It’s time to do away with the belief that only thin women can suffer from an eating disorder.

By Sam Reed
May 03, 2021 @ 5:29 pm
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Tess Holliday Is What Anorexia Looks Like
Credit: E! Entertainment/Getty Images

Over the weekend, the model and body positivity activist Tess Holliday tweeted about her anorexia nervosa diagnosis. It should go without saying that I believe her diagnosis is real. Full stop.

Many of Holliday's followers reacted to the tweet like I did, with supportive comments and expressions of solidarity about how all-consuming an eating disorder can be. There were others, though, that decided Holliday's medical history was not a fixed fact, but rather, a topic up for debate. 

The trolls' arguments were padded with fatphobic rhetoric about weight and eating disorders, as well as misinformation about the "definition" of the disease. They called Tess, who has always been unapologetic about her appearance and unconcerned with the trolls who litter her comments sections with "concerns about her health," a liar seeking sympathy. 

Holliday is unbothered by the comments. As she's mentioned previously, her health is between her and her doctor, and not the nosy anonymous accounts of people that read one Wikipedia article and believe their knowledge is equal to medical professionals'. Nevertheless, their understanding of anorexia worried me. The stereotype of a thin woman wasting away on nothing but crumbs and tea, as these users seem to picture, denies the vast range of people who struggle from disordered eating, and who oftentimes suffer in silence. The number of bones protruding from your sternum does not legitimize an eating disorder, because above all, anorexia, bulimia, and all the forms that eating disorders take, are diseases of the mind, not of a body type.

There is a specific picture of women — and it's always cis women — with eating disorders that's often included in doctors' office brochures: In this photo, she is whittled away to nothing but bone, a skeleton with paltry lungs and cheek bones so sharp as to be dangerous. She is the model of eating disorders that they show us in health class in middle school and high school. She is the one we should be looking out for. She is the one we don't want to be. She looks nothing like Tess Holliday, and she looks nothing like I did when I suffered from anorexia.

For years, I denied that I had an eating disorder to friends and family, and mostly to myself. My obsession with calorie counting and weighing myself and standing in front of the mirror to document the fluctuating millimeters between my thighs were all in the name of "health." When my period stopped, I accepted myself as one of the millions of women with "irregular" menstruation. As an athlete, I was bony but also sinewy, muscle bulging on my thin frame. I could not be anorexic because I did not look like her, I thought.

When my restricted eating became unsustainable, replaced instead with bouts of binging and purging, I told myself I couldn't be bulimic because I was also rapidly gaining weight. Clinically, the number on my scale was still "healthy." As long as I didn't purge more than three (or four, and then five) times per week, I didn't have a problem, I thought. I was simply "making myself feel better." 

I wasn't the woman in that photo we all know, and so I wasn't sick. I told myself this lie for years. 

Holliday's trolls were mostly concerned with semantics, referencing outdated definitions in the Diagnostic and Statistical Manual of Mental Disorders (DSM) which list "low weight" or a low BMI (another can of worms, but I digress) as requirements for a diagnosis. The DSM-5, the most recent edition, still has a "low body weight" requirement, however, as Chelsea Kronengold, associate director of communications for the National Eating Disorders Association (NEDA) tells InStyle, this is a step up from the DSM-IV criteria which included specific numbers. In this case, the semantics are an issue of the DSM not keeping up with the latest language used to describe and treat disorders. "Hopefully, by the time it's the DSM-6 all references to weight will be removed," she says. 

As it stands currently, people with higher body weight who meet all existing criteria for anorexia nervosa except for low body weight, are diagnosed with atypical anorexia nervosa, which falls under Other Specified Feeding and Eating Disorders (OSFED). Kronengold says, however, that this "atypical" classification can be problematic. "Atypical anorexia nervosa is anorexia nervosa with weight stigma attached to it," she adds. Subclinical diagnoses that fall under OSFED include purging disorder (bulimia without the binge eating element), and binge eating or bulimia where the disordered eating occurs infrequently.

"Eating disorders including anorexia can impact any person in any sized body," says Kronengold. "But many people suffering from atypical eating disorders don't recognize or take seriously the severity of the disorder." These disorders, she adds, can have equally as impactful physical and psychological consequences. 

When I should have been seeking help, I further enmeshed myself in the vicious cycle of disordered eating, the roller coaster that I could never disembark no matter how exhausted I became. There were highs when I lost weight, lows when I gained, and because food is such a profound part of being a human — of simply being alive — my eating disorder consumed every aspect of my life. I was unable to think of anything else but the foods I couldn't eat, the calories in my next meal, or whether or not a social function would have snacks I might "lose control" in front of. My sense of goodness was tied wholly to the number of calories consumed on any given day. In my college circle we were all like this, more or less. We were all "just trying to be healthy." 

Today, I imagine what my life would have been like had I understood that my obsession with weight was a disease I could seek help for; if I had known that my shame and body dysmorphia didn't have to be "part of being a girl." Maybe if I had seen a girl who looked like me in the brochures, or a woman who looked like Tess, then the years I spent fighting my body would have been instead spent living more fully.

But that didn't happen. Ten years after the first day I began counting calories, I was finally able to accept a diagnosis I didn't think was possible because my body didn't look like a stereotype. And my diagnosis set me free.

If you're struggling with disordered eating, NEDA has put together a list of free or low-cost COVID-19 resources, in addition to their confidential and toll-free National Eating Disorders helpline. You can also refer to their Black Lives Matter resources for additional support.