Atypical Anorexia: Anorexia In a Larger Body
In May, model and body positivity activist Tess Holiday shared her diagnosis of atypical anorexia. She revealed that she’s struggled with an eating disorder for years but explained that, because she’s plus-size, it was “jarring and hard and confusing” for people to hear her say she’s anorexic.
Defining Atypical Anorexia
Given this revelation and the public’s reaction, it’s important for people to understand atypical anorexia and how it can present. As nutritionist Elaina Efird, RDN, CD, CEDRD, CSSD explains in a recent YouTube video, “Anorexia can impact people of all weights, shapes, and sizes.”
Atypical anorexia, which is a subtype of Other Specified Feeding or Eating Disorder (OSFED), refers to an eating disorder in someone who meets all the criteria for anorexia except for their weight category. They obsess over calories, restrict their intake, and have an extreme fear of gaining weight that impacts their social and psychological state. However, they are at a normal or even higher weight for their height and body shape. Because the suffering individual doesn’t “look” anorexic, the eating disorder is difficult to recognize and often goes undiagnosed.
Atypical Anorexia Case Study
In this case study, the individual was actually diagnosed with atypical anorexia even though she was in a larger body — which, again, is challenging! As Elaina explains, “She did not fit the weight criteria, but all of the other psychological impact was happening as well as the restriction that led her to this diagnosis.”
When this individual first came to The Kahm Clinic in August 2019, she was 308.1 pounds at a height of 5 feet, 11 inches. She had recently left a residential treatment program for her eating disorder. During her stay, she gained weight as her treatment team worked with her to restore her relationship with food. She was consuming an appropriate amount of calories and maintained this weight for a bit. She came to us for step-down care; specifically, she wanted help with her meal planning and getting to full eating disorder recovery.
Her initial metabolic testing results were fairly positive. Her metabolic rate was actually higher than we expected (2, 574 calories versus 2, 205 calories), and her protein metabolism was only slightly above normal (1.1 percent). These numbers are likely a result of her work during treatment to adequately restore her intake. Remember: At this point, she had only recently left treatment and hadn’t been actively restricting her calories.
When she came back to see us in September 2019, she had begun to relapse. It was only a month later, but her weight had decreased significantly to 294.7 pounds. “She started getting in her head that she wasn’t good enough at this certain size. That eating disorder voice really started to take over,” Elaina says.
She quickly fell back into her pre-treatment disordered eating patterns. She started restricting her intake to only 300 to 700 daily calories. She would eat only one meal — or sometimes no meals (fasting) — each day. She was also purging because, after only a few weeks of restriction, 300 to 700 calories started to feel like a lot of food. By October 2019, she had lost 15 more pounds and was down to 279.5 pounds.
Unfortunately, some people look at her weights and think these numbers are great — but that’s clearly not the case. She was severely restricting her intake, purging, and obsessing over food and her body. By November 2019, she was back in a residential treatment program to work on her eating disorder behaviors and prevent another quick relapse from occurring.
To talk to a professional about eating disorder diagnosis, treatment, and recovery, please reach out to our staff or schedule an appointment at The Kahm Clinic.