Come As You Are: Higher-Weight Anorexia Nevosa

When you think of people with anorexia, you probably think of someone who looks like I did before I began recovery — emaciated. When you hear that people in any size body can have an eating disorder, perhaps you think that the people with non-emaciated figures struggle with bulimia or binge eating disorder. In addition to anorexia nervosa, bulimia nervosa, and binge eating disorder, there are several other severe eating disorders, including one called “Other Specified Feeding and Eating Disorders” (OSFED). One example of an OSFED is “‘atypical’ anorexia nervosa.” 

The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) requires a patient to meet the following criteria for a doctor to diagnose anorexia nervosa: 

1. Food restriction leading to low body weight,
2. Intense fear of gaining weight or becoming fat, and
3. Body image issues or denial of low body weight.

Individuals with “atypical” anorexia meet the criteria for anorexia other than having an unusually low body mass index (BMI) despite notable weight loss. Because BMI is not an indicator of individual health, it is essential to remember that people can be under their body’s optimal, healthy set point weight range and still be in a higher BMI category. That is, people can be under their healthy weight in all size bodies, including quite large ones.

Thus, people with “atypical” anorexia can suffer from the same severe and even deadly medical and psychological impacts as people with anorexia. We must take it seriously. They deserve competent, effective care and recovery. 

Unfortunately, however, people in larger bodies often receive inadequate medical and mental health care, and there is not an exception for people with “atypical” anorexia. Frequently, the diagnosis is missed entirely; they fly under the radar.

Even worse, clinicians, indoctrinated into diet culture, often prescribe weight loss (i.e., diet and exercise) for people with higher-weight anorexia. Either they are unaware or do not believe that their patient is struggling with severe restriction or excessive exercise behaviors, and their recommendations can exacerbate the disorder. It is not just clinicians with weight stigma; most of society normalizes dieting and praises people in larger bodies for anorexia’s symptoms and behaviors.

I invite people in larger bodies who struggle with restriction, exercise, fear of gaining weight, body image concerns, or body dysmorphia to come as they are and advocate for the care they need and deserve if they feel like they can. However, this takes a lot of emotional energy and power that, understandably, they may not have available.

Thus, the rest of us need to work harder to be allies and fix the system. We need to fight societal weight stigma, weight discrimination, and fatphobia. We must make life easier for people struggling with, or in recovery from, “atypical” anorexia.