By: Anna M. Lutz, MPH, RD, LDN, CEDS-C
When most people picture someone with an eating disorder, they imagine a very thin person. Unfortunately, this stereotype has caused countless people to go without the life saving care they need.
The truth is that eating disorders do not have a “look”. People in midsize and larger bodies can experience severe food restriction, intense fear of weight gain, overwhelming body image distress, and serious medical complications while being overlooked or even praised for behaviors that are signs of illness.
If you’ve ever wondered whether your struggle is “serious enough”, this article is for you.
What Is Atypical Anorexia?
Atypical anorexia is a recognized eating disorder diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). A person with atypical anorexia meets all of the psychological and behavioral criteria for anorexia nervosa, including significant food restriction, an intense fear of weight gain, and persistent distress about body shape or weight, but their body weight is not classified as “underweight.”
Ironically, the name “atypical” is a complete misnomer. Despite its name, atypical anorexia is not particularly ‘atypical.’ Community-based research has found that atypical anorexia is substantially more common than the DSM-defined anorexia nervosa, yet it remains under-recognized and is often diagnosed later because many people do not fit the stereotypical image of someone with an eating disorder (2). The word atypical reflects the historical emphasis on body weight in diagnostic systems, not a less severe illness.
“Atypical anorexia” may include:
- Restricting food intake or eliminating entire food groups
- Constant thoughts about food, calories, eating, or body size that interfere with daily life
- Intense fear of weight gain or anxiety around eating, especially in social situations
- Distorted body image or difficulty recognizing the seriousness of restrictive behaviors
- Medical complications such as electrolyte imbalances, hormonal disruption, bone density loss, and cardiovascular changes
- Receiving praise from friends, family members, or even healthcare providers for weight loss or restrictive eating behaviors that are actually symptoms of an eating disorder
Many people with atypical anorexia spend years believing they cannot possibly have an eating disorder because they don’t “look sick.” That misconception, fueled by weight bias in our society, delays treatment and often allows the illness to become more deeply entrenched.
Why Eating Disorders Go Undiagnosed
One of the greatest challenges facing people with an eating disorder whose body doesn’t fit into the stereotype is that the illness often goes unrecognized.
Several factors contribute to this diagnostic gap:
1. Weight Bias in Healthcare
Healthcare providers are not immune to cultural assumptions about body size. Someone in a larger body who loses weight through severe restriction may be congratulated instead of screened for an eating disorder by their medical provider. Individuals in larger bodies are more likely to experience weight stigma at the doctor’s office and thus more likely to avoid medical appointments.
Questions about eating behaviors, obsessive thoughts, or psychological distress are often never asked.
2. Diet Culture Rewards Restriction
We live in a culture that frequently celebrates dieting, food rules, and weight loss.
Concerning behaviors are often praised. Restriction can become normalized, even encouraged, making it much harder for someone to recognize that they are struggling.
3. The Eating Disorder Stereotype is Extremely Inaccurate
For decades, media portrayals and even medical education centered on eating disorders around thin, white, adolescent girls.
As a result, people in larger bodies, people of color, men, transgender and nonbinary individuals, and older adults are all less likely to be screened, diagnosed, or referred for specialized treatment.
4. Internalized Doubt
Many people with atypical anorexia have spent years hearing that their body is the problem.
When restrictive eating is praised, it’s understandable for someone to not know they have an eating disorder and to wonder if their suffering is “bad enough”.
It is.
Your level of suffering is not determined by your body size. Every person deserves an accurate diagnosis, compassionate care, and the opportunity to recover.
The Medical Risks Are Just as Real
One of the most harmful myths about atypical anorexia is that it is medically safer than anorexia nervosa.
It isn’t.
Research consistently shows that people with atypical anorexia experience equal severity of medical complications as those with anorexia nervosa3. The body responds to prolonged restriction regardless of weight. In people of all sizes, routine laboratory tests can appear normal while significant medical instability is developing.
Potential complications include:
- Heart rate irregularities and cardiovascular strain
- Hormonal disruption affects menstruation, bone health, and energy regulation
- Electrolyte imbalances
- Fatigue, dizziness, hair loss, difficulty concentrating, and disrupted sleep
- Worsening anxiety, depression, obsessive thinking, and social withdrawal
These complications are related to inadequate nourishment, not body weight.
“Atypical Anorexia” Treatment That Sees the Whole Person
Effective atypical anorexia treatment looks very similar to treatment for the DSM-defined diagnosis of anorexia nervosa, because the illnesses are essentially the same and thus deserve the same level of care.
Recovery is most successful when supported by a multidisciplinary treatment team that includes:
- A physician to monitor medical stability
- A therapist experienced in treating eating disorders
- A registered dietitian specializing in eating disorders
At Lutz, Alexander & Associates Nutrition Therapy, we provide weight-inclusive, evidence-based nutrition care that meets you exactly where you are. With anorexia, the first goal is safety – nutritional rehabilitation. As a person moves through recovery, we help them rebuild trust with food, reconnect with their body’s internal cues, reduce fear around eating, and develop a relationship with food that supports both their physical and emotional well-being
If your eating disorder has gone undiagnosed, or even praised, due to weight bias, you are not alone.
At Lutz, Alexander & Associates Nutrition Therapy, our registered dietitians specialize in compassionate, weight-inclusive nutrition therapy for eating disorders. We believe your experience matters, your symptoms deserve to be taken seriously, and recovery is possible.
Whether you’re looking for nutrition therapy for yourself or someone you love, we’re here to help. Our team provides eating disorder nutrition therapy throughout North Carolina and Oregon, offering care that sees the whole person.
- Stice, E., Marti, C. N., & Rohde, P. (2013). Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. Journal of Abnormal Psychology, 122(2), 445–457. https://doi.org/10.1037/a0030679
- Remmert JE, Convertino AD, Roberts SR, Godfrey KM, Butryn ML. Stigmatizing weight experiences in health care: Associations with BMI and eating behaviours. Obes Sci Pract. 2019;5(6):555-563. Published 2019 Nov 12. doi:10.1002/osp4.379
- Peebles, R., Hardy, K. K., Wilson, J. L., & Lock, J. D. (2010). Are Diagnostic Criteria for Eating Disorders Markers of Medical Severity? Pediatrics, 125(5), e1193–e1201.