Eating Disorders and People with Higher Weight

Historically, eating disorders have been conceptualised as illnesses of people of low body weight and typified by disorders such as anorexia nervosa. There is now substantive evidence that this is inaccurate. Eating disorders occur across a range of body types and across the weight spectrum. 

An eating disorder diagnosis may be missed for people with higher weight as the perceived traditional stereotype of a person with an eating disorder is not observed. Weight stigma (discrimination or stereotyping based on a person’s weight) may also be experienced.    

An important aspect in addressing weight stigma is in the use of language that avoids stigmatising terms for someone experiencing weight stigma. While there is not one universally agreed-upon term for people with higher weight, the terms ‘people with higher weight’ or ‘living in a larger body’ are preferenced by NEDC to replace ’overweight’ or ‘obesity’. These terms were chosen based on consultation with people with a lived experience of eating disorders and high weight, as well as research in this area (e.g., Hart et al., 2021; Puhl, 2020) 

Despite the high prevalence of people experiencing eating disorders and high weight, eating disorders are consistently under-recognised and under-treated in this population. People who are of higher weight and experiencing an eating disorder have often experienced delayed identification of the eating disorder, misdiagnoses in assessment, subsequent inappropriate and inadequate treatment and widespread stigma. There has been little to guide clinicians on the management of eating disorders for people with higher weight. To address this important gap, NEDC have developed Management of eating disorders for people with higher weight: clinical practice guideline. To read more about the Guideline click here.  

Important issues to understand about eating disorders and higher weight:

  • Eating disorders are not disorders of people with low body weight. Eating disorders can occur across a range of body types and across the weight spectrum 
  • Eating disorders experienced by people with higher weight are under-recognised and undertreated 
  • Binge eating disorder is not the only eating disorder potentially experienced by people with higher weight. People with higher weight may experience a range of eating disorders including but not limited to other specified feeding or eating disorder (OSFED; which includes ‘atypical anorexia nervosa’), bulimia nervosa and binge eating disorder 
  • Eating disorders are common and increasing in prevalence. This is particularly true for people with eating disorders who are of higher weight. This population comprises more than half of all people with an eating disorder in Australia with rates of eating disorders increasing most in people with higher weight (Da Luz et al., 2017) 
  • Early intervention is crucial and provides the best chance of recovery from an eating disorder 
  • Every person experiencing an eating disorder is deserving of equitable, safe, accessible, and evidence-based care regardless of their body size 
  • Eating disorders experienced by people with higher weight are just as serious and life threatening (from medical complications and self-harm) as eating disorders among people with lower weight (Appolinario et al., 2022; Whitelaw et al., 2018) 
  • Eating disorders experienced by people of any weight are associated with high levels of psychological distress and mental disorders 
  • Many people experiencing eating disorders and higher weight are not aware they have an eating disorder. However, these people frequently present for weight loss treatment. 
  • Weight loss should not automatically be praised and reinforced  

References 

Appolinario, J. C., Sichieri, R., Lopes, C. S., Moraes, C. E., Veiga, d. G. V., Freitas, S., Nunes, M. A. A., Wang, Y.-P., & Hay, P. (2022). Correlates and impact of DSM-5 binge eating disorder, bulimia nervosa and recurrent binge eating: a representative population survey in a middle-income country. Social Psychiatry and Psychiatric Epidemiology, 1-13. https://doi.org/https://doi.org/10.1007/s00127-022-02223-z  
 
Da Luz, F., Sainsbury, A., Mannan, H., Touyz, S., Mitchison, D., & Hay, P. (2017). Prevalence of obesity and comorbid eating disorder behaviors in South Australia from 1995 to 2015. International Journal of Obesity, 41(7), 1148-1153. https://doi.org/10.1038/ijo.2017.79  

Hart, L. M., Ferreira, K. B., Ambwani, S., Gibson, E. B., & Austin, S. B. (2021). Developing expert consensus on how to address weight stigma in public health research and practice: A Delphi study. Stigma and Health, 6(1), 79.  

Puhl, R. M. (2020). What words should we use to talk about weight? A systematic review of quantitative and qualitative studies examining preferences for weight‐related terminology. Obesity Reviews, 21(6), e13008.  

Whitelaw, M., Lee, K. J., Gilbertson, H., & Sawyer, S. M. (2018). Predictors of complications in anorexia nervosa and atypical anorexia nervosa: Degree of underweight or extent and recency of weight loss? Journal of Adolescent Health, 63(6), 717-723. https://doi.org/10.1016/j.jadohealth.2018.08  

See also

Disordered Eating & Dieting

Disordered eating sits on a spectrum between normal eating and an eating disorder and may include symptoms and behaviours of eating disorders, but at a lesser frequency or lower level of severity. Disordered eating may include restrictive eating, compulsive eating, or irregular or inflexible eating patterns.

more

Body Image

What is body image?Body image is a combination of the thoughts and feelings that you have about your body. Body image may range between positive and negative experiences, and one person may feel at different times positive or negative or a combination of both.

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Eating Disorders in Males

Eating disorders can affect people of any gender. There has been an under representation of males in eating disorder research (1), and research with males is almost exclusively with cisgender males and may not be inclusive of people who identify as trans or gender diverse.

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Eating Disorders and Diabetes

If you are living with diabetes and experiencing disordered eating or an eating disorder, you are not alone.  Anyone living with diabetes can be at risk of developing an eating disorder.

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Risk & Protective Factors

The elements that contribute to the development of an eating disorder are complex, and involve a range of biological, psychological and sociocultural factors.

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