Busting Common Eating Disorder Myths

Eating disorders are one of the most misunderstood mental illnesses, and that lack of knowledge prevents many people from getting the care they need and deserve. For Eating Disorder Awareness Week, I’m busting four of the most common eating disorder myths that get in the way of people needing help.

This week is Eating Disorder Awareness Week (EDAW), a time to raise awareness of the second deadliest mental illness (after opioid addiction). When I look back at what I thought I knew about eating disorders as a new practicing dietitian, compared to what I now know after years of experience (and what I know I don’t know, because we’re all constantly learning!), it's not surprising to me that there's a ton of eating disorder myths among the general population.

Unfortunately, although it has gotten much, much better, a lot of the awareness raising I see during EDAW promotes some of the same eating disorder myths that prevent people who don’t fit the traditional mold from getting care. Focusing on thin, young, white women with anorexia nervosa at the expense of the broader range of people who develop eating disorders and different types, fuels the misconception that eating disorders “have a look.” Because most people with eating disorders don’t present the way that society expects, it causes many, many people to needlessly suffer without the care they need and deserve.

This week, I want to bust four of the most common eating disorder myths that come up in conversations about EDs:

Eating Disorder Myths

Someone who is suffering from an eating disorder looks thin.

When most people think of someone with an eating disorder, their mind goes to an image of a very thin, emaciated person, usually a young, white woman, who looks visibly malnourished. These are the “shock” images I remember from after-school specials when I was a teen. While yes, someone with an eating disorder can look extremely thin with bones protruding, it's not all people with eating disorders, or even most people with eating disorders.

If you look at the research, only about 6% of people diagnosed with an eating disorder are underweight. That includes anorexia nervosa, where “atypical” anorexia (i.e. higher weight anorexia) is at least 3 1/2 times more likely than traditionally defined anorexia nervosa, in which someone must have a weight considered < 85% of normal (using an extremely flawed system of categorizing bodies). That number is actually likely to be low, as people with atypical anorexia are less likely to receive a diagnosis. In fact, the prevalence of atypical anorexia nervosa by age 20 years is 28% versus < 1% for anorexia nervosa.

While most people associate eating disorders with anorexia, there are other types of EDs, including bulimia and ARFID (avoidant-restrictive food intake disorder). Many people struggle with an array of symptoms that change over time and don’t fit neatly into a diagnostic box. There’s also binge eating disorder, the most common eating disorder, which despite being associated with higher weight bodies, affects people who are thin too. While people with binge eating disorder (BED) are assumed to be struggling with willpower, that couldn’t be further from the truth. BED often has roots in restriction, which can fuel a restrict-binge cycle. Unfortunately, because binge eating disorder is viewed as a lack of willpower, many people will seek out treatment trhough weight loss programs and bariatric surgery. Binge eating is extremely common among those seeking weight loss treatment, with about 9-29% reporting binge eating behaviors. Among people seeking bariatric surgery, rates of clinical binge eating disorder are higher, with up to 47% meeting criteria for diagnosis.

This myth is a HUGE barrier for those who need treatment for eating disorders. For those who are thin, if they don't look emaciated, there's this idea that they aren't sick enough. And for those whose weight falls in a higher range, their eating disorder is often completely missed, or celebrated as "successful weight loss." For more on higher weight anorexia, I encourage you to read this article in the New York Times, which features a few dear friends of mine who bravely spoke out.

Eating disorders are rare.

More than 30 million people will develop an eating disorder at some point in their lifetime. That's just diagnosable eating disorders - the minority of people who are struggling with food who meet the diagnostic criteria. Disordered eating occurs on a spectrum, and there's a huge number of people who experience disordered eating at some level, but don’t meet the specific criteria for ED diagnosis. In fact, research suggests the vast majority of people struggle struggle with disordered eating at some point in their life. Just because someone doesn’t fall into the diagnostic criteria, doesn’t mean they aren’t struggling immensely or deserve support.

A frustrating experience many of us eating disorder dietitians regularly have is speaking up to our colleagues about harmful practices that put people at risk for eating disorders, only to have our concerns brushed aside under the assumption that we’re blowing things out of proportion. They assume the health risks of “o*besity” outweigh the health risks of an eating disorder, as if people whose BMI puts them in that category don’t have eating disorders too. The reality is that when you work with eating disorders, you can clearly see the red flags everywhere. As I often remind dietitians, even if you say you don’t work with eating disorders, you are working with eating disorders!

Eating disorders only affect women.

While the majority of those who are suffering from eating disorders are female, eating disorders can affect anyone, regardless of sex or gender. Up to 40% of people with eating disorders are male, but because of the eating disorder myth that they are a "girl thing," early signs are missed. Many men's eating disorders are only diagnosed when severe, because they have flown under the radar for so long. As with women, for men, many eating disorder behaviors are normalized, but in a different way. Eating disorder behaviors might been seen as an attempt to “bulk up” with diets like paleo or keto, or things like biohacking, which is popular among the tech industry.

People who identify as trans or gender nonconforming are also hugely at risk for eating disorders - at least 4 times more likely to develop an eating disorder than cis-gender individuals. Despite the elevated risk, there are few resources for trans or gender nonconforming folks, especially treatment facilities. Because body image is deeply affected by gender dysphoria, it’s essential to have a trans-friendly space and providers who can explore these nuances.

Eating disorders are a choice.

One of the most common eating disorder myths is that they are simply a diet gone wrong, and recovery involves simply choosing to eat. Eating disorders are not a disease of vanity. Yes, many times eating disorders involve an intense focus on one’s body size or shape, but that does not mean someone is choosing to have an eating disorder in order to be thin, or to get attention.

Eating disorders are considered a biopsychosocial disorder, caused by complex interactions between environmental, physchological, and genetic factors. Beauty standards and the thin ideal are certainly a a major environmental factor, and dieting is the most common trigger for an eating disorder, however it is much more complex than that.

When someone’s brain is exposed to an energy deficit or weight loss, at at certain point it can behave almost like a light switch and turn on obsessive thoughts about food and body, or ramp up preexisting psychiatric conditions like anxiety or obsessive-compulsive disorder. I suspect that pretty much everyone has this point, with some people’s brains a bit more resilient to malnutrition than others. A classic example of this is the Minnesota starvation study, a 1944 study where 36 young, male participants who were specifically screened for “psychological hardiness” were subjected to semi-starvation to study the consequences, and all developed symptoms of an eating disorder. Presumably, college-aged men in the 1940s were not subject to the same beauty ideals as people today, and yet the biological effect of prolonged undereating was the same.

Another example is ARFID, where selective eating behaviors may be part of one’s neurotype, or a way of navigating sensory processing challenges. Behaviors are a way to help someone with ARFID navigate the world in a safe way. To expect someone to choose to not have ARFID is like expecting them to choose to not have their specific neurotype.

Even if an eating disorder is mainly about controlling weight, it is still much more complex than a diet gone wrong. The reality of our culture is that it treats people in fat bodies extremely poorly, and for many people restricted eating behaviors are about avoiding weight stigma, or succeeding in a career that puts pressure to maintain a certain body type. Trying to control weight can also be a way to cope with trauma, and although thinness or fatness does not necessarily protect against abuse and oppression, it can make someone feel safer.

At the end of the day, recovery from an eating disorder is much more complex than “just eating more.” We work with clients for months and years, helping to nutritionally treat the malnutrition that develops from disordered eating, as well as the many gastrointestinal side effects. We spend time developing plans to help clients reduce anxiety around food and eating, feel more comfortable in their body, and relearn food self care skills. We work alongside our clients therapists and psychiatrists to help them identify tools to process and manage the confusing and overwhelming thoughts, feelings and emotions that come with having an eating disorder. It is the hardest work I’ve ever done - and the most rewarding.

As I frequently remind my clients, while having an eating disorder is not a choice, there are choices you can make towards healing. One of those choices is to get support. We work with clients providing recovery coaching throughout the US, or in person in our Columbia, SC office. We’re also happy to connect you with someone in your area. Click here to learn more information about our services, and reach out if you’re interested in working together.

Here’s some more recovery resources: