Atypical Anorexia and Weight Stigma

When I was a school and first learnt about Anorexia Nervosa, I’ll admit I thought it was just something young girls had. This was a common assumption it turns out, still for many to this day, and this tends to be the media focus of eating disorders. As I developed a keen interest and started learning more about eating disorders, I learnt that most people with disordered eating are not thin, and many are at higher weights/in larger bodies.

Only approximately 6% of people with an eating disorder are classified as underweight.

This is hugely important for the way we view, and help, people with eating disorders. It’s the reason why I’m so passionate about the connection between weight stigma and disordered eating, and about my therapeutic work with people experiencing eating distress and body image issues.

So I wanted to talk about “Atypical Anorexia” in this blog as this is an aspect of disordered eating which impacts people who are not underweight, and this is greatly impacted by weight stigma.

What is Atypical Anorexia?

Atypical Anorexia falls under the diagnostic category of OSFED (Other Specified Feeding and Eating Disorder), which is a catch-all for eating disorders that don’t fit into other categories.

The behaviours, thoughts, and emotions of atypical anorexia mirror those of anorexia nervosa, which involves food restriction and preoccupation with weight. The only main difference is that people with atypical anorexia are not classified as underweight according to the BMI chart (Body Mass Index). So the “atypical” part is about weight, but as many people who struggle with food restriction are not underweight, it’s hardly “atypical” in that sense.

The BMI is outdated and flawed; it was made in the 1800s by a mathematician, not to measure individual health but for population statistics, and was only based on white European men. Despite being at a "healthy" or higher weight, those with atypical anorexia can still suffer from malnutrition, physical health complications, and significant distress. As underweight people with anorexia often have to be prioritised for NHS care (due to the severity of the illness and the high mortality risk), services are under-resourced to take all patients needing help. This often leaves people looking for help elsewhere as they may not be able to access NHS services. For this reason, I feel it’s important that all counsellors and therapists have an understanding of disordered eating and weight stigma, as they are likely to encounter these clients at some point.
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Unfortunately, weight stigma can also be a barrier to getting a diagnosis of any eating disorder, as stereotypes and biases often mean we expect a certain “look” or body size of those with restrictive eating, or binge eating. In fact, someone with a restrictive eating disorder can be at a higher weight, and those who binge eat may still be “normal” or low weight. Barriers to help can leave people feeling minimised, unheard and devalued.
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Weight Stigma

Weight stigma refers to biases or discrimination based on body size. Weight stigma negatively impacts mental and physical health through increased stress, chronic dieting and disordered eating. Lived experience reports from people in larger bodies often show they are dismissed by healthcare providers, or told to lose weight. Encouraging weight loss for somebody who already is struggling with food can be extremely harmful as it’s likely to exacerbate their difficulties. Anecdotally, I’ve heard many stories of people struggling with disordered eating tied to years of dieting and weight loss attempts that have been recommended slimming clubs, weight loss injections and weight loss surgery. These interventions only fuel weight stigma and create more harm for many people, especially those struggling with disordered eating.

Although eating disorders aren’t always connected to dieting (they have a complex mix of biological, psychological and social influences), research shows that dieting is a prominent risk factor, along with other socio-cultural factors such as appearance ideals and experiences of bullying. Experiencing trauma, and being from a minoritized group, can also increase the risk of developing an eating disorder. Broader societal inequalities impact who may be at risk, but also who has access to help.
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From a therapeutic perspective, working with people with eating disorders in my experience needs to be individualised as everyone has different experiences, needs and ways of working towards recovery. An important basic requirement is a non-judgmental approach and an understanding the harm they may have faced from weight stigma.
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​Stigma and Shame

Diet culture and the thin ideal perpetuate harmful narratives that equate thinness with health and worth. These beliefs not only fuel disordered eating but also create shame and self-blame for those who don’t fit this mould. As an eating disorder therapist, a lot of what I do is work with shame; feelings of not being “good enough”, being “broken” or “defective” in some way, body hatred and shame, embarrassment around certain ways of eating, shame about weight, and much more. Experiencing stigma, biases and discrimination in the world, whether that’s to do with your size or another aspect of yourself, can be traumatic.

You are worthy of help

If you’re struggling with disordered eating, know that your weight doesn’t define the validity of your experience. Disordered eating is serious, regardless of your size, and seeking help is a brave and necessary step. Your body deserves to be met with compassion, not judgment. Atypical Anorexia is a very real and important thing – whether you have a diagnosis of any eating distress or not – you are worthy of help.
 
I offer counselling sessions online – you can find out more about my counselling services here, or please get in touch here if you would like to enquire.

I also offer workshops and training on disordered eating for professionals – find out more here.