Eating disorders are not size-specific.
You cannot look at someone and know if they are struggling with food, body image, or disordered behavior. Contrary to popular belief, eating disorders don’t have a “look,” and they aren’t confined to a specific population.
Unfortunately, for people in larger bodies, the system is stacked against their recovery from the very beginning.
Most Eating Disorders Go Missed in Fat Bodies
If someone presents with a thin body, eats almost nothing, exercises obsessively, or has a fear of food, they’re met with concern and urgency.
But when someone in a fat body presents with the exact same behaviors?
They’re often praised. Encouraged. Congratulated for their “discipline.” Even though they are miserable and their mental health is in serious jeopardy.
That’s not care. That’s neglect.
“We find it hypocritical to prescribe practices for heavier people that we would diagnose as eating disordered in thin ones (McEntee, 2023).”
And yet—it’s happening every single day.
The Data Doesn’t Lie
Let’s look at the numbers:
- Only 2% of those who meet clinical criteria for an eating disorder are “underweight” (Sonneville, 2018)
- Among individuals labeled “overweight,” 20% of boys and 40% of girls report using disordered eating behaviors (Darby, 2007)
- Fat individuals with eating disorders are less likely to be diagnosed, and even when diagnosed, less likely to be referred for treatment
- When they are sent for treatment, their condition is taken less seriously and their treatment plan may be different from straight-sized peers of the same or less severity
- Worse? Some are referred to weight loss programs instead of recovery programs—reinforcing the very behaviors that caused the disorder in the first place
This is a public health crisis fueled by weight stigma disguised as medicine.
The Harm of Weight-Focused “Treatment”
Telling someone in a larger body to keep restricting, over-exercising, or ignoring hunger cues in the name of weight loss is not treatment. It’s gaslighting. It’s a guarantee that the eating disorder will grow stronger, not weaker.
Imagine being praised for losing weight when that weight loss is driven by starvation, fear, and obsession. Imagine trying to seek help and being handed a diet plan.
This is the reality for thousands of fat people with eating disorders.
Things must change in the way we manage eating disorders for people in large bodies. These are some of the very real things that happen and cause harm:
- “Providers recommending ‘weight management’ or simultaneously treating ‘EDs and Obesity’ perpetuate weight stigma by maintaining an explicit focus on weight (rather than health behaviors) as the target for treatment (McEntee, 2023).”
- Not weight restoring fat patients or underweight restoring. This oversight makes the patient significantly more at risk for relapse.
- Overuse of BMI and fat percentage.
- Mandatory weigh-ins without harm reduction. “It should be clearly communicated to the patient why they are necessary, how they fit within a more comprehensive treatment plan, and how weight stigma will be addressed (McEntee, 2023).”
- Comments and judgments about the quality and quantity of food patients consume.
- Lack of communication between healthcare providers (e.g., PCP prescribes weight loss or praises weight lost due to ED because they have not talked to the ED team).
In one heartbreaking study, a person suffering from an eating disorder explains that the second time she went to treatment. She was in a large body her second time around, and her experience was incredibly different from the first time she was in care. She shares:
My therapist “took me into the main group room, where my peers were hanging out […] She pointed to my peers and asked me […] “look at them, and compare them to yourself. What do you notice?” […] Cindy [her therapist] went on to explain […] “They need this treatment. They need to be here. Look at yourself. You’re going to be fine.
“I had lost 20-25% of my body weight through food restriction, over-exercising, and frequent purging behaviors […] I was put on a restricted caloric meal plan that mimicked my disorder.”
This “affirmed my disordered beliefs that my body was somehow ‘different’ or ‘broken.'”
“It affirmed my peers’ disordered beliefs that larger or fatter bodies should be starved or restricted.”
“It visibly separated me from my peers with similar diagnoses and behaviors, solely based on my physical appearance.”
Real Recovery Can’t Be Weight-Focused
You cannot heal your relationship with food while being told your body is wrong. You cannot recover from an eating disorder while being pushed to shrink.
Recovery must prioritize nourishment, not numbers. It must center on food freedom, body trust, and mental health, rather than weight loss. This applies to everyone, in everybody.
Until we accept that eating disorders happen in all body sizes and are just as life-threatening, we will continue to put more and more people in the path of eating disorders and the very damaging consequences of those disorders.
Until, as a society, we change our perception of fat people and stop mistreating and fearing people in large bodies, eating disorders for all people will continue to be one of the deadliest mental health conditions.
If You’re in a Larger Body and Struggling With Food
Please hear this: You deserve care. Real care. Not a diet disguised as therapy. Not a weight-loss goal wrapped in shame.
Your struggle is valid. Your pain is real.
And your path to healing does not require shrinking your body to be taken seriously. We must do better, as no one will be free from body oppression until we accept body diversity. Schedule a Free Consult Today!