Health Risks of Losing Weight With Atypical Anorexia
Are you tired of your doctors ignoring your eating disorder and recommending that you lose weight? Are you tired of being perceived as not “sick enough”?
You’re not alone.
It’s unknown to many that eating disorders come in all body shapes and sizes. More specifically, it is more common than not to see people with anorexia who are not underweight. This means that most people with anorexia are not in very thin bodies. But because of eating disorder stigma, and weight stigma, individuals are dismissed, or worse recommended weight loss/dieting advice when they are stuck in their eating disorder.
What is atypical anorexia nervosa?
According to the DSM-5, the definition of atypical anorexia nervosa is “when an individual meets all of the criteria for anorexia nervosa, except despite significant weight loss, the individual is at or above what is considered a normal weight”. (the use of “normal” here is based on a flawed and unhelpful BMI scale and isn’t something we don’t support as dietitians)
In other words, those with atypical anorexia nervosa experience all of the same symptoms as anorexia nervosa; however, they are considered to be within or above “normal” body-mass-index (BMI) range. Even though the term “atypical” is harmful to those struggling with eating disorders that aren't in thin bodies, the term is used in medical, nutrition, and psychological settings.
Anorexia is harmful no matter what size body you have. Using the term “atypical” perpetuates weight stigma, invalidates eating disorder diagnoses, and reinforces fatphobic beliefs. And most importantly, it misses a lot of people that need eating disorder treatment and care because of this which means that people can go lifetimes without ever getting a diagnosis.
At Bravespace Nutrition, we don’t use the term “atypical” because atypical anorexia isn’t atypical at all. In fact, most people struggling with anorexia aren’t underweight. Eating disorders exist in all bodies of all sizes, and using the word “atypical” invalidates the experience of restrictive eating for those who aren’t in thin bodies.
Why are people with atypical anorexia encouraged to still lose weight?
There is scientific evidence that using “atypical anorexia” as a diagnosis is harmful. Despite this, doctors and healthcare practitioners still use it. Even worse, because of weight stigma they might encourage patients with anorexia to lose weight because they are in a larger body size.
There are several reasons why this happens, including:
Over Reliance on BMI to diagnose anorexia and eating disorders
If you aren’t underweight according to BMI scale but meet criteria otherwise for anorexia nervosa, you’re diagnosed with atypical anorexia (or not diagnosed with an eating disorder at all). This can cause you to feel like you aren’t “sick enough”, invalidates your experience with food, and can encourage you to engage in the eating disorder behaviors so you can be perceived as “sick enough” for a diagnosis.
Use of BMI for insurance coverage
Insurance companies use BMI as a criteria to evaluate the severity of an eating disorder and the need for treatment. Oftentimes, those with atypical anorexia don’t qualify for insurance coverage solely because they aren’t underweight according to the BMI scale. Eating disorder treatment can be expensive out of pocket, and this leads a lot of people with atypical anorexia to feel as if they don’t deserve or need treatment. They might try to lose weight to qualify to receive financial assistance from their insurance.
Use of BMI and weight as a sole measurement of health
Some people struggle with anorexia, yet aren’t diagnosed because they are in a larger body. There is a misconception that you have to be underweight to struggle with anorexia. Sometimes healthcare providers miss the symptoms of anorexia in individuals in larger bodies and give unsolicited weight loss advice which causes harm. Patients that are already struggling with their body image are then encouraged to keep restricting and doing behaviors that are often already part of the eating disorder.
What are the health risks of losing weight if you have atypical anorexia?
If you have atypical anorexia and you’re thinking of losing weight, there are some things you should know.
Losing weight with atypical anorexia puts you at risk for:
Electrolyte deficiencies or imbalances
If you have atypical anorexia and are pursuing weight loss, you are at risk for severe electrolyte deficiencies and imbalances, including hypokalemia (low potassium), hyponatremia (low sodium), hypophosphatemia (low phosphorous), and hypomagnesemia (low magnesium). It’s important for your body to maintain particular electrolyte levels, and deficiencies or imbalance of electrolytes can put your health at great risk.
Cardiovascular risk
Losing weight with atypical anorexia negatively affects your cardiovascular health. It can cause hypotension (low blood pressure) and brachycardia (low heart rate). This is extremely dangerous for your body, regardless of whether you are underweight or not!
Gastrointestinal issues
Pursuing weight loss and restriction if you have atypical anorexia has a profound impact on your gastrointestinal health. You’re at an increased risk for:
Bloating and constipation
Delayed gastric emptying
Your stomach holds onto food much longer than usual
Reduced intestinal motility
This can cause severe abdominal pain and bloating
Gallstones
Acid reflux
Blood imbalances
Losing weight with atypical anorexia can affect your red and white blood cells and cause the following:
Low red blood cell count
Low white blood cell count
Low platelet count
Red and white blood cell imbalances can negatively impact your immune and cardiovascular health.
Bone and skeletal issues
Losing weight can cause you to have low bone density, putting you at risk for osteoporosis, osteopenia and bone fractures.
Psychiatric health
Losing weight while struggling with atypical anorexia worsens all aspects of the eating disorder, often causing or worsening anxiety, depression, body image issues, and sometimes suicidal ideations.
There are many health risks associated with weight loss in those with atypical anorexia. It is incredibly dangerous for your body, and the health consequences are the same no matter your body size.
If you’re struggling with anorexia and are not classified as “underweight” according to BMI, you deserve support.
It’s not your fault that the healthcare system and insurance companies utilize BMI as the primary measure of severity in anorexia. It’s not your fault that the system is extremely flawed, and it’s not your fault that you don’t receive the same treatment as those in smaller bodies. It’s a problem with the system and how we treat eating disorders.
The eating disorder dietitians at Bravespace Nutrition know this and would love to support you if you’ve been diagnosed with atypical anorexia and/or you suspect that you may have it.
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Tired of providers that don’t seem to care about your relationship with food and body image? Tired of feeling invalidated in your experience with food? We’re here to help!
At Bravespace Nutrition, we recognize the harms of using BMI to diagnose patients with eating disorders. Our caring, nonjudgmental eating disorder dietitians are here to help you navigate your relationship with food and body image and validate your experiences with food. To get started on your healing journey today, schedule a free 15 minute discovery phone call!