Eating Disorders Can Affect People of All Sizes

Key points

• Eating disorders do not always look obvious from the outside.
• Weight stigma can make symptoms easier to miss.
• Many people delay help because they feel “not sick enough”.
• Restriction, bingeing, purging and overexercise can occur at any size.
• Support can help before things become severe.

Eating disorders are not always visible

Eating disorders can affect how a person eats, thinks about food, relates to their body, and copes with distress. They do not follow one body type, and body size alone cannot tell you whether someone is struggling.

One harmful myth says a person must look underweight to have an eating disorder. That stereotype can stop people in medium, larger, or changing bodies from recognising their own symptoms. It can also affect how friends, families, and health professionals respond.

Weight stigma means judging, blaming, or treating someone differently because of their body size. In eating disorders, it can lead to missed symptoms, delayed care, and the painful belief that someone is “not sick enough” to need help.

This article looks at how eating disorders can go unnoticed when body size becomes the focus, and why distress around food, eating, weight, and shape deserves attention at any size. For a broader overview of symptoms, diagnosis, and the effects eating disorders can have, you may also find our article on eating disorders and their impact helpful.

Why “not sick enough” is such a common belief

Many people with eating disorders minimise what is happening. They may compare themselves to a narrow image of illness and think, “I am still functioning, so it must not be that bad,” or “My weight is not low enough, so I cannot really be unwell.”

This belief can feel especially strong when other people praise weight loss, comment on “discipline”, or assume a person has become healthier because their body has changed. From the outside, someone may look calm or in control. Inside, they may feel frightened by how rigid, secretive, or consuming food has become.

Feeling “not sick enough” can delay help for months or years. It can also make people feel ashamed for struggling, as though they need to prove their distress before it counts.

You do not need to wait until other people notice. If food, weight, exercise, or body image takes up more of your life than you want it to, that is enough reason to talk to someone.

How weight stigma can hide eating disorder symptoms

Weight stigma makes eating disorder symptoms harder to see. When body size becomes the main measure of health, people often miss important warning signs.

For example, friends or health professionals may congratulate a person in a larger body for weight loss, even when that person barely eats. Someone who binge eats may hear that they lack willpower, rather than receive help for distress and loss of control. A person who exercises compulsively may get praise for commitment, even when exercise has become punishing or frightening to miss.

This does not mean every conversation about health, food, or movement causes harm. The problem begins when people use body size as a shortcut for understanding health, without asking what is happening psychologically or behaviourally.

Eating disorders often thrive in secrecy. Weight stigma adds another layer of silence, because people may worry others will judge them, misunderstand them, or tell them to diet when dieting is part of the problem.

Symptoms people may miss when body size becomes the focus

Eating disorder symptoms can show up in many ways. Some appear obvious. Many do not.

Signs can include:

• rigid food rules or fear of eating certain foods
• skipping meals, fasting, or eating very little
• binge eating in secret or feeling out of control around food
• vomiting, laxative use, fasting, or overexercise after eating
• panic, guilt, or shame after meals
• body checking, frequent weighing, or avoiding mirrors
• withdrawing from meals, events, dating, or social activities
• feeling unable to rest because exercise rules feel urgent
• dizziness, fatigue, digestive issues, or difficulty concentrating

Some people eat “normally” in public while struggling intensely in private. Others move between restriction, bingeing, purging, and attempts to regain control. The pattern may not fit neatly into one stereotype, but it still can be serious.

Eating disorders that people often overlook

Binge eating disorder

Binge eating disorder involves repeated episodes of eating a large amount of food with a sense of loss of control. Many people describe shame, distress, secrecy, or self criticism afterwards.

People often misunderstand binge eating disorder. They may frame the symptoms as overeating, poor discipline, or comfort eating, rather than recognise a serious eating disorder. This can leave the person feeling blamed rather than helped.

Bulimia nervosa

Bulimia nervosa often involves cycles of binge eating followed by behaviours intended to compensate, such as vomiting, fasting, laxative use, or excessive exercise.

Many people with bulimia are not underweight. Because of this, their symptoms can stay hidden for a long time. Someone may attend work, maintain relationships, and appear well, while still feeling trapped in a frightening cycle that feels difficult to stop.

Atypical anorexia

Atypical anorexia includes many of the psychological and behavioural features of anorexia, such as restriction, intense fear of weight gain, and a strong focus on weight or shape, without the person being at a low body weight.

The word “atypical” can mislead people. It does not mean mild. People with atypical anorexia can face serious psychological distress and medical risk, particularly when weight loss has happened quickly or restriction has become severe.

Other specified eating disorders

Some people have symptoms that do not fit neatly into one diagnostic category. That does not make their difficulties less real. A person may restrict, binge, purge, avoid certain textures, fear fullness, or feel trapped by body image distress without having a simple label for what is happening.

A diagnosis can help, but people do not need a diagnosis before they deserve care. This doesn’t always fit with how people imagine eating disorders looks, but it can still deserve attention.

Why weight loss can mislead people

People often treat weight loss as automatically positive, especially when someone lives in a larger body. This can become dangerous when fear, shame, restriction, purging, or compulsive exercise drives the change.

A person may receive compliments at the exact time their world becomes smaller. They may avoid meals, feel panicked around food, lose flexibility, or withdraw socially. Confusion can set in because other people seem pleased by something that makes them feel worse.

This is one reason eating disorders can feel hard to name. When the outside world rewards the behaviour, the person may feel even less entitled to ask for help.

A better question than “what is happening to your weight?” is often “what is your relationship with food and your body costing you?”

When health advice becomes harmful

Some people with eating disorders have painful experiences in health settings. They may raise concerns about eating, exhaustion, dizziness, bingeing, or distress, only to have the conversation return to weight.

Advice to diet, restrict further, or focus mainly on weight loss can cause harm when no one has understood the person’s history. For someone already caught in eating disorder patterns, that advice can strengthen the illness.

Good care looks at the whole picture. This includes eating patterns, mood, body image, physical symptoms, medical risk, social withdrawal, trauma history, exercise patterns, and shame. It also includes careful listening when a person says something feels out of control.

Weight can offer one piece of information, but it should not become the whole story.

The role of shame, trauma, and control

Eating disorders rarely centre only on food. For many people, eating disorder behaviours develop alongside stress, anxiety, bullying, body shame, trauma, rejection, perfectionism, or emotional overwhelm.

Restriction can create a short term sense of control. Bingeing can numb distress or bring relief after long periods of deprivation. Purging can become a desperate attempt to undo panic. Exercise can shift from enjoyable movement into a rule that feels impossible to break.

These patterns often make sense in context, even when they cause harm. Therapy usually involves understanding what the eating disorder does for the person, not just telling them to stop.

That understanding matters because shame usually makes symptoms worse. People often need curiosity, structure, and compassion, not another reason to criticise themselves.

What therapy may focus on

Therapy for eating disorders can involve several parts, depending on the person’s needs and level of risk. For some people, the first step involves naming what is happening and reducing secrecy. Others may also need help from a GP, dietitian, or psychiatrist.

A psychologist may help with:

• recognising eating disorder thoughts and rules
• reducing shame and self criticism
• understanding triggers for restriction, bingeing, purging, or overexercise
• building more flexible responses to distress
• improving body image and self worth
• addressing perfectionism, control, anxiety, trauma, or relationship patterns
• planning for meals, social situations, and moments of high risk

Approaches may include CBT, CBT focused eating disorder work, ACT, compassion focused therapy, schema therapy, or other therapies depending on the person. The work should feel steady and realistic. Recovery rarely comes from one perfect insight. It usually builds through repeated, supported changes over time. If you are looking for more information about therapy options, you can read about our approach to eating disorder treatment in Melbourne.

Seeking help before things become severe

Many people wait because they think they should manage alone. Others worry that a psychologist will not take them seriously, especially if someone has already dismissed their concerns because of body size.

You can seek help even if you still go to work, study, parent, exercise, or appear fine to others. You can seek help if symptoms come and go. It also makes sense to ask for help if you feel unsure whether it “counts”.

Consider speaking to someone if food decisions feel exhausting, body image affects your day, eating feels secretive or frightening, or exercise has become hard to miss without guilt.

Earlier support can help people understand what is happening before patterns become more entrenched.

Supporting someone who feels “not sick enough”

If someone you care about struggles with food or body image, try not to make their body the focus. Comments like “you look healthy” or “you do not look like you have an eating disorder” can feel invalidating, even when they come from kindness.

A simple comment may help more, such as “I have noticed food seems really stressful at the moment,” or “You do not have to prove you are sick enough for this to matter.”

Try to avoid commenting on weight loss, weight gain, portion sizes, or appearance. Instead, focus on distress, isolation, mood, secrecy, and how much mental space food and body image seem to take up.

Encouraging professional help can help, but pressure and arguments often make people retreat. Calm, steady concern usually works better than trying to force immediate change.

Getting support at Cova Psychology

Cova Psychology is a Melbourne psychology practice with locations in Melbourne and North Melbourne. Our psychologists work with adults who experience eating disorders, disordered eating, body image distress, anxiety, shame, and related patterns.

People come to therapy at different stages. Some feel unsure whether they have an eating disorder. Others have lived with symptoms for years. Many feel embarrassed because they do not match the stereotype they were taught to expect. If you would like to understand the broader range of concerns our team works with, you can also read more about our psychology services in Melbourne.

Appointments are available in Melbourne and North Melbourne, with telehealth appointments with a psychologist also available where appropriate.

If eating, body image, or exercise takes up too much of your life, you are welcome to contact Cova Psychology to ask about support.

FAQs

Can you have an eating disorder if you are not underweight?

Yes. Eating disorders can affect people in all body sizes. Someone may live in a smaller, medium, larger, or changing body and still experience serious eating disorder symptoms. Body size alone cannot show how distressed a person feels, how restricted their eating has become, or how much food, exercise, weight, or body image shapes their life.

What does “not sick enough” mean in eating disorders?

“Not sick enough” describes the belief that symptoms do not count because a person still functions, does not look visibly unwell, or is not underweight. This belief can stop people from seeking help. Stereotypes about eating disorders often reinforce it, especially when other people praise weight loss or overlook distress.

What is atypical anorexia?

Atypical anorexia involves many of the same features as anorexia, such as restriction, fear of weight gain, and intense body image distress, but the person is not at a low body weight. The term can sound less serious than it is. People with atypical anorexia can still face significant psychological distress and medical risk.

How does weight stigma affect eating disorder care?

Weight stigma can lead people to judge, blame, or give simplistic advice to someone based on body size. It can also cause people to miss serious symptoms because the person does not match a stereotype. This may delay treatment, increase shame, and make someone less likely to speak honestly about restriction, bingeing, purging, or compulsive exercise.

What symptoms might suggest I should get help?

It may help to speak to someone if food rules feel rigid, eating causes guilt or panic, bingeing happens in secret, exercise feels compulsory, or body image affects your mood and choices. You do not need to wait until symptoms become severe. If eating or body image takes up more space than you want it to, support may help.

Should I see a psychologist, GP, or dietitian?

Many people benefit from a team approach. Psychologists can help with thoughts, emotions, behaviours, shame, anxiety, trauma, and body image. Your GP can assess physical health and medical risk. A dietitian with eating disorder experience can help with eating patterns and nutrition. The right starting point depends on your situation, but any of these professionals can help you work out next steps.

How can I support someone without making body comments?

Focus on how the person seems to feel, rather than how they look. You might mention that food seems stressful, they seem more withdrawn, or they sound caught in harsh self criticism. Avoid praising weight loss, commenting on portions, or debating body size. Gentle concern, patience, and encouragement to seek professional help usually work better than pressure.