Is Anorexia in Bigger Women Really a Thing?
It’s far more common than you realize to have anorexia but not be “underweight.” Yes, you did read that right! Anorexia is not just diagnosed in small, thin bodies. It’s diagnosed in larger bodies too. And yes, that includes people whose BMI categorizes them as “overweight,” or “obese.”
Anorexia in Bigger Women Is More Common Than You Know
One of the most common things I hear from clients when we are discussing an eating disorder diagnosis is, “I don’t think I have an eating disorder, I’m not that small!” or, “I can’t have anorexia, I’m overweight!”
But you can. These statements come from stereotypes and misunderstandings about eating disorders, as our culture is largely unaware and uneducated about this topic–largely because of how much our culture is synonymous with the dieting culture and industry. So, let’s clear this up.
What is Atypical Anorexia?
Atypical anorexia is an eating disorder diagnosis in the DSM 5 that acknowledges that anorexia shows up in all body shapes and sizes and is not exclusive to small or emaciated bodies. In the DSM 5 they say “despite significant weight loss the individual’s weight is within or above the normal levels.” I actually don’t love the language here, because it implies that there is a “normal” weight, and that this kind of anorexia is atypical.
Is Atypical Anorexia the Same as Anorexia?
Atypical anorexia is exactly the same as anorexia, the only difference is that the person doesn’t have a low body weight, or a body weight that the BMI distinguishes as “below normal.” This diagnosis is essential because so many individuals are walking around thinking they must not really have a problem because they “didn’t lose that much/enough weight” to have anorexia or they’re “too big to have anorexia.”
What Qualifies Atypical Anorexia?
The things I usually look for when making this diagnosis are the exact things I look for when making the Anorexia Nervosa diagnosis:
Large preoccupations with food and body, aka “I am always thinking about food or how I look in some way.”
A fear of weight gain or a sense of refusal or disgust with being at a person’s current weight.
Being disconnected from what your body really looks like. Often this is the person that (regardless of their size/shape) really feels that they look like xyz.
Restriction of food intake, aka not eating enough (but it is very common for people with anorexia and atypical anorexia to feel that they are eating enough and that there really isn’t a problem, or that they are just being healthy)
Why is “Atypical Anorexa” Not a Clear Definition?
As I mentioned before, eating disorder specialist’s such as myself aren’t thrilled with the “atypical” language in this diagnosis, as it makes it sound like “atypical anorexia” is unusual. And let me tell you...it is NOT unusual or uncommon, and I’d say I even see more people with atypical anorexia than anorexia nervosa.
So, having anorexia but not being underweight is more common than you may think!
Studies show that “atypical anorexia” likely accounts for ~ 20% of youth with eating disorders, and is no less dangerous than anorexia showing up in “underweight” BMI’s. Research also indicates that psychological distress about food and body image is worse in people with atypical anorexia as compared with anorexia nervosa, which validates the seriousness of this type.
What is the DSM-5?
The DSM-5 is the 5th edition of the diagnostic and statistical manual of Mental Disorders, so it’s used to understand different mental and emotional experiences and cluster symptoms together to make “diagnoses” that we can understand more. Within any diagnosis, there are various experiences and different symptoms- but the DSM-5 helps professionals like myself have a sense of what might be going on, and what might help.
How Does DSM-5 Classify Anorexia Nervosa?
The DSM-5 classifies it as food restriction that leads to significantly low body weight + fear of weight gain and fat + a disturbance in how the person views their weight.
It wasn’t until the most recent DSM (the 5th edition) that atypical anorexia was brought in, because (despite its name) the eating disorder field was seeing how “typical” higher weight eating disorders were, but how there was no acknowledgement of it. With research to back that up now, we finally have a diagnosis for the huge category of individuals who are suffering from anorexia despite having lost a bunch of weight or being seen as “emaciated/underweight.”
The 3 Classifications from the DSM 5
To summarize, the DSM 5 classifies anorexia as:
1. Restriction of food intake (resulting in low body weight) *Atypical anorexia just deletes “resulting in low body weight”*
2. Intense fear of fat/becoming fat/gaining weight
3. Having a distorted view of body image/weight/size
*In addition to these 3 criteria, clients can exhibit binge eating and purging behaviors.
4 Signs That You May Be Anorexic But Not Underweight
You might feel like food and body are on your mind a lot, almost like you have a second brain with a running dialogue evaluating what you are or aren’t eating, what others are aren’t eating/looking like etc.
You might find yourself lifting your shirt up to look at your belly in the mirror or you might find yourself pinching your skin/fat to evaluate whether it has increased after a meal that felt like “too much.”
You might say that you “binged,” when you really just ate 2-3 cookies or a large bowl of ice cream. Both normal amounts to eat and signs that your eating disorder is expecting you to eat such small amounts.
You grew up dieting because you were told you were “overweight” or “obese,” and you’ve never stopped dieting-you may have anorexia despite being in a larger body.
The terms “overweight,” and “obese” are in quotes here because these are not accurate measures of health, and we don’t use these terms in our practice as they are stigmatizing and inaccurate. We know many of you heard these terms growing up, and still hear these terms during visits with your doctor, or while reading a health handout or article.
Anorexic But Not Underweight?
This is called atypical anorexia, but it’s not atypical at all.
If you need support please consider my monthly memberships and on-demand online course bundle: Body Freedom Bundle ($55) or taking my single course Support for Restricting or Binging ($35) - Preview below!
Please get help, and don’t hesitate to reach out to us for referrals/support.
If you are a parent and feel that your teen may have an eating disorder you may be interested in my on-demand courses:
The Eating Disorder Informed Parent Bundle
I think My Teen Might Have an Eating Disorder
Feeding Your Pre-Teen/Teen
References:
Vo, M., Accurso, E. C., Goldschmidt, A. B., & Grange, D. L. (2016). The Impact of DSM-5 on Eating Disorder Diagnoses. International Journal of Eating Disorders, 50(5), 578-581. doi:10.1002/eat.22628
Sawyer SM, Whitelaw M, Le Grange D, et al. Physical and Psychological Morbidity in Adolescents With Atypical Anorexia Nervosa. Pediatrics. 2016; 137 (4).
