Someone with an eating disorder can look 'healthy'

Eating disorders are still misunderstood. Ask most people in the UK about their understanding of people suffering and you will likely hear adjectives such as ‘thin, emaciated, young, female, white and teenage’. 


Although this demographic does represent a valid proportion of people with eating disorders, it is the tip of a ginormous iceberg. We know that 85% of people with an eating disorder are not underweight (1) and symptoms are frequently hidden beneath a normal or overweight body frame. Confusingly, many sufferers may even have gym-honed physiques with muscle definition and can look extremely ‘healthy’ from the outside.

Here are some examples of hidden eating disorder presentations:

The male gym-rat

The male gym-rat weight trains several times a week. He may appear to be the pinnacle of health with a muscular physique and low body fat. But behind closed doors, he is obsessed with every morsel of food that is passing his lips, rigidly counting calories and macros. He can’t eat out socially due to the fear of disrupting his meal plan and several times a week, he finds himself binge eating wildly out of control and consuming thousands of calories. This leads to intense levels of mental distress and low mood.

The grandmother stuck in yo-yo dieting

She started her first diet at 12 years old, taken along to the slimming club (with noble intentions by her family) who were themselves in cycles of ongoing weight loss and gain. She has spent a life starving herself for extensive periods, with very restrictive eating. This has led to food preoccupation and anxiety around social eating. She is often feeling cold and distracted due to hunger and has an unhealthy addiction to the weighing scales. Others have never shown concern about her eating, as her weight is still within a healthy body mass index range, so everyone assumes that she couldn’t possibly have an eating disorder. Whereas she is suffering from atypical anorexia nervosa – all the symptoms of this horrific illness, minus being low body weight. 

The transgender woman 

They are experiencing intense body dissatisfaction and acute distress around body image. They are body-checking multiple times per day on reflective surfaces and comparing themselves endlessly to others. They are restricting their food intake and engaging in compensatory behaviours after eating, such as self-induced vomiting or taking laxatives. They have bulimia nervosa. Traditional eating disorder services do not seem to offer a language or accessibility that feels welcoming or understanding of their struggles. They feel isolated and alone, holding a deep sense of shame.

It's helpful to develop awareness and understanding of eating disorders beyond the anorexia nervosa stereotype. It is likely that there are people in your social network who are struggling, who may or may not be aware of this. Our culture gives confusing messages about eating disorders with the endless dialogue around health and weight loss. People are often praised for their aesthetic appearance when deeply struggling inside.

As we have more conversations about the reality of eating disorders and appreciate the diversity of people who can suffer, this improves education, understanding and treatment in this field.


(1)  Fairburn and Harrison 2003

The views expressed in this article are those of the author. All articles published on Counselling Directory are reviewed by our editorial team.

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Cambridge, CB1
Written by Harriet Frew, MSc; MBACP Accred
Cambridge, CB1

Harriet Frew is a counsellor specialising in eating disorders and body image.
She runs eating disorders and body image training for professionals, supervision and online courses.

Find Harriet on Instagram: @theeatingdisordertherapist_ and listen to The Eating Disorder Therapist Podcast on your favourite platform.

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