Atypical anorexia is part of a category of eating disorders called Other Specified Feeding and Eating Disorders (OSFED), which includes eating disorders that don’t meet the clinical criteria for diagnoses like anorexia or bulimia; it’s estimated that up to 6 percent of the population has OSFED, according to the Eating Recovery Center.
With atypical anorexia, where the eating disorder behaviors are clearly evident, but the weight is not low enough to meet criteria for anorexia nervosa, it is easy for the individual to receive positive reinforcement for the ‘discipline’ they might show in public or the consequent weight loss that may render this individual into a ‘healthier’ BMI,” Joyce Faraj, Phd, RDN, CDN, a nutritionist at Mountainside, tells Bustle. “Unfortunately, this may be a very common scenario, where an overweight patient with atypical anorexia walks into a doctor’s visit, and they are applauded for their weight loss, without perhaps assessing how the individual reached their current weight. This positive reinforcement can lead individuals to think that whatever they are doing is right, without considering the effects on overall health, nutritional status and mental health.”
A more holistic view of health, one that takes mental health and relationships with food into account, suggests that weight is not necessarily indicative of health, and similarly, weight loss doesn’t always equate to metabolic or cardiovascular improvement. Recent research around body mass index (BMI), the oft-cited ratio between weight and height, establishes that this ratio is not actually a good metric to measure overall health; screening based on frequency of disordered eating behaviors and mental health disparities, Faraj says, would be a more effective way to help catch more cases of disordered eating before they become extreme.
Despite the clear science-backed evidence, many people still engage in toxic diet culture. And diet culture’s glorification of thinness, and the so-called positive reinforcement that goes along with it is what fuels so many others who may be struggling with atypical anorexia.
According to Faraj, behaviors are what matter most in eating disorder diagnosis. “Weight as a currently established criteria for typical anorexia nervosa would only catch the most severe and long-term cases of anorexia, and not those who may be at risk or who have only just begun restricting,” she says.
That’s one reason why experts are beginning to acknowledge a more holistic model of nutrition that doesn’t use weight as the sole metric of health. Faraj says that people who take part in habits and behaviors that help them feel better, mentally, physically and emotionally, are more likely to have better metabolic outcomes (meaning, they are less likely to develop diseases like heart disease, high blood pressure, or type 2 diabetes), as well as decreased stress, which are both determinants of health and disease. “A well-nourished brain and body are more likely to accept and understand the benefits of choosing other factors to measure health, such as blood pressure, depression, stress levels, anxiety scores, as opposed to a number on a scale,” Faraj says.
In a culture that is still reluctant to let go of its fatphobia, people who fit a particular size can easily have their struggles with atypical anorexia overlooked. “A lot of people think only of the physical effects of anorexia, but your brain suffers a lot too.
“Accepting that our body’s genetic predisposition is meant for us to naturally be in a weight that is much different from our expectation may be another challenging aspect of eating disorder recovery,” Faraj says. “But changing the focus from weight, shape or size, to functionality and mindfulness is another goal of recovery.”