I’m not overweight or underweight – I can’t have an eating disorder
- Joss Burns
- Feb 17
- 5 min read
Updated: Feb 17
Illnesses and disorders don’t always show on the outside. While not a universal truth, this is a good rule of thumb for almost all mental health related issues.
People – especially men – often hide when they are suffering from depression. The dedicated employee might be smiling all day in the office, but secretly the workload is too much and they’re struggling. And then you have domestic violence, a topic so often shrouded in silence that we all know someone affected by it, we just may not know that they are.
When it comes to eating disorders, there is the common assumption that if someone is severely underweight or severely overweight, then they have one. It is true that these may be signs of an unhealthy relationship with food, but they are far from definitive.
In a National Alliance on Mental Illness webinar, Dr. Maria Rago, President of The National Association of Anorexia Nervosa and Associated Disorders (ANAD), spoke about eating disorders – and busted some common myths while doing so.
The continuum of eating
Food is a complicated topic when it comes to our relationship with it. Unlike alcohol, drugs, gambling or other addictions, we need food to live. And that must fall somewhere within a happy medium. Nobody is going to have a problem by drinking too little alcohol or never gambling – but not getting enough food is as life threatening as having too much.
This raises the question: what is a healthy or unhealthy relationship with food?
Dr. Rago defines it as the difference between "non-disordered" eating and an eating disorder. She explains that it isn't just about what is on the plate, but the mental space food occupies. In other words, it is a continuum where the "extreme end" is characterized by obsession, fear, and isolation.
As Dr. Rago says, “What percentage of your time do you spend thinking about food, weight, and body image? That’s why it’s like a continuum." For people who don’t have a balanced relationship with food, “An eating disorder is taking control of a lot of their thoughts and behaviors... they’re almost bricked into a tower of a very lonely place."
Anorexia, bulimia, binge eating, & ARFID: Recognizing the major types
We said at the beginning that a person’s appearance doesn’t necessarily mean anything. As Dr. Rago says, "Be careful about that – don’t say someone doesn’t have anorexia just based on weight... if you really know about eating disorders, you don’t have to be a certain weight to have those qualities."
This is a vital point to understand: eating disorders are internal battles, not a dress size. The reality is that someone can be in a life-threatening situation even if they look "healthy" to the casual observer. For those struggling with anorexia, it’s less about the number on the scale and more about a paralyzing "drive for thinness" and a profound fear of food.
It often comes down to the mental "math" people do to get through a day. With bulimia and binge eating, there’s a distressing sense of losing control, usually followed by an invisible set of rules to "fix" the mistake.
Compensating behaviors
As Dr. Rago explains, "Compensating behavior runs all through eating disorders... I can’t just eat the dinner, I have to have some kind of plan to make up for those calories." Whether it’s excessive exercise or restriction the next day, that need to "pay" for a meal is a major red flag.
Then there is ARFID (Avoidant/Restrictive Food Intake Disorder), which is more common in children and often has nothing to do with body image. It’s a sensory or fear-based avoidance – like a child being terrified of choking – that makes eating feel impossible.
Eating disorders are life-ending disorders
It's easy to underestimate the physical toll because these struggles are so often hidden. But the reality is stark: eating disorders carry the highest death rate of any psychiatric illness.
Dr. Rago describes a "medical fallout" that touches every part of the body – from cardiovascular issues and bone loss to dangerous electrolyte imbalances – noting that "every system of the body is affected."
Compounding factors
This physical strain rarely happens in isolation. Most people are fighting a dual battle; roughly 62% of patients struggle with anxiety, while 52% face depression. It’s a vicious cycle where the body and mind fail together. If your body is running on empty, your mind simply doesn't have the fuel it needs to heal.
Dr. Rago captures this perfectly: "How are you going to get better from your depression if you're super starving? That’s just going to be depressing in and of itself.”
What can I do if I suffer from an eating disorder?
Recovery doesn't happen in a vacuum, and often, the world outside makes the internal battle even harder. Dr. Rago points out that we live in a "cruel world" where weight stigma and media shaming act as triggers, making "body injustice" a significant barrier to healing.
To counter this, she advocates for the Health at Every Size (HAES) approach – the idea that you should "be whatever size you are and be as healthy as you can in that size, in that body." It’s a vital shift from judging a body’s value based on a scale to supporting its actual well-being.
Marathon – not a sprint
Breaking free from these cultural pressures is the start of a recovery process that Dr. Rago describes as a "marathon, not a sprint." Because the journey is long, getting the right help is about finding the appropriate level of care, whether that’s outpatient therapy, nutrition counseling, or intensive residential treatment.
For younger people, the "gold standard" is Family-Based Therapy (FBT), which empowers parents to see the disorder not as defiance, but as terror. As Dr. Rago explains, "If you see any eating disorder behaviors, they are fearful. They're not 'I won't do it'; they're 'I'm afraid to do it.'"
By understanding that distinction, families can help the individual "talk back" to the internal "Ed voice" and reclaim their life. It requires a willingness to "go the distance," but with the right support, the isolation of the disorder can eventually be replaced by a healthy, balanced relationship with food.
Would you like help from us at MHAI?
If you don’t know where to begin, begin with us. Simply taking a mental health test can give you the information you need to kickstart a new you, and a new relationship with food.
You can also contact us directly to talk with one of our support personnel, who will help put you in contact with the right person for you. And, of course, the team at ANAD is also willing and ready to help give you guided support on this journey.
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