Using HAES Principles to Help Treat Patients with “Atypical” Anorexia
Body weight and body mass index (BMI), while inaccurate and inappropriate for many reasons, are still used to indicate the presence and severity of an eating disorder. (1) This approach is not weight inclusive and can lead to misdiagnosis in those with “atypical” anorexia nervosa (AAN) who often present with “normal” or “above normal” body weight. (2)
The Health at Every Size® (HAES®) approach is a more accurate and appropriate paradigm to use when assessing health–and may help those displaying the signs of symptoms of “atypical” anorexia. Because it removes weight bias, HAES may help someone who may have an eating disorder receive an accurate diagnosis and proper treatment.
What is HAES?
Health at Every Size is an alternative healthcare approach that proposes a weight-inclusive model of health that takes the focus off body weight as a gauge of health and, instead, looks at metabolic indicators to assess health status. (3)
Evidence-based HAES principles teach people how to accept their body size and shape, enjoy movement in their own way, and eat intuitively. (3)
How weight stigma affects people with “atypical” anorexia
“Atypical” anorexia nervosa often shares similar characteristics to anorexia nervosa (AN), with the exception of low body weight and/or significant weight loss. (4) This means that an individual with “atypical” anorexia can have a higher body weight not typically seen in those living with anorexia, and, unfortunately, be a victim of weight bias from healthcare providers. (5)
Weight bias among healthcare professionals who treat eating disorders includes: (6)
- Making negative comments about higher weight patients
- Having negative attitudes toward higher weight patients
- Feeling uncomfortable about treating higher weight patients
- Attributing patients’ higher weight to their behaviors
- Perceiving poorer treatment outcomes for higher weight patients
Weight bias among these, and other, healthcare professionals can result in a person presenting with the symptoms of “atypical” anorexia being misdiagnosed or missed entirely. Since a person with “atypical” anorexia is often above the “normal” weight range, a doctor may not think they have an eating disorder and even encourage weight loss, which can make that individual’s disordered eating thoughts and behaviors much worse.
However, “atypical” anorexia is just as dangerous as anorexia if left untreated.
How HAES can help patients with “atypical” anorexia nervosa
In a patient with “atypical” anorexia, or any other eating disorder, when body weight isn’t considered a primary diagnostic, disordered eating behaviors can be recognized and a more accurate diagnosis can be made.
Other ways HAES principles can benefit patients with “atypical” anorexia include:
- Promoting body acceptance and challenging diet culture and the thin ideal
- Honoring the body’s natural cues for hunger and satiety, not following food rules focused on weight control
- Encouraging pleasurable movement for pure enjoyment rather than exercising for weight maintenance.
Educating treatment providers about weight inclusivity and the HAES approach is a critical step toward people living with “atypical” anorexia nervosa receiving an accurate diagnosis and effective treatment. The care partners at Within Health strive to provide inclusive, trauma-informed care for all people who are struggling with an eating disorder. Every eating disorder is treatable, and help is available now at Within.
- The limitations of diagnosing anorexia with BMI. WithinHealth (n.d.). Retrieved February 1, 2023, from https://withinhealth.com/learn/articles/the-limitations-of-diagnosing-anorexia-with-bmi
- Veillette, L. A. S., Serrano, J. M., & Brochu, P. M. (2018). What’s Weight Got to Do With It? Mental Health Trainees’ Perceptions of a Client With Anorexia Nervosa Symptoms. Frontiers in Psychology, 9, 2574. https://doi.org/10.3389/fpsyg.2018.02574
- What is health at every size? WithinHealth (n.d.). Retrieved January 26, 2023, from https://withinhealth.com/learn/articles/what-is-health-at-every-size
- What is atypical anorexia nervosa? Definition & criteria. WithinHealth (n.d.). Retrieved January 26, 2023, from https://withinhealth.com/learn/articles/atypical-anorexia-nervosa
- What is atypical anorexia nervosa: Symptoms, causes and treatment. Eating Disorder Hope. (2022, November 23). Retrieved January 26, 2023, from https://www.eatingdisorderhope.com/information/atypical-anorexia
- Puhl, R. M., Latner, J. D., King, K. M., & Luedicke, J. (2014). Weight bias among professionals treating eating disorders: attitudes about treatment and perceived patient outcomes. The International Journal of Eating Disorders, 47(1), 65–75. https://doi.org/10.1002/eat.22186