Written By: Erin Birely, LCPC
Alumni Services Coordinator at The Renfrew Center
Many people mistakenly believe you can identify eating disorders based on appearance, but this myth overlooks the complexity of these mental health conditions. Eating disorders can affect individuals of any size, age, gender, or background, and recognizing the emotional and behavioral signs is crucial. This blog explores misconceptions, stigma, and ways to provide meaningful support.
Growing up, I can remember seeing magazines speculate and hearing people say they believed someone had an eating disorder simply by looking at that person’s appearance.
For a period of time, it was widely believed that you could tell who was struggling with an eating disorder simply based on physical characteristics. This was in part due to a widely held belief, later proven to be a myth, that eating disorders only impacted higher socioeconomic status, Caucasian, thin, cisgendered females, in their teens or early 20s. It was thought that an eating disorder could only happen to someone whose weight was so dramatically low it would be visible to anyone who looked at them. But this has been proven to just be a major misconception about what an eating disorder truly is.
What we know now is that eating disorders do not discriminate and can impact anyone of any weight, race, ethnicity, socioeconomic status, gender, or age. We also know that we cannot tell the severity of an eating disorder just by looking at someone. Eating disorders are complex disorders that can stem from issues related to body image and physical appearance, but these factors do not define them, nor do they represent how eating disorders manifest for the majority of those affected.
Understanding Eating Disorders
Eating disorders are complex mental health disorders that involve symptoms related to food, weight, body shape, and/or exercise (and others) in an attempt to dampen, distract, or avoid uncomfortable emotions. These behaviors can look drastically different based on the type of eating disorder someone is struggling with.
These differences in behavior are part of the reason why physical appearance is not a reliable indicator of who is struggling with an eating disorder and who is not. In a study by Ramaswamy, N., & Ramaswamy, N., in 2023, researchers found that “despite the fact that individuals with higher body weight have a 2.45 times greater chance of engaging in disordered eating behaviors as patients of normal weight, such patients receive a clinical diagnosis of an eating disorder half as frequently as patients with normal weight or underweight.” This highlights that we cannot assume that someone with an eating disorder will be easily identifiable by physical appearance alone.
According to NEDA, an average 9% of the US population will experience an eating disorder in their lifetime (approximately 28.8 million Americans). When physical appearance is the only thing prompting questions about someone’s relationship with food and their body, many people who are struggling will not be noticed.
Myth Of The “Typical Eating Disorder”
The myth of the “typical eating disorder” presentation was largely reinforced by limited access to care and a lack of awareness about the various ways eating disorders can manifest.
Prior to May 2013 (before the DSM 5 was published), the only eating disorders that were recognized were anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified (EDNOS). As a result, many clients that did not meet the strict criteria for anorexia or bulimia – criteria which have since evolved – were often unable to receive a diagnosis and, consequently, the care they needed for their eating disorder. Much of the research on eating disorders was conducted primarily on individuals who could access care, which led to the overrepresentation of higher socioeconomic status, Caucasian, cisgender, young girls.
As diagnostic criteria have expanded to encompass the full range of eating disorder symptoms, many individuals who fall outside of this stereotype have finally been able to receive the help and support they have needed and deserved.
What To Look For
When conceptualizing an eating disorder, it is important to remember that we are looking for connections between behaviors and emotions. This means that while the eating disorder symptoms – like restricting, bingeing, or purging – may be more obvious, we don’t want to discount what someone is experiencing mentally, emotionally, and socially.
From a behavioral perspective, be on the lookout for changes in eating patterns, such as skipping meals, eating secretively, over-exercising, using the bathroom frequently after meals, or avoiding certain types of foods. These behaviors can be signs that someone might be struggling, but they aren’t the sole indicators of an eating disorder diagnosis.
Remember to also pay attention to changes in mood, relationships, and overall presentation. You might notice someone being more irritable or lethargic. Maybe they’ve become more rigid with their schedule or unusually particular about what social events they’re willing to attend. Perhaps the person is isolating more or expressing increased anxiety about things they used to handle with ease.
Eating disorders are not just about the behaviors, so it is important to recognize the mental, social, and emotional impacts as well. Many behaviors that are part of an eating disorder could also be part of normal changes in someone’s life, but the cognitive, social, medical, and emotional struggles that come along with the behaviors are what makes an eating disorder such a serious mental health issue.
The Role of Stigma
Stigma can play a major part in whether someone’s eating disorder gets recognized for what it is, if they are able to access the support they need, and if they feel deserving of the care. Cultural and medical weight stigma can make individuals struggling with an eating disorder while in a larger body feel as though they are the ones failing. They may have been told – and may believe – that they just “lack the willpower” to stick to their diet, when in reality they are restricting and engaging in a harmful cycle no one could maintain.
This cycle ultimately damages self-image and self-esteem, exacerbates the emotional impact of weight stigma, and reinforces the grip of the eating disorder. Weight stigma can also have a financial impact, if insurance policies deny authorization for higher levels of care when someone is within a weight range they deem “normal.”
Additionally, many people experience internalized stigma around seeking help for mental health struggles, as they believe they should be “strong enough” to handle things without support. This desire to manage emotional struggles on their own can lead to eating disorder symptoms functioning as a temporary and harmful way to manage emotions.
Low self-esteem, a common emotional struggle associated with eating disorders, can lead people to feel undeserving of care. This feeling can be exacerbated when people comment that they don’t “look sick” or couldn’t possibly be struggling because they “don’t look like someone with an eating disorder.” These external and internal stigmas and biases can create various barriers for someone seeking validation, understanding, and support.
How To Be Supportive
Start with a nonjudgemental approach when supporting someone who might be struggling. Approaching the person with acceptance and acknowledging how hard asking for help can be, can reduce any shame the person may be feeling. Try to be curious rather than critical. Ask open-ended questions about how they have been feeling and what they’re experiencing. While it can be helpful to acknowledge the behaviors you’ve noticed, you also don’t want to do so in an accusatory manner. Simply communicate your observations and ask them if they’ve noticed these changes as well. If the person is open to receiving help, you can offer to assist them in finding providers or a treatment center that is right for them.
If someone isn’t open to help, remember that it is not your role as a support to force them to get help. Remain open and nonjudgemental and let them know that you are there for them in the future if they do want more support or to talk about anything. Leaving this door open provides the person with a chance to reflect and come back to you for support later.
Conclusion
In conclusion, it is important to remember that eating disorders are complex mental health disorders that impact so much more than the physical body. Relying solely on appearance will cause us to overlook many people struggling with eating disorders and intensify the shame for those who are brave enough to advocate for themselves and seek the support they need.
Instead of judging how someone is feeling based on their appearance, we can instead talk with them, actively listen, and seek to understand what they are actually experiencing. We can educate ourselves on the impact of weight stigma by reading books like Fearing The Black Body by Sabrina Strings, and learn how weight alone isn’t a reliable indicator of who is struggling with an eating disorder by reading Sick Enough by Dr. Jennifer L. Guadiani.
Challenging eating disorder myths and stereotypes will help combat weight stigma, promote discussions about healthy coping strategies, and encourage open conversations about our relationships with food and our bodies.
