Why We Need to Stop Thinking All People with Eating Disorders are Underweight
When plus-size supermodel Tess Holliday recently revealed that she is in recovery from anorexia, she was met with a barrage of misinformed responses.
“I’ve had a lot of messages from folks that have anorexia that are livid and angry because they feel like I’m lying,” Holiday told Good Morning America. “I am plus-size but advocating for diversity in larger bodies so I think for people hearing me say I’m anorexic was really jarring.”
Holliday’s experience reveals an unfortunate, pervasive issue with the public perception of eating disorders — namely the myth that any person with an eating disorder must be underweight. That notion isn’t just false; it’s dangerous. And it’s part of the reason so many people fail to receive the diagnoses and care they deserve to overcome their eating disorders.
“Eating disorders can affect anyone – people of all shapes and sizes,” says clinical psychologist, Elizabeth Gordon, PsyD, who is a therapist at Equip. “In fact, most people with eating disorders are not actually underweight.” Gordon’s point is underscored by a 2017 study that found that only 5.6% of women and 0% of men with eating disorders are considered "underweight.”
According to the National Eating Disorder Association (NEDA), despite decades of media representations exclusively portraying people with eating disorders as emaciated, it’s impossible to tell whether someone has an eating disorder based on appearance alone. And as a University of California San Francisco (UCSF) study revealed in 2019, despite the fact that “lower weight has historically been equated with more severe illness in anorexia,” not everyone at risk for the devastating potential side effects of the disorder (like slow heart rate, menstrual dysfunction, and electrolyte imbalance) can be classified as “underweight.” Unfortunately, the stereotype only serves to perpetuate the problem.
“The belief that all people with eating disorders are underweight leads many people with severe eating disorders who are not underweight to not seek treatment or even acknowledge they have a problem,” Gordon says. “Medical doctors, therapists, and other helping professionals who believe these harmful stereotypes might believe that someone with a serious eating disorder is ‘fine’ if they are not underweight. This belief perpetuates so much suffering among people with eating disorders who are not underweight, who can be equally sick and deserve treatment and help.”
The experience Gordon describes is similar to the one of Equip Peer Mentor, Ally Duvall. “I spent my childhood and teenage years with an undiagnosed eating disorder because I was fat,” Duvall says. “Every doctor, dietitian, and weight loss program missed the signs and symptoms — not because I didn't share them, but because my fatness was the only thing they wanted to solve. I didn't even know I had an eating disorder because I too had only heard of the underweight, white, cis-woman stereotype. Even after receiving my diagnosis in 2017, I didn't see my body represented in eating disorder conversations so it was extremely tough to feel validated about the very real disorder I was fighting."
One crucial way we can start chipping away at the myths about weight and eating disorders is by embracing the Health At Every Size® (HAES®) approach. HAES® isn’t new — it started in the 1960s — but it’s still a revolutionary concept to many people, including those in the medical field. The basic premise is this: your well-being has nothing to do with a number on the scale. You can’t tell how “healthy” or “ill” someone is by assessing their appearance or weight, and HAES® advocates believe in promoting size-acceptance, ending weight discrimination, and lessening the cultural obsession with weight loss and thinness. The approach is all about “balanced eating, life-enhancing physical activity, and respect for the diversity of body shapes and sizes.”
As Dr. Lindo Bacon wrote in the book, Health at Every Size: The Surprising Truth About Your Weight, “We’re losing the war on obesity. Fighting fat has not made the fat go away. However, extensive ‘collateral damage’ has resulted: Food and body preoccupation, self-hatred, eating disorders, weight cycling, weight discrimination, poor health...Few of us are at peace with our bodies, whether because we’re fat or because we fear becoming fat. It’s time to withdraw the troops.”
In the context of eating disorder recovery, a HAES® approach can go a long way in getting people the care they need and deserve, regardless of whether they fit the physical stereotype of what society thinks an eating disorder looks like. The principles of HAES®, which was trademarked by The Association for Size Diversity and Health (ASDAH), advocate for weight inclusivity, accessible health information, respectful care, flexible and individualized eating, and physical activities that allow people of all sizes, abilities, and interests to enjoy movement — all those aspects and more are essential in supporting eating disorder recovery.
For people who don’t feel they fit the physical criteria of what they assume an eating disorder “should” look like, based on false media representations and outdated assumptions, getting help can be scary. But the bottom line is this: everyone deserves compassionate, effective care if they need it — period.
So what can a person do if they feel they don’t “look the part” of someone with an eating disorder but suspect their thoughts and behaviors are problematic? “Seek help anyway, from a treatment team (therapist, dietitian, medical doctor) informed about HAES®,” Gordon says. “If you think you need help for an eating disorder, you do! Your weight has no bearing on how sick you are or how much you need help.”
Duvall agrees with Gordon’s sentiments and encourages anyone to seek the help of sensitive, trained experts if they feel they need support. "No one deserves to have their eating disorder overlooked because of myths rooted in anti-fatness,” she says. “Excluding fat folks from the eating disorder community further reinforces the stigma around who can develop an eating disorder and creates even more barriers for seeking and receiving treatment. We can all help shift the conversation away from how an eating disorder 'should' look and focus on what really matters: getting individuals who are fighting an eating disorder the treatment they need to begin their healing journey, regardless of their weight and body size."
About Michelle Konstantinovsky
Michelle Konstantinovsky is a San Francisco-based freelance journalist and UC Berkeley Graduate School of Journalism alum. She’s written extensively on health, body image, and lifestyle for outlets like Vogue, Scientific American, WIRED, Cosmopolitan, Marie Claire, Teen Vogue, O: The Oprah Magazine, Seventeen, , Entrepreneur, WebMD, and more.
Equip is a virtual eating disorder treatment program helping families recover from eating disorders at home. Equip’s holistic, data-driven, gold-standard care program is delivered by a team of five care professionals, giving families confidence they’re providing the best opportunity for progress and lasting recovery.