Why Someone Who Looks Healthy May Have An Eating Disorder

Not everyone who suffers from an eating disorder looks like they have one. Here are the most common misconceptions.
Why Someone Who Looks Healthy May Have An Eating Disorder. Image is a warm-feeling setting of a group of 5 friends sitting around a table outside around sunset. 4 of the friends are raising a toast, whereas the one person in the left foreground is sitting with their head in their hands.
Author: Katharine Chan, MSc, BSc, PMP
By Katharine Chan, MSc, BSc, PMP
July 6, 2023(Updated: July 10, 2023)

You meet up with your friend for lunch and notice she’s lost weight. She looks great. You immediately compliment her. You don’t question her new change. She downplays your comment and tells you she feels fat because she still has an additional 10 pounds to lose before fitting into her bikini. 

As you begin ordering, she talks nonstop about calories, grams of protein, carbs, and fat and overanalyzes the menu. She barely touches her salad and goes to the washroom an excessive number of times. You don’t question her eating habits or think she’s got a problem. She looks healthy. 

However, not everyone with an eating disorder looks like they have one. They may not appear to be underweight. They may even be overweight. An eating disorder can present itself in individuals of various sizes and shapes. 

It’s important to understand the truth behind eating disorders as it can help raise awareness of this serious mental health condition, create a more informed and accepting community and encourage those who are struggling to seek treatment early.

This article explores one of the most common misconceptions about eating disorders.

You can learn more by reading our eating disorders blog series:

Part 1: 3 Most Common Types of Eating Disorders

Part 2: Why Someone Who Looks Healthy May Have An Eating Disorder

Part 3: Disordered Eating Isn’t The Same as an Eating Disorder

Part 4: Psychedelics and Their Potential for Treating Eating Disorders

What is atypical anorexia?

In 2013, atypical anorexia was added to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.

Someone with atypical anorexia has similar symptoms as anorexia; they have an extreme fear of gaining weight, have beliefs that their self-worth is connected to their body weight, shape, and size, and practice dangerously restrictive diets that do not contain sufficient nutrients and calories for proper bodily functioning. 

Symptoms of Atypical Anorexia

Behavioral symptoms of atypical anorexia include:

  • Intense desire to be thin
  • Extremely fearful of being fat
  • Over exercising
  • Avoiding certain foods and feeling afraid to be around them
  • Constantly thinking about food
  • Highly restrictive diets
  • Avoiding complete food groups
  • Refrains from eating with other people or in social settings
  • Makes excuses for refusing to eat

Physical symptoms of atypical anorexia include:

  • Gastrointestinal problems
  • Abdominal pain, constipation
  • Weakened immune system
  • Very dry skin
  • Thinning hair
  • Yellowing skin
  • Extreme fatigue, low energy
  • Difficulty concentrating and thinking

However, the difference with anorexia is that someone with atypical anorexia is not underweight. They may have substantial weight loss but are still within a normal weight range or overweight. Furthermore, research has shown that compared to anorexia nervosa, the psychological distress associated with body image and eating is worse among those with atypical anorexia.

Why Someone Who Looks Healthy May Have An Eating Disorder. Image is a side-view of a person walk to the right side of the image, wearing a pink hoodie with the hood pulled over their head completely so you can only see their hands holding the hood. The wall behind them is painted with pastel colours in bold shapes.

The Challenges of Diagnosing Atypical Anorexia

Atypical anorexia is particularly challenging for mental health clinicians to diagnose because the person with the condition does not physically appear to be unhealthy or malnourished. This condition is often underdiagnosed or misdiagnosed. It is estimated that less than 8% of individuals with an eating disorder are underweight.

The media have portrayed those with an eating disorder as someone who looks frail, ill, sickly and severely thin. Our society promotes a lean physique as the standard of good health. When Hollywood celebrities gain weight, media outlets scrutinize their bodies and shame them for their change in body shape. When they lose weight, their efforts are glorified and attention is given to how they achieved such a desirable result. Social and cultural influences have normalized constantly dieting, being dissatisfied with our bodies and obsessively exercising. 

Therefore, individuals who have atypical anorexia may not be aware of their condition because the number on the scale and what they see in the mirror do not indicate it. In addition, their friends and family may not recognize their need for help. They may pass it off as just a phase or believe that their behavior is socially acceptable since going on a diet is seen as an effort toward attaining a healthy lifestyle.

Even if someone is aware of their troublesome eating behaviors, they may use their normal weight as an excuse to refuse medical care, mental health treatment and nutritional counseling. They may justify it by telling themselves they aren’t “sick enough” to deserve help.

Long-Term Health Complications

Unfortunately, it is estimated that less than a quarter of those with a diagnosable eating disorder access treatment.

Without treatment, they may face serious health consequences due to malnutrition. Almost one-third of hospital inpatient eating disorder treatment programs are for those with atypical anorexia. It is estimated that at least 40% of those with atypical anorexia require hospital admission. Among adolescents with atypical anorexia, 1 in 3 and 1 in 4 presented with amenorrhea and bradycardia, respectively. 

Long-term medical health complications of untreated atypical anorexia include the following:

  • Cardiovascular complications such as low blood pressure and low heart rate
  • Reduced bone mineral density, increasing the risk of fractures
  • Menstrual irregularities such as amenorrhea
  • Dizziness
  • Fainting
  • Increased symptoms of anxiety, depression
  • Thoughts of suicide and self-harm
  • Anemia
  • Muscle loss
  • Hair loss
  • Death

Therefore, atypical anorexia is often overlooked and misunderstood due to social and cultural factors. However, it is a very serious mental health condition with devastating consequences if left untreated. It’s crucial to increase awareness of this debilitating condition and change the current beliefs and perceptions of how eating disorders are presented.

Binge Eating Disorder (BED) and Bulimia Nervosa (BN)

Binge eating disorder (BED) is the most common type of eating disorder. It involves recurrent episodes of consuming a large quantity of food while experiencing an inability to stop. Those who struggle with BED tend to be overweight or obese

Bulimia nervosa (BN) is characterized by repeated episodes of binge eating followed by behaviors to eliminate the calories consumed such as induced vomiting, use of laxatives, fasting, restricting diets, and excessive exercising. Individuals with BN may be underweight, normal weight, overweight, or even obese. 

Therefore, it is impossible to determine whether someone has an eating disorder just based on their physical appearance. It can be harmful to make assumptions about someone’s health and well-being from what we perceive of them on the outside. It is not always obvious that a person is ill.

Seeking help from a mental health professional can help you understand your body image issues, address eating habits and develop ways to recover and heal your relationship with your body and food. Find a clinic or therapist near you or online in our therapy directory who specializes in treating eating disorders.

If you or someone you care about may be struggling with an eating disorder, contact the National Eating Disorders Association (NEDA) Helpline for support, resources, and treatment options at 1–800–931–2237. They have text, online chat, and phone call options.

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APA. (2022). Other Specified Feeding or Eating Disorder -Atypical Anorexia Nervosa. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-OtherSpecifiedFeedingDisorder.pdf

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The content provided is for educational and informational purposes only and should be a substitute for medical or other professional advice. Articles are based on personal opinions, research, and experiences of the author(s) and do not necessarily reflect the official policy or position of Psychedelic Support.

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Author: Katharine Chan, MSc, BSc, PMP
Katharine Chan, MSc, BSc, PMP
Katharine has over 15 years of experience working in British Columbia's healthcare system, leading patient safety incident investigations, quality and systems improvement projects, and change management initiatives within mental health, emergency health services, and women's health. She has published in scientific journals and co-authored health research books. Her bylines include Verywell Mind, CBC Parents, Family Education, Mamamia Australia, HuffPost Canada, and CafeMom. Check out her books at Sum (心,♡) on Sleeve.

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