top of page
  • Helly Barnes

Restrictive Eating Disorders DON'T Have a Size!

Updated: Aug 18, 2023

Perhaps the biggest and most damaging stereotype about restrictive eating disorders is that they have a look—people with restrictive eating disorders are stereotypically thought of as being emaciated, alongside female, young and white middle class of course! This post is written for any of you who don't fit the 'size' stereotype and have a restrictive eating disorder in a bigger body… and you know what? There will be more of you reading this now who are in just that situation than those who do fit the stereotype.

I have written and spoken a lot over the years about restrictive eating disorders—what they are in relation to being an addiction to energy deficit and how to overcome them and I've always tried to be clear that the content that I put out is as applicable to people in bigger bodies as smaller ones. I regularly try to reinforce the fact that someone in a body that is not 'underweight' by BMI is no less 'sick' or 'eating disordered' than a person who does fall into the low-weight BMI category. But I haven't yet written a post on this topic alone and so I figured it was time I did!

In my recently published book, Addicted to Energy Deficit, I have written about restrictive eating disorders affecting people of all body sizes and in my soon to be published second book, Aiming for Overshoot, I have included more information and tips about how to manage the additional challenges that come with overcoming a restrictive eating disorder from a starting point of already being in a bigger body. So, please feel free to pick up copies of either or both of those books for more. In this post, I will provide a brief overview of the very real fact that restrictive eating disorders don't have a size.

Restrictive Eating Disorders Affect People of All Body Sizes

Recognition of the fact that restrictive eating disorders can and do occur in people of all body shapes and sizes has been all too slow in coming, although this is now gradually shifting. Slowly, eating disorder professionals are being forced to acknowledge that someone can be just as mentally and physically compromised with a restrictive eating disorder in a plus-size body as someone with a very low body mass index.

The psychiatric diagnostic bible, also called the DSM-5 has now introduced a separate category for a form of anorexia nervosa (AN) called "atypical anorexia". For this diagnosis, someone needs to meet all the same diagnostic criteria as for AN but their, "weight remains within or above the normal weight range, despite significant weight loss". This is a small shift, as previously AN was not diagnosable in anyone with a BMI above seventeen(!) but it still doesn't really go far enough. Having 'atypical anorexia' as a separate diagnosis still perpetuates the stereotype not just in the general public but in our health professionals too, that restrictive eating disorders have a look.

To my mind, there shouldn't be a differential diagnosis between anorexia types depending on body size—and if there is, anorexia in someone with a 'bigger' body should definitely not be given the name 'atypical'. The reality is that atypical anorexia is one of the most common eating disorders. By current diagnostic criteria, atypical anorexia is far more typical than non-atypical anorexia. In fact, it’s currently believed to be around three times more common (and as we know that people in non-emaciated bodies are less likely to be diagnosed at all, that true figure is likely to be much higher still).

The Symptoms & Risks From a Restrictive Eating Disorder are the Same Irrespective of Body Size

Finally now, research is demonstrating repeatedly in published papers that restrictive eating disorders, with all the same symptoms and risks can and do occur in people of all sizes.

Studies are showing that restrictive eating disorders in people in the healthy, overweight or obese BMI ranges face the same cardiovascular and other health risks as someone at the lower BMI spectrum. These risks include a low heart rate and other heart arrhythmias, electrolyte imbalances and bone density loss. Females with anorexia in larger bodies are just as likely to experience a loss of their menstrual cycle and hormonal changes. Any weight suppression of just 5% below genetic set weight range is of significance in terms of the medical complications it can create.

And when it comes to psychological complications, people at higher weights can be more significantly effected than those at lower weights, with greater preoccupation around food avoidance and negative feelings about body shape and weight.

Despite all this evidence that current body shape and size don't equate to how affected someone is by an eating disorder, I'm sure that it will come as no surprise to you that people at higher weights are under-diagnosed and have symptoms for longer, with a higher level of weight loss before they are diagnosed. And once diagnosed, they are less likely to be offered intensive treatment.

It's little wonder that for years, eating disorder services and health professionals have left people feeling that they need to lose more weight to justify the help they desperately need.

Eating disorder professionals have been slow to listen to the general eating disorder community and to hear the changes they have been calling on for years—primarily removing BMI as a criteria for treatment. This is why recent publications such as one in the highly esteemed Nature journal that are now backing up these calls for change are so important. It can only be hoped that the medical communities cannot continue to fail to notice, diagnose and support people with very real restrictive eating disorder symptoms and complications who are in normal or higher weight bodies for much longer.

What Does This Mean for You if You Have a Restrictive Eating Disorder at a 'Higher' Weight?

If you are reading this and you have a restrictive eating disorder but are not at a weight considered 'low' by BMI (and we know BMI is meaningless), then please know that you are no less sick, less at risk or deserving of support and treatment than anyone else. The eating disorder affecting you is valid and just as critical to address.

Perhaps you are still wondering, but what advice should I follow to overcome the eating disorder?

When it comes to the information and guidance in both my books, my blogs and podcasts, everything applies equally to anyone with a restrictive eating disorder, no matter their body shape or weight. The advice to abstain from restriction and all your addictive compensatory behaviours, habits and rituals is the same, as is the advice to do everything possible to emerge from your current energy deficit state and aim for overshoot. And of course I am not naive enough to think that you won't have additional challenges to overcome to do that. Gaining weight in a world that frowns on weight gain is hard enough for someone who is coming from that lower end of the body size spectrum, let alone if you are starting out at the higher end.

In Aiming for Overshoot I have provided some more general and practical tips and advice on how to keep going if you are in the position of trying to overcome an addiction to energy deficit from a higher weight and I will do a future post to cover this in more detail. But really and truly, please know that all the advice I give is true for you. You abstain from restriction, abstain from compulsive movement and behaviours and let your body gain weight to your set point, allowing for overshoot because even if your body isn't perceived by our less informed society to be malnourished—with a restrictive eating disorder your body is just that and so it will be struggling and need to heal. And when you do push into the process of overcoming the eating disorder, going against all that feels right and all that diet culture tells us is right, you will not only find your mental and physical freedom, but you will be one bad-ass superhero that the world should be inspired by!

Don't do this alone though. You don't need to go through this process without support. Everyone needs support to overcome an eating disorder, so please seek the support you need and that you feel will help you best and then bash this eating disorder out of your life and find out what great things your future can hold!

**The information here is taken from my newly available books, 'Addicted to Energy Deficit - A Neuroscience Based Guide to Restrictive Eating Disorders' which you can buy now and 'Aiming for Overshoot', available if you click here!

If you like to listen, as well as (or instead of read!) then this blog post is the transcript of a podcast episode which you will find on my podcast series,

available on this website, all mainstream podcast platforms and on YouTube.


bottom of page