If you happen to’re nervous about your personal or another person’s health, you’ll be able to contact Beat, the UK’s eating disorder charity, on 0808 801 0677 or beateatingdisorders.org.uk  

Adam, 27, first showed signs of an eating disorder at 12. His weight remained stable despite other overt signs that his body was in crisis – he had early-stage kidney and bowel problems and was not developing testosterone. “Nobody ever nervous,” he says, because he was never underweight and so his eating disorder slipped under the radar. His body has been permanently damaged in the method.

At 23, Adam was diagnosed with ‘atypical anorexia’. It’s characterised by all the identical behaviours as anorexia nervosa: caloric restriction, disordered eating and psychological markers reminiscent of an intense fear of gaining weight, and body image distortion and preoccupation. Nevertheless, to receive a ‘typical’ anorexia diagnosis, you must have a body mass index (BMI) that classifies you as ‘underweight’. Never mind that BMI is famously a deeply flawed indicator that fails to account for differences in race, gender, age, or muscle mass – the scale of the body is diagnosed as an alternative of the behaviour. 

With atypical anorexia, although what you do, think and feel is similar, you might not have lost weight, or not enough weight to present as emaciated. The ‘atypical’ label declassifies the disorder as not yet dangerous, pushing the patient down the danger matrix. The premise of treatment is subsequently the worst-case scenario: waiting until the patient’s BMI drops to a threatening level for motion to be taken.

This plan of action could be harmful for any medical condition, but is especially damaging relating to eating disorders. “Your mind is already continually telling you that you simply aren’t sick enough – perhaps not even sick in any respect. So telling someone that they must be skinnier with a purpose to be taken seriously and to receive help encourages them to get sicker. It makes them wish to prove that they’re struggling,” says Taylor*, 21, who has been diagnosed with atypical anorexia. “Eating disorders, especially anorexia, are so competitive. You continually compare yourself to others who’re struggling. As if the one who gets the sickest wins. It could be incredibly helpful if doctors wouldn’t take part in this ’competition’ by only treating the one who has the bottom BMI.”

15-year-old Aurora had an identical experience to Taylor* after receiving a diagnosis at 12. “Having a weight requirement for anorexia only fuels the motive to drop some weight even further,” she says. “It’s very damaging, especially since the disorder is so focused on the sufferer’s perception of their body.”

In our culture, where thinness has long been idealised, disordered eating becomes uniquely permissible for many who aren’t already thin. From family and friends to medical professionals, when an individual with a bigger body loses weight it’s rewarded as a universal moral good – irrespective of the value. “Someone in a fat body could lose half their body weight before people even think it’s a priority,” says Erin Harrop, a researcher and clinical social employee with personal experience of atypical anorexia, on the podcast Maintenance Phase. “For many of that point, individuals are going to be congratulating them.”

Fatphobia is rife in our society – we live in a rustic where fat-shaming is actively encouraged in newspapers because the only fix for the so-called ‘obesity crisis’. The medical sphere isn’t resistant to this – anti-fat bias has been a recorded preoccupation of NHS doctors as recently as last year. “Weight stigma makes reaching out for help even harder, as people can worry they won’t be taken seriously in the event that they haven’t lost weight as a part of their eating disorder,” says Tom Quinn, the director of external affairs at eating disorder charity Beat. 

In response to Quinn, despite NICE guidelines stating that an eating disorder can’t be defined by BMI alone, Beat knows plenty of people that have been turned away from treatment due to their weight. “This stigma can worsen eating disorder thoughts and behaviours and make it far more difficult to get well.” In consequence, individuals with atypical anorexia report more severe psychological symptoms than those without an elevated BMI.  

Amidst this backdrop, the term ‘atypical’ is alienating and exclusionary. Taylor* describes receiving the diagnosis as “humiliating”. Adam finds the wording similarly unhelpful. “Each eating disorder diagnosis is atypical because there isn’t a typical,” he says. The concept that there is simply one profile of anorexia flattens the “melting pot of what influences someone’s risk aspects and receptiveness to treatment.” For Adam, who has ADHD and autism, his co-occurring disabilities are a crucial a part of the image of his eating disorder that isn’t considered by BMI alone.

“Eating disorders are mental illnesses, not physical conditions, and it’s crucial that GPs can spot the behavioural and psychological signs” – Tom Quinn

Meanwhile, LGBTQ+ people also suffer from eating disorders at a proportionally higher rate. For trans and non-binary people, who’re two to four times more likely to experience an eating disorder, this could be a way of coping with body and gender dysphoria. 

Looking beyond the reductive and binary categorisation that currently exists, many advocate for an anorexia spectrum diagnosis to raised accommodate the various contexts and desires of various people. Talking to Dazed, Harrop says they’re in favour of this approach, arguing that a diagnosis mustn’t depend on “arbitrary” and “ever-changing” weight classifications. As a substitute, the perfect plan of action is to be sure “weight is simply one a part of the image, alongside other physical markers of starvation (reminiscent of losing a period) and psychological and behavioural markers: how much an individual is restricting and their rate of weight reduction, in addition to other aspects that hugely increase risk, reminiscent of purging.”

Beat’s Quinn affirms this: “Eating disorders are mental illnesses, not physical conditions, and it’s crucial that GPs can spot the behavioural and psychological signs of their patients.” For this to work, he says, believing patient testimony is tantamount. “It’s crucial that eating disorder professionals ensure people feel validated of their illness no matter their weight or shape.”

Ultimately, we should always be any self-deprivation or self-starvation as a medical concern, no matter what the body of the person suffering looks like. And treating everyone who presents the symptoms with respect and equal importance. As Taylor* says, “it’s absolutely essential to validate the patient’s feelings and reassure them that they’re in truth sick enough and need to receive help.”