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Atypical Anorexia is More Typical Than We May Think -
Begging for Shifts in Treatment and Culture

by: Stephanie Haines, MEd, CHES, Walden Behavioral Care
December 12, 2022
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Atypical Anorexia is More Typical Than We May Think

What is Atypical Anorexia?

Atypical anorexia occurs when all criteria are met for anorexia nervosa such as restricting food and fluid and fear of gaining weight, but they are not what one would consider a significantly low weight earning it the title of “atypical.” The fortunate few who receive a correct diagnosis of atypical anorexia nervosa are ideally referred to an outpatient team who specializes in treating eating disorders.

This illness, however, is not atypical at all. According to a New York Times article, “starting in the mid-2000s, the number of people seeking treatment for the disorder rose sharply. Whether more people are developing atypical anorexia or seeking treatment — or more doctors are recognizing it — is unknown, but this group now comprises up to half of all patients hospitalized in eating disorder programs. Studies suggest that the same number of people, even as many as three times as many, will develop atypical anorexia as traditional anorexia in their lifetimes. One high estimate suggests that as much as 4.9 percent of the female population will have the disorder.”

Anorexia Nervosa: Underweight and Elevated

Of all the feeding and eating disorders, anorexia nervosa often gets the most press.

When people think of eating disorders, it’s usually anorexia nervosa that first comes to mind. That’s in large part because it is often romanticized in the media, and it’s one that is the most “visible.”

Medical and psychological providers see the evidence of the disease more readily in underweight anorexia nervosa patients, and measures are swiftly taken to care for them and protect them from their potentially tragic trajectories.

In reality, anorexia nervosa is the rarest eating disorder. That’s why it’s important to talk about the other eating disorders that aren’t actually atypical at all.

Atypical Anorexia: “Overweight” and Unaddressed

If someone is in a larger body, their struggle with an eating disorder is far more likely to be ignored, minimized, or dismissed completely. Should a medical provider’s perception be that someone is “overweight”, they often suggest weight loss as a primary solution to all their problems.

This furthers the person’s journey through life attempting to engage in unrealistic dieting behaviors, blaming themselves for their lack of “success,” thus strengthening their eating disorder. The dire medical consequences go unaddressed.

A recent New York Times article “You Don’t Look Anorexic,” features Sharon Maxwell’s story about recovering from atypical anorexia, a diagnosis she finally received after suffering from disordered eating for 19 years.

Conditioned Weight Stigma Means Inequality in ED Treatment

As we collectively come to understand that eating disorders are more inclusive than we thought, we would do well to check our own biases. If body size influences how we feel toward and furthermore how we diagnose someone who exhibits eating disorder behaviors, we must consider the power of conditioned weight stigma.

We all make assumptions. For many years, we thought that only underweight, biological females met the criteria for anorexia nervosa. It’s been less than a decade that we have allowed individuals born biologically male to be properly diagnosed with anorexia nervosa. It’s been less than a decade that we have recognized atypical anorexia nervosa as a diagnosis, but we know more now.

And still atypical anorexia is widely underdiagnosed as many primary-care doctors and pediatricians are not aware of this type of eating disorder. Furthermore, folks with atypical anorexia are often victims of bias in the healthcare setting and given messages that undermine their illness with additional encouragement to restrict intake, utilize fad diets, or engage in unrealistic amounts of exercise.

Severe health concerns that would be an automatic ticket to higher levels of care for someone who is underweight are minimized for those in average or larger bodies. These include but are not limited to low/high heart rates and blood pressure, abnormal labs, dizziness, loss of vision, shortness of breath, fatigue, hair loss, and trouble sleeping.

According to the New York Times article, “recent research has found that body size is a less relevant indicator of the severity of both eating disorders than other factors, including the percentage of body mass lost, the speed of that loss, and the duration of the malnourished state. ”

We are growing increasingly aware that this life-threatening illness can afflict anyone. We know to look more closely at any person who has a pattern of interfering with attempts at nourishment and an intense fear of weight gain. We must practice seeing people for their symptoms and not disqualifying or ignoring based on gender identity or body size.

The result will be a correct diagnosis sooner and access to more appropriate and effective anorexia nervosa treatment for more people who need it.

Become Aware of Your Bias

The first step in changing potentially harmful or unfair bias is to become aware of your own personal biases. Researchers at Harvard developed the Weight Implicit Association Test to test weight stigmas and better understand implicit weight bias.

A New Weight Philosophy

At Walden, we are committed to evidence-based practice and delivering care that does not perpetuate weight stigma or reinforce weight bias. That is why we created a Weight Inclusivity Task Force to assess and advance Walden’s clinical programming and treatment planning with guidance from research. This interdisciplinary team of experts spent 18 months clarifying, codifying, educating, and training our staff on Walden’s philosophy and the clinical protocol around weight and weight-related treatment objectives.

We are actively sharing our Weight Philosophy with providers to shift treatment and culture across the eating disorder community and ultimately provide equitable care for all.

For more information about Walden Behavioral Care, please visit waldeneatingdisorders.com.


Stephanie Haines, MEd, CHES (she/her) has been providing school communities with specialized addiction prevention education since 1999 and has taught students of all ages in most U.S. states and more than 25 countries across five continents. After completing her graduate work at Plymouth State University’s Eating Disorders Institute in 2013, Stephanie joined Walden Behavioral Care as their Prevention Education Specialist, creating an eating disorders prevention curriculum designed for use in school communities. Stephanie takes great joy in raising awareness about the prevention and treatment of eating disorders and substance use disorders as a private consultant, and helping families get the care and support they need and deserve as a member of the Walden team.

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