Awareness for eating disorders is on the rise. But many people still have one burning question: “What does an eating disorder actually look like?” If you’ve been wondering this, the easy answer is that eating disorders don’t have a “look.” But the much longer answer is that in order to promote better understanding and prevention of eating disorders, we all must to do better to understand just how varied and wide-reaching they really are.
A quick note: If you’re struggling with an eating disorder, working with a therapist and a registered dietitian can help you recover far more quickly than you would on your own. To learn more about my nutrition counseling services for eating disorders and disordered eating, go here.
Why is there so much confusion around what an eating disorder looks like?
In a recent Outside column, I wrote about how bad our culture is at spotting, preventing, and treating eating disorders. And, I really struggled to make my point without writing thousands and thousands of words.
It’s hard to write succinctly about eating disorders. They are so vast and present in so many different ways.
It’s hard to stay focused on why the way we talk and think about eating disorders needs to change. Because there are SO many issues.
It’s hard to really talk about the causes and symptoms of eating disorders without going deep into systemic issues. Racial inequities. Trauma and coping mechanisms. Weight stigma and anti-fat bias. How poverty shapes a person’s relationship with food.
It’s hard to make people really, truly understand that you can’t tell whether or not someone has an eating disorder just by looking at them.
The confusion around what an eating disorder looks like is understandable. Lots of well-intentioned people want to know, so that they can spot EDs in those they care about. (And, sometimes, in themselves.) But, the questions itself is extremely flawed, because eating disorders don’t have a look. There is no way to know if someone has an eating disorder just by looking at them.
Eating disorders affect people of all backgrounds, in all bodies.
For the column, I spoke with Whitney Trotter, a dietitian and nurse who specializes in eating disorders and works primarily with BIPOC patients. These communities are completely underrepresented and underserved in the eating disorder space. The dominant narrative around eating disorders is STILL that they affect mostly white, thin, wealthy women. But that’s unbelievably false.
A 2011 paper published in the Social Science Research Network found that black teenagers are 50 percent more likely than white teenagers to exhibit binge-purge behavior. A 2011 survey published in the Archives of General Psychiatry found that bulimia is far more common among Hispanic adolescents than among their non-Hispanics, and that BIPOC adolescents were more likely to have binge eating disorder than their white peers.
A 2020 review published in Current Psychiatry Reports found that food insecurity (not being able to afford enough nutritious foods to meet your needs) is associated with higher levels of certain eating disorders and eating disorder behaviors, particularly binge eating and bulimia.
A 2017 study published in Eating Behavior collected data from nearly 10,000 college students and found that those with BMIs in the “overweight” and “obese” categories were significantly more likely to develop eating disorders and showcase eating disorder behaviors like bingeing followed by compensatory behaviors.
But, eating disorder prevention and treatment doesn’t reflect this at all.
According to a 2003 study published in the International Journal of Eating Disorders, people of color are significantly less likely than their white counterparts to receive treatment for an eating disorder, or to be asked by their doctor about eating disorder symptoms.
Those who experience food insecurity likely also have limited (or no) access to healthcare, making treatment difficult or impossible. Even with healthcare, doctors are far less likely to screen this population for EDs, because they don’t fit the dominant stereotype.
A quick Netflix search confirms that only very thin, white, wealthy, young are represented in movies, shows, and stories meant to raise awareness of eating disorders and their consequences.
And, even eating disorder prevention campaigns don’t show people from diverse backgrounds, with diverse body sizes.
My own experience with an eating disorder is one example of the awful consequences of assuming that eating disorders have a “look.”
I’m going to leave you with an experience of mine that didn’t make it to the final draft of the column. Trigger warning for some very fatphobic messaging coming from a source you might not expect (or maybe you would, depending on how long you’ve been around).
Growing up, I struggled with my own eating disorder. This isn’t a secret, but it’s not something I spend lots of time talking about. Partly because I find most recovery stories to be extremely problematic. And partly because my experience was very stereotypical and doesn’t really do much to push the boundaries on what eating disorders, and recovery, look like.
But even I, as someone who pretty much fit the mold for what our culture thinks an eating disorder “looks” like, was not immune to the extremely problematic messaging floating around about prevention, treatment, and recovery.
It started with a NEDA campaign…
In the years leading up to the development of my ED, one of the most triggering things I came across was in a teen magazine. It wasn’t an ad for jeans, or Tampax, or a Venus razor. It was an ad for the National Eating Disorders Association (NEDA).
In the early 2000s, NEDA ran a campaign featuring (thin, young, white) actresses Melissa Joan Hart and Jamie Lynn Sigler. One particular magazine ad featured Hart eating an ice cream cone. There was text that read: “Eat what you want — when you are truly hungry. Stop when you’re full. And eat exactly what appeals to you. Do this instead of any diet, and you are unlikely to ever have a weight problem, let alone an eating disorder.”
You see where I’m going with this? In a campaign about eating disorder prevention and awareness, NEDA put fatphobia front and center. It made me, a pre-teen, second-guess both my body and my eating habits. I thought I ate when I was hungry and stopped when I was full. (Although I wasn’t super focused on this…because I was twelve). But I wasn’t as thin as the actress in the picture. Did this mean I had a “weight problem,” as NEDA put it? Seeing that term — ”weight problem” — in an ED prevention ad made me seriously worry about the size of my body. ‘If the eating disorder people are worried about fatness, I guess I should be, too.’
For years, this ad haunted me.
(I dug it up on Google to write the first draft of the column. Even 21 years later, I remembered the text almost verbatim.) It’s tough to recover when you’re trying to walk the impossible tightrope between an eating disorder and a so-called “weight problem.” Seeing this from an organization dedicated to preventing eating disorders was very jarring. It’s VERY messed up of NEDA to imply that certain body sizes are wrong. (For the record: I was not a skinny pre-teen, but I never had a very large body, either. Imagine what this ad might have done to someone much fatter than me.)
Even well-intentioned messages about eating disorders and recovery can have unintended, severe consequences.
I share this for many reasons. One, because honestly I’m still pretty angry about it. Two, because it’s a good reminder that even well-intentioned messages about eating disorders and recovery can have unintended and very severe consequences. Being at a higher weight is not a problem; NEDA should have recognized this, even 21 years ago.
Three, because you CAN’T encourage a healthy relationship with food but also say(or imply) that it’s bad to be fat. Many people will never have a healthy relationship with food until they feel safe in their body, no matter its size. Yet, STILL, NEDA runs campaigns that don’t make recovery feel safe or possible for many. Those in larger (or non-white, or non-female) bodies just aren’t represented very often. And, no doubt, that’s still causing serious harm.
If you have thoughts on this that you’d like to share, comment below or reach out to christine[@]christinejbyrne.com.
And, if you’re struggling with your own eating disorder and are searching for nutrition counseling, I can help. I’m a dietitian who specializes in eating disorders and disordered eating. I take a weight-inclusive, gender-affirming, patient-centered approach. Learn more about my in-person nutrition counseling in Raleigh, NC, or my virtual nutrition counseling offered to clients in 24 states.