Eating disorders are complex illnesses. They are a mental illness that often result in the deterioration of physical health, and there is not one recovery method that has a high success rate as of yet. They have a complicated entanglement of genetic and environmental causation that is entirely individual to each person. There are many different types of eating disorders (anorexia, bulimia, EDNOS/OSFED, ARFID, BED, purging disorder, rumination disorder, pica), and people of all ages, genders, weights, ethnicity, sexual orientation (etc, etc) can develop one. And yet we are bombarded only with images of eating disorders in the form of extreme anorexia: the emaciated, skeletal bodies of those walking the fine line between life and death. The media blasts out the headlines that often scream something like “I WAS 4ST AND ONLY ATE A LETTUCE LEAF A DAY”. They plaster photos of bones protruding across the articles and present to us an “after” photo of the recovered victim: nearly always a slim, beautiful, white young woman.
And there we have it: the damaging stereotype of what an eating disorder looks like and who develops one. This stereotype harms everyone who deviates from the narrative of pretty young white girl who starves herself to within an inch of her life. I’ve never seen an article about anyone black with an eating disorder. Ever. I’m sure that there are one or two articles out there, but the media all but erases the existence of black men and women with eating disorders. It erases the existence of older adults with eating disorders. It erases the existence of men with eating disorders. In fact, the media erases nearly all eating disorders in themselves – the minority of people with eating disorders experience anorexia nervosa, and an even smaller amount have the chronic anorexia that the magazines depict. “Before the latest change in diagnostic criteria, it was estimated that of those with eating disorders, 10% were anorexic, 40% were bulimic and the rest fall into the EDNOS category” (from here). Most of the 90% of people with eating disorders that are not diagnosed as anorexic will be fit into the “healthy”, “overweight”, or “obese” BMI categories. That’s not to mention all the undiagnosed people who are not seeking help and are invisible because of their weight, who are not getting the help and support that they need and deserve.
There are also different types of “invisible people” with eating disorders at a “healthy” weight. Those who have lost lots of weight but come from a higher weight are one set of people. These people are often congratulated for their weight loss, even though it has been lost in exactly the same way that someone going from a “healthy” BMI to an “underweight” one has – someone who would be diagnosed with anorexia rather than praised for their efforts. We offer treatment to those that lose weight and fall into the weight criteria for an anorexia diagnosis, and pat those on the back that lose the same amount of weight but come from a weight perceived as socially unacceptable (or a weight perceived as “acceptable” but not “desirable”). And what many people do not know, or forget, is that we all have our own natural healthy weights (that can be pretty much any weight, shape, or size), and if people are well below those weights, they are underweight for their own individual body. So if someone is naturally a BMI of 27 and they starve themselves to a BMI of 20, they are severely underweight for themselves, but their eating disorder are often dismissed as “healthy weight loss efforts”. Their illness can be not only hidden, but recognised as something positive, and therefore encouraged and reinforced. Included in this category are those who will never dip below a “healthy” BMI and could remain invisible for any amount of time, and those who will continue to lose weight. At this point society will go “woah, lose weight but not too much weight!” This is when their weight loss will be recognised as an issue, but as it was never noticed before, by now the person will likely be entrenched with their eating disorder.
Another group are people who have eating disorders but find that their weight doesn’t change much, or there are those that gain weight during their eating disorder. Weight is only a secondary symptom of some eating disorders, and it is important to understand that not everyone experiences a change in weight when suffering from an eating disorder. They are primarily mental illnesses.
Another group of “invisible people” at a “healthy” weight are those who are recovering from a low or lower weight and have gained weight to a weight that society deems “fine”. Peoples see them in the street and don’t suspect a thing. Friends stop worrying and family heave a sigh of relief. Those close to the person show less concern and more frustration: they think that the journey is over. You look fine therefore you must be fine. It’s important to remember that this is a mental illness, and that the physical symptoms are secondary. It is also important to remember that the person may still be at an unhealthy weight for their own personal body, and though they may be an acceptable size in terms of society’s standards, they may be underweight still regardless of BMI. Just because you can’t see their pain doesn’t mean that they are not experiencing it. The mental anguish that led them to rock bottom is still there and still needs to be addressed.
People who look fine but have expressed that they are not need to be taken seriously. They need to be supported, and they need to be encouraged to move towards being healthy and happy: whatever that looks like for them. It might not look like your idea of healthy and happy, but you have to put aside your biases, your judgements, and your prejudices in order to help that person achieve the best life that they can for them.
If you are someone who is living at what society says is a “healthy” weight, but you have engaged in disordered habits to get there, or you are regaining weight and are still unwell but people think you “look fine”, then sit those people down that are important to you and tell them. Set your boundaries, let them know what you need, and ask them to support you to get better. Be open and honest. Don’t downplay your struggles. Be assertive when telling them what is helpful and what is unhelpful. Print off information on eating disorders to support what you are saying and to give them something to read later to help them to understand how pervasive and powerful an eating disorder is mentally. Write a letter if that is easier. Whatever you do, talk. Your voice needs to be heard.
This article was first published on my eating disorder and diet recovery website here.