If someone mentions eating disorders, your brain might automatically envision a white, thin woman with thinning hair, brittle nails, and a pale complexion. Not only has this been the stereotype of what having an eating disorder looks like, but it also acts as the stereotype for anorexia nervosa (AN). Yet, AN affects people from all walks of life. It can present differently across all different bodies, and harmful stereotypes such as these can interfere with the diagnosis of AN.
By: Elizabeth Foot
The statistics about anorexia are scary. According to research in 2007, about 1% of females and 0.3% of males had anorexia.¹ Seven years later, a separate study found that 25% of participating males had AN and were at higher risk for death due to delayed or lack of diagnosis.² Historically, these studies are dominated by white participants, who have usually not faced systemic racism or institutionalized oppression. Recognizing these injustices is essential because many marginalized groups might face even higher diagnosis barriers. One marginalized identity that compounds any of the racial risks of delayed AN diagnosis is being in a larger body.
The Diagnostic Criteria For AN, Outlined Below, Are Very Stringent:
- High energy restriction leads to significant weight loss and low body weight.
- Intense fear of gaining weight.
- Disturbance in the way an individual sees themselves.
- Denial of seriousness of low body weight.
Having a low BMI has been what is often associated with significantly low body weight. Yet — many individuals experience other symptoms, such as restrictive feeding practices, distorted emphasis on body shape and appearance, and not meeting weight cutoffs. While there are diagnoses to account for this, research shows that individuals with higher weights are much less likely to be diagnosed with AN. Additionally, recent research suggests that individuals with higher weights experience AN at increased rates but are less likely to be referred and admitted for treatment.³ This speaks to the ever-present weight bias in our society and is something registered dieticians, physicians, and other medical professionals working in the eating disorder field should be aware of. Being able to rely on metrics other than BMI category for diagnosis is vital for identifying all individuals needing treatment and help. For example, looking at a history of attitudes around food or weight, changes in mood, energy, or resting metabolic rate could act as protective criteria when assessing individuals’ anorexia when they do not present with a low BMI.
Finally, health professionals, family members, and peers must be sensitive regarding significant weight loss and weight biases. In a culture that prizes thinness, applauding weight loss and ignoring larger bodies can be easy. However, taking a step back and acknowledging our internalized and societal biases is crucial. That way, people struggling with AN do not fall into the dangerous spiral of an eating disorder without the necessary support.
BALANCE knows there are many misconceptions surrounding eating disorders, including who can develop anorexia. Click here to watch BALANCE’s webinar, Anorexia in All Bodies. This webinar debunks stereotypes of anorexia, explores why the diagnosis of atypical anorexia is problematic, provides listeners with tools for self-advocacy, and more. You can also see other BALANCE webinars and panel discussions on our YouTube channel.
If you or a loved one are struggling with anorexia, our admissions team would happily answer any questions about our programs and services, such as our Day Treatment Program, Weeknight Program, and our new Flexible Treatment Program. Book a free consultation call below, or read more about our philosophy here.
This post was written by BALANCE Blog Contributor, Elizabeth Foot (she/her).
Elizabeth is currently pursuing her Master’s of Public Health in nutrition and dietetics from the University of Michigan, on track to become a registered dietician. Prior to returning to school, Elizabeth received her B.A. in Public Policy from Hamilton College in 2020.
Since graduating Hamilton, Elizabeth has worked for an infertility insurance company as a marketing associate, has volunteered with Multi-Service Eating Disorder Association (MEDA), and has advocated on Capitol Hill for expanding insurance coverage to registered dietitians as part of the Eating Disorders Coalition (EDC). Elizabeth is also a strong supporter of intuitive eating, HAES, and is excited to become a licensed practitioner working in the ED field. In her free time, Elizabeth can be found creating recipes, practicing yoga, or counting down the days until she can get a dog.
References
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Keski-Rahkonen A, Hoek HW, Susser ES, Linna MS, Sihvola E, Raevuori A, …, and Rissanen A. (2007). Epidemiology and course of anorexia nervosa in the community. American Journal of Psychiatry, 164(8):1259-65. doi: 10.1176/appi. Ajp.2007.06081388.
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Mond, J.M., Mitchison, D., & Hay, P. (2014) “Prevalence and implications of eating disordered behavior in men” in Cohn, L., Lemberg, R. (2014) Current Findings on Males with Eating Disorders. Philadelphia, PA: Routledge.
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Harrop, E.N., Mensinger, J.L., Moore, M., & Lindhorst,T. (2021) “Restrictive eating disorders in higher weight persons: A systematic review of atypical anorexia nervosa prevalence and consecutive admission literature”. International Journal of Eating Disorders, 54(8): 1328-1357. https://doi.org/10.1002/eat.23519.
