Why You Can’t Judge an Eating Disorder by its Cover

Woman with eating disorder in field

Contributor: Courtney Howard, B.A., Director of Operations & Business Development at Eating Disorder Hope and Addiction Hope.

You cannot tell whether someone has an eating disorder just by looking at them. This cannot be emphasized enough. Though the general population has an idea in their mind of what someone with an eating disorder looks like, typically an emaciated young woman, this contributes to the stigma and keeps people sick.

This particular stigma can make the many men and women struggling who do not fit this picture wonder whether they are “sick enough” to deserve treatment. It can make physicians misdiagnose them and fail to see the red flags. It often leads to insurance companies cutting off their coverage based primarily on body mass index (BMI).

The Harmful Habit of Judging Based on Appearance

People often talk about not judging a book by its cover, but the reality is that people do it every day. This can be especially harmful to the mental health community since mental health struggles cannot typically be seen on the outside. However, people think they know better when it comes to eating disorders, when everyone suddenly becomes a medical expert.

“You don’t look like you have an eating disorder.” This is one of the most harmful things you can say to someone battling an eating disorder, as it is both dismissive and triggering. In most cases, it will make the individual feel as though he or she has not been “good enough” at his or her eating disorder and will lead to increased behaviors.

On the flip side, actress Ellen Pompeo recently expressed frustration over the false rumors that she had an eating disorder early in her career. With a naturally thin frame, Pompeo explains that she always felt it was irresponsible of the media to portray her as having an eating disorder since it sent a message to young women that if they want to be like her, they need to starve themselves.

Insurance Coverage for All

It can be extremely difficult to obtain insurance coverage for eating disorders. Insurance providers often base much of their decision of whether to continue coverage on a patient’s BMI, which is an inaccurate tool for various reasons.

First, BMI is nWoman in fieldot an accurate indicator of how sick someone is. A patient might be actively bingeing and purging on a daily basis but still fall within a “healthy” BMI. Additionally, even if a patient comes in at a low BMI, gaining weight in treatment is not a sign that he or she is ready to discharge or even transfer to a lower level of care.

Weight restoration is incredibly important for eating disorder recovery, but it is just the first piece of the puzzle. It is heavily emphasized throughout treatment since weight restoration is necessary to restore brain function in individuals with eating disorders, especially in cases of anorexia nervosa [1].

Until brain function is improved in patients, the tools learned in treatment will not be as effective. It is at that point that the work can really begin, but many patients are not given the opportunity to continue treatment since many insurance companies view weight restoration as recovery, dismissing the intense psychological needs that must be addressed for long-term recovery.

Obesity and Weight Stigma

If someone struggling with obesity goes to the doctor, the doctor will likely tell the individual to eat a “healthier” (and possibly more restrictive) diet and exercise more. Unless the doctor specializes in eating disorders or has been trained to screen for disordered behaviors, the general stigma against obesity even within the medical community will likely overshadow any eating disorder red flags the patient exhibits.

Obesity and binge eating disorder (BED) do not always co-occur, and it should be noted that assuming someone has BED based on their weight is the same as attributing anorexia nervosa to someone’s thin frame.

Flowers in handHowever, obesity and BED can co-occur. Individuals who fall into this group often vacillate between bingeing and restricting.   Asking someone with disordered food behaviors to go on a strict diet can then trigger these restrict-binge-restrict cycles.

The general stigma against the overweight population can lead to mistreatment and judgment of these individuals. A 2009 study [2] revealed that study participants perceived overweight people they viewed lying on a couch as lazy, but did not attribute the same negative views to thin people lying on a couch.

The perpetuation of stereotypes and resulting stigma against overweight individuals seem to parallel those facing the eating disorder community, particularly when these populations overlap. It is vital that we stop judging people based on their appearance and instead have compassion for all. As author Wendy Mass eloquently explains, “Be kind, for everyone you meet is fighting a battle you know nothing about.”

Community Discussion – Share your thoughts here!

When have you encountered the stereotypes of what someone with an eating disorder “should” look like? How did you respond?

Courtney Howard Image - 2-17-16About the Author: Courtney Howard is the Director of Operations & Business Development at Eating Disorder Hope and Addiction Hope. She graduated summa cum laude with a B.A. from San Diego State University, holds a paralegal certificate in Family Law, and is a Certified Domestic Violence Advocate. After obtaining her certification as a life coach, Courtney launched Lionheart Eating Disorder Recovery Coaching in 2015 and continues to be a passionate advocate for awareness and recovery.


[1]:  Kerem, Nogah C; Katzman, Debra K. “Brain structure and function in adolescents with anorexia nervosa.” Adolescent Medicine 14.1 (Feb 2003): 109.
[2]:  Berry, Tanya; Spence, John C. Automatic activation of exercise and sedentary stereotypes. Research Quarterly for Exercise and Sport, 2009; 80 (3): 633-640

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on October 2, 2016
Published on EatingDisorderHope.com