Eating Disorders Aren’t Usually Visible—Looking Beyond Body Weight

When I talk to people that I meet in my life about where I work—an intensive hospital-based treatment program for people with moderate to severe eating disorders—most people assume that I work with people with anorexia nervosa.  While this is true, I also work with people with bulimia nervosa, purging disorder, and many people whose eating disorders do not fit these narrowly defined diagnostic categories.  Although most people are aware that different types of eating disorders exist, there seems to be a pervasive assumption that a serious eating disorder will manifest itself in terms of low body weight.  While weight (more specifically, body mass index) is certainly an important factor in assessing the severity of an eating disorder—many other factors are also important, including whether and how often the individual is engaging in binge eating and/or purging behaviours such as self-induced vomiting and laxative abuse.  In fact, research shows that all eating disorders are associated with an elevated risk of premature death comparable and sometimes higher than in other severe mental illnesses.

Unfortunately, this commonly held belief that an eating disorder isn’t serious unless the person’s weight is very low, can have major implications for individuals living with eating disorders that do not involve being underweight—in particular, it can create a serious barrier to accessing much needed treatment.  How so? Sadly, many people with eating disorders hold this belief themselves, preventing them from asking for help from their family physician or other supports.  Friends and family members, and even some healthcare professionals, may not recognize that their loved one or patient has an eating disorder if they are not underweight—or they may make the mistake of dismissing the eating disorder as not serious.

Eating disorders are complex mental illnesses and it is quite common for affected individuals to have considerable difficulty acknowledging the seriousness of their illness.  I have diagnosed many people who were shocked to learn that their eating disorder was severe because they did not think it was possible to be seriously ill at their weight.  Reaching out for help can take a lot of courage—although many people have very positive experiences with receptive and understanding healthcare professionals and loved ones, others have told me that their disclosure about their eating disorder was not taken seriously because they didn’t “appear sick”.  These interactions with personal supports and healthcare professionals can have powerful effects on affected individuals who may already be struggling to acknowledge the seriousness of their eating disorder—and can make the difference between someone receiving life-saving treatment or not.  In my experience, it is common for individuals with eating disorders to see themselves as undeserving of treatment—even those who are significantly underweight often feel like they aren’t sick enough to receive treatment.  This is likely one of the reasons why the average patient in our treatment program has been ill with an eating disorder for over 8 years before receiving treatment.

Eating disorders affect men, women, transgender, and nonbinary people of all ethnicities, shapes, and sizes.  For many individuals, eating disorder symptoms such as binge eating, purging, and food restriction become methods of coping with or managing life stressors and psychological difficulties such as low self-esteem, interpersonal problems, feeling out of control in one’s life, posttraumatic stress disorder, depression, and anxiety.  Eating disorders are serious mental illnesses that are about so much more than food, body weight, and shape.  Every person struggling with an eating disorder is deserving of treatment.  If you or someone that you care about is struggling with eating disorder symptoms and questioning whether treatment is appropriate, please reach out for help. 

The National Eating Disorder Information Centre (NEDIC) is available via helpline and instant chat services, and can help to connect you with appropriate treatment services in your area or provide you with more information relating to eating disorders and food and weight preoccupation. You can call the NEDIC helpline at 1-866-633-4220 (toll free) or 416-340-4156 (Toronto), or access the instant chat services at nedic.ca.

Dr. Kathryn Trottier is a Psychologist and Clinical Team Leader in the Eating Disorder Program at University Health Network, and Assistant Professor in the Department of Psychiatry at the University of Toronto.  Kathryn has been working as both a researcher and clinician in the field of eating disorders for over 15 years. Her work focuses on ensuring that individuals with eating disorders receive treatments that are effective and meet their mental health needs.