. The overwhelming focus on weight and BMI as an indicator of an eating disorder, and of the severity of an eating disorder, has many flaws.
There are many people who are straight sized or overweight, and still have an eating disorder.
Research has shown that people of higher weights have a higher prevalence of disordered eating behaviors than those at a “normal weight” or below.
This has been found for several eating disorder types. Studies have shown that those who present with anorexia at a higher weight, also known as “atypical anorexia,” show the same severity of symptoms as their underweight peers. Another recently released study showed that people with bulimia who enter eating disorder treatment at a higher weight have a higher severity of symptoms than their underweight peers. Binge eating disorder is also commonly associated with restriction, which is not often addressed in individuals with binge eating disorder. This is usually because in our diet-obsessed society, overweight people are expected to lose weight, and are expected to eat less in order to do so.
How can you tell if someone has an eating disorder if their bodies don’t change much at all?
Many people engage in a variety of eating disorder behaviors. This can lead to a lot of weight fluctuations. Severe weight loss may never occur. For example, many people suffering from anorexia report episodes of binge eating, as the body is more driven to nourish itself in a period of starvation. On the other hand, many people with bulimia as well as binge eating disorder report periods of starvation.
Engaging in restrictive, binging, and purging behaviors frequently causes the body to either fluctuate in weight, or not budge at all. But this doesn’t mean that these behaviors aren’t happening.
Stereotyping is dangerous for an individual with an eating disorder: Here’s How
SIZE STEREOTYPES KEEP PROFESSIONALS FROM RECOGNIZING THE SEVERITY OF AN EATING DISORDER.
No matter what kind of disorder you may have, and no matter your weight, an eating disorder is severe and life threatening. For example, research has shown that those who present with anorexia at a higher weight, also known as “atypical anorexia,” show the same severity of symptoms as their underweight peers.
In fact, people who start off overweight/obese and then develop an eating disorder are often likely to face more severe physical and psychiatric consequences than those who start off at a “normal weight” and then develop an eating disorder. This can be attributed to the fact that many medical providers are weight biased, and are less likely to diagnose a straight sized or obese person with an eating disorder. The longer a person goes without receiving needed treatment, the more frequent and severe their eating disorder behaviors become.
SIZE STEREOTYPES REMAIN A BARRIER TO RECEIVING EATING DISORDER TREATMENT.
Weight bias can keep medical professionals from noticing an eating disorder. It can also act as a barrier to treatment.
Many people have been denied the level of care they need, simply because of weight. Insurance companies will often measure “recovery” by physical weight restoration, and stop covering expensive treatment costs after someone with an eating disorder reaches a certain weight.
Related: Weight stigma is a huge problem in the eating disorder treatment setting. Read more about it here.
SIZE STEREOTYPES INVALIDATE AN INDIVIDUAL WITH AN EATING DISORDER.
If you do not “look” like you have an eating disorder, and no one recognizes it by your behaviors (which are one of the best indicators of an eating disorder) then it can be difficult to believe you even have a problem.
If you do not physically “look” like you have an eating disorder, you may not seek treatment because you feel like an imposter. You may feel like you don’t have a “real” eating disorder, because you are still straight sized or clinically overweight. Those of a “normal” weight or above often find themselves struggling while in treatment, specifically in terms of comparison. Many have reported feeling like they didn’t “need” treatment after being admitted, because they compare their bodies to others in treatment.
Related: Do you feel like you’re not “sick enough” to have an eating disorder? Find out what to do when you feel invalidated about your eating disorder.
So how can you tell if you have an eating disorder?
The real indicators of eating disorders are thoughts and behaviors. This makes sense, as mental disorders cause you to think and act a certain way.
THOUGHTS THAT TELL YOU IF YOU MAY HAVE AN EATING DISORDER:
You may be at risk for an eating disorder if you:
- are often preoccupied with thoughts about your weight, shape and size
- apply judgment to your body based on how it looks
- are very worried about gaining weight
- feel out of control around food
- view exercise as a way to “earn” food
- feel anxious when unable to follow a strict exercise regime
- view food, or the avoidance of food, as a way to regulate your emotions
BEHAVIORS THAT TELL YOU IF YOU HAVE AN EATING DISORDER:
You may be at risk for an eating disorder if you do any of the following:
- eat in secret or hide food
- use stimulants, chewing gum, caffeine, nicotine, or excessive amounts of water to suppress hunger
- exercise while ill, fatigued, or in secret
- keep to a very strict exercise routine, despite illness, time constraints, or the weather
- weigh yourself often
- frequently catalogue what you consume in a dieting/”fitness” app
- spend excessive amounts of money on food
- hoard food
- avoid certain groups of food out of fear
- consume items that are not considered food (dirt, paper, etc.)
- (if you are a diabetic) restricting the amount of insulin you need out of fear of gaining weight
- engage in “purging” behaviors (i.e. vomiting, diuretics, laxatives, excessive exercise)
If you notice these kinds of thought patterns or behaviors in someone else, they may be showing signs of an eating disorder. Anyone can have an eating disorder, as there is no “look” to it. Those who do not fit the mold face different challenges than underweight individuals with eating disorders, especially in terms of receiving treatment. But when you know the signs of an eating disorder in yourself or someone else, you can take the first step, and ask for help.
If you or someone you love is suffering from an eating disorder, take the first step today and talk to talk to someone about recovery or simply learn more about the eating disorder recovery programs we offer.
