By Meggie Holden, MDA, RD, LD, CEDS
When most people think about an eating disorder, they picture someone who is very thin or visibly unwell. But eating disorders don’t have a specific body type.
You can’t tell if someone has an eating disorder just by looking at them.
As a dietitian who specializes in eating disorders, this is one of the biggest misconceptions I see. You don’t have to “look sick” to have an eating disorder.
Eating disorders are serious mental illnesses that affect a person’s thoughts, feelings, and behaviors around food, eating, exercise, and their body. They can also affect the whole body, including the heart, gastrointestinal system, bones, hormones, and energy levels.
Eating disorders can happen to people of all body sizes. Someone in a larger body can have a restrictive eating disorder, including anorexia nervosa. They may be eating very little, eliminating entire food groups, experiencing significant fear around food, or exercising excessively. They may be struggling with inadequate nutrition even though they don’t fit the stereotype of what someone with an eating disorder is “supposed” to look like.
And sometimes, their weight loss is even praised. Comments like “You look great!” or “Have you lost weight?” may seem like compliments, but for someone struggling with an eating disorder, that attention can reinforce harmful behaviors.
Weight alone cannot tell us whether someone is adequately nourished, medically stable, or struggling with an eating disorder.
Eating disorders are about much more than wanting to be thin. They can involve restricting food, binge eating, purging, compulsive exercise, or a combination of these behaviors. For some people, an eating disorder may begin with what looks like a harmless attempt to “eat healthier” or lose weight.
For someone with ARFID, food may be restricted because of sensory sensitivities, fear of choking or vomiting, or simply a lack of interest in eating. Weight and body image may have nothing to do with it.
Eating disorders are not a choice, and recovery is not as simple as deciding to “just eat.” It is important to recognize the signs and reach out for help when something doesn’t seem right.
Some signs to watch for include:
Increasing anxiety around food or meals
Avoiding meals, snacks, or certain foods
Cutting out entire food groups
Exercising excessively or despite illness or injury
Spending a lot of time thinking about food, weight, or exercise
Feeling shame or guilt around eating
Withdrawing from friends or activities because of food or body concerns
If you are concerned about yourself or someone you love, you don’t have to wait until things become severe to ask for help.
Treatment often involves a team that may include a medical provider, an eating-disorder dietitian, and a therapist. A medical provider can monitor physical health, a dietitian can help with nutrition and challenges around food, and a therapist can address the thoughts, emotions, and behaviors contributing to the eating disorder. Treatment addresses both the physical and mental health effects of the illness.
If you’re worried about someone, start by letting them know you’ve noticed some changes and that you care about how they are doing. Listen without judgment and encourage them to talk with a healthcare professional who has experience treating eating disorders.
Eating disorders can affect anyone, at any body size. No one should have to wait until they “look sick” to get help.
Meggie Holden, MDA, RD, LD, CEDS, is a registered dietitian and Certified Eating Disorder Specialist and the owner of Compassionate Nutrition in Sioux Falls, South Dakota. She specializes in eating disorder treatment and helping people develop a more peaceful and flexible relationship with food and their bodies. Meggie takes a compassionate, weight-inclusive approach to nutrition and works primarily with adolescents and adults. She is passionate about helping people move away from diet culture and toward a healthier, more sustainable relationship with food. Follow us on Facebook, Instagram, YouTube, and TikTok to stay connected. Our programming includes the medical Q&A show On Call with the Prairie Doc® (most Thursdays at 7pm on YouTube, and Facebook), along with two podcasts and a weekly radio program (Sundays at 6am and 1pm on SDPB).