Less than 1 in 10 sufferers Are medically underweight — what this means for recovery
Binge eating disorder (BED) is the most common ED (22%), followed by bulimia (19%), other specified feeding or eating disorder, or OFSED (47%), Anorexia (8%), avoidant/restrictive food intake disorder (ARFID) 5%.
For years, the public perception of eating disorders has been shaped by a single, narrow image—a dangerously thin, visibly frail person in crisis. But this stereotype does not reflect the reality for most people with eating disorders.
🔹 94% of those struggling with an eating disorder are not medically underweight¹.
🔹 Many of us live in bodies that don’t match the stereotype, yet face the same obsessive thoughts, compulsive behaviours, and deep distress.
🔹 Because we don’t ‘look sick enough,’ we can convince ourselves to believe that we aren’t.
This creates barriers to diagnosis, treatment, and recovery, leaving millions without access to the support they need.
1. The Myth That Eating Disorders Are Only About Weight
For too long, eating disorders have been reduced to a weight problem. But this oversimplification is deeply harmful—both for those of us suffering and for the way treatment is structured.
Many of us never lose significant weight, yet struggle with extreme restriction, purging, or bingeing.
Some of us gain weight due to cycles of restriction and bingeing, leading to greater stigma and even dismissal².
Those in larger bodies often experience severe medical complications—yet receive the least support.
“I kidded myself it wasn’t unwell enough to justify the cost of treatment and time away from work, even if I could have afforded it. Suddenly, a decade had passed. I couldn’t even remember what it was like to live without my ED.”
2. How This Leads to Misdiagnosis & Lack of Access to Care
Most healthcare systems still rely heavily on BMI as a diagnostic marker for eating disorders. If we aren’t underweight, we often don’t qualify for care. But eating disorders are not defined by BMI. Many of us experience:
🔸 Severe malnutrition, even if our weight appears stable.
🔸 Electrolyte imbalances and heart issues, even if we aren’t visibly unwell
🔸 Osteoporosis, fertility struggles, digestive disorders and other serious, long-term complications.
“I did get myself onto the waiting list for NHS care. By the time any options were available I had fallen back into denial. I wasn’t better. Not at all. I think I just started to normalise struggling so much after a while. ”
3. Why BMI Should Not Be the Only Diagnostic Factor in Treatment
BMI was never designed to diagnose eating disorders. It was created as a statistical tool—not a measure of individual health. Yet, it continues to be used as a gatekeeper to treatment, despite its clear limitations.
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BMI doesn’t measure compulsive exercise, obsessive thoughts, or cycles of restriction and bingeing.
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Those in larger bodies are less likely to be diagnosed, despite often facing more severe medical complications².
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Early treatment is critical, yet many of us are told to wait until our BMI is low enough to access care.
4. The Overlooked Majority — Why Most Sufferers Are Left Without Support
When eating disorders are only recognised at the extremes, the majority of sufferers fall through the cracks.
🔹 People in larger bodies are less likely to be diagnosed, despite facing high medical risks².
🔹 Adults are less likely to seek treatment, due to competing responsibilities and fear of stigma or discrimination³.
🔹 Many with chronic eating disorders are overlooked, as care tends to focus on younger, dependent patients and acute cases.
⤷ How This Affects Women Across Life Stages
Women’s changing roles, societal pressures, and biological transitions often shape their eating disorder experience—yet these critical life stages are rarely considered in treatment models.
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Body changes, the pressure to ‘bounce back,’ and hormonal shifts can trigger or worsen disordered eating.
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Many women deprioritise their health, struggling in silence while caring for others.
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Metabolic changes, weight gain, and shifting social roles can reawaken old patterns of restriction, over-exercise, or body shame.
Yet most treatment models are built around adolescent patients, ignoring the unique challenges women face as they move through life.
“In a large-scale study of American women between ages 25 and 45, 75% reported disordered eating and body image dissatisfaction, and 6% were trying to lose weight, although over half of these dieters were already at a normal weight.”
Yet most treatment models are built around adolescent patients, ignoring the unique challenges women face as they move through life.
“Over 13% of women over 50 have current ED symptoms (Gagne et al. 2012) surpassing the 12.4% of American women who have breast cancer (National Cancer Institute 2015). ”
5. A Better Way Forward — Recovery Without Outdated Criteria
At Ianthe House, we recognise that eating disorders are not just about weight—they are about suffering.
We provide care based on behaviours, distress, and overall well-being—not BMI alone.
🔹 No outdated BMI cut-offs for those medically stable enough to engage in psychological treatment.
🔹 A long-term, structured recovery model—not just short-term stabilisation.
🔹 A recovery approach that prioritises mental and emotional healing, not just physical markers.
“A striking observation when we first meet women suffering at midlife or later is their severe shame and embarrassment for having a “teenager’s problem.” They apologise for needing our time and attention, repeatedly blaming themselves because they “should know better.””
⤷ Final Thought
Eating disorders don’t have a weight requirement.
Suffering doesn’t have to be visible to be valid.
We don’t have to wait until we are at our worst to deserve help.
“Trust the process and don’t be scared. The group is such a lovely, safe space. You will get an incredibly rare opportunity to connect with other (amazing) women who truly understand.”
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Flament, M. F., Henderson, K., Buchholz, A., Obeid, N., Nguyen, H. N. T., Birmingham, M., & Goldfield, G. S. (2015). Weight status and DSM-5 diagnoses of eating disorders in adolescents from the community. Journal of the American Academy of Child and Adolescent Psychiatry, 54(5), 403-411.
Phelan, S.M., Burgess, D.J., Yeazel, M.W., Hellerstedt, W.L., Griffin, J.M. and van Ryn, M. (2015), Obesity stigma and patient care. Obes Rev, 16: 319-326. https://doi.org/10.1111/obr.12266
Griffiths, S., Rossell, S. L., Mitchison, D., Murray, S. B., & Mond, J. M. (2018). Pathways into treatment for eating disorders: A quantitative examination of treatment barriers and treatment attitudes. Eating Disorders, 26(6), 556–574. https://doi.org/10.1080/10640266.2018.1518086
Eating Disorders in Women at Midlife and Beyond — A Biopsychosocial-Relational Perspective, By Margo Maine, Karen Samuels
