Can You Spot the Person with Anorexia?
An individual who appears to be of average size, or with a larger body, can also have anorexia.
Updated 6/14/2026
When we think about anorexia, many of us might envision an emaciated individual, typically a young woman with clothes hanging off a skeletal frame. However, it’s important to recognize that serious eating disorders can affect individuals of all body sizes, genders, and ethnic groups. In fact, less than 6% of individuals with eating disorders are underweight, and it is not possible to “guess” whether they have anorexia nervosa or not.
What is Anorexia Nervosa?
Anorexia Nervosa is the refusal of food/nutrition, along with an obsessive fear of gaining weight or “becoming fat”. This results in a disturbance in how body image is perceived and experienced. In other words, the individual with anorexia not only believes their body is larger than it is, but they also experience it to feel bigger – as if they are taking up more space than they actually are. At Sanford Behavioral Health, we treat anorexia nervosa in residential and outpatient modalities.
Anorexia results in a loss of weight or a failure to gain weight at the rate expected along the developmental trajectory for a child or adolescent. Some individuals will also engage in compensatory behaviors such as vomiting, laxative abuse, or excessive exercise in a desperate attempt to rid the body of unwanted calories.
Sanford Behavioral Health Comprehensive Treatment for Eating Disorders
At Sanford Behavioral Health, our eating disorder programming has shaped the way the entire organization looks at body image, eating, and meals. We know that body dissatisfaction is a risk factor in the development of an eating disorder. But it also plays a role in other mental health conditions. In that regard, Sanford endorses and practices a Health at Every Size approach.
Research shows that weight bias can occur in healthcare settings and may contribute to delayed care, avoidance of medical appointments, and poorer health outcomes. However, weight alone is not an indication of health in any of our practice areas. Our trauma-informed treatment is respectful of all body sizes and shapes.
Sanford Comprehensive Treatment for Eating Disorders endorses and practices a Health at Every Size approach.
Anorexia in Larger Bodies
Anorexia, where restriction of food leads to severe weight loss, is the condition most people think of when they picture someone with an eating disorder. However, an individual who appears to be of average size or with a larger body can also have anorexia. Eating disorders are mental health issues with physical symptoms and changes. An eating disorder is largely an internalized set of obsessive thoughts and rigid beliefs that drive dangerous behaviors.
Often, the serious consequences of eating disorders are not obvious to the naked eye. Not understanding this can lead to a lack of recognition regarding the development of an eating disorder, causing treatment to be delayed or even denied. Furthermore, because there is a stigma associated with being in a larger body in our society, many individuals avoid routine medical care out of fear of being shamed. The biggest medical consequence of being in a larger body can be substandard medical care, where routine screenings for cancer, high blood pressure, and heart problems are missed, along with mental health issues. At Sanford Behavioral Health, we work to educate and collaborate with medical practices.
Where Do the Terms “Overweight” and “Underweight” Come From?
What do the terms “overweight” and “underweight” mean? In general, these terms are used to compare an individual to the “norms” on BMI charts. It’s important to understand that BMI was developed as a concept to normalize weight trends in whole societies. BMI was not intended to be applied to individuals. BMI does not take into consideration race, gender, or muscle mass. Consequently, even elite athletes can fall into the “obese” category.
We reward thinness and consider restrictive dieting normal in today’s society. Even MDs can be susceptible to bias, overlooking significant weight loss as potentially dangerous behavior. Physicians may not screen for binge eating or purging behaviors due to a lack of knowledge. This delay in receiving the proper diagnoses allows the condition to become more entrenched and makes recovery much more difficult. With education and collaboration, we intend to help improve diagnosis and early intervention.
Stigma and Trauma – Larger Bodies
We also need to recognize that the term “obesity” is more of a societal construct than a true health condition. There is no medical term for “overly tall” or “unusually short” that flags individuals for special treatment considerations. We don’t devise federal programs for a “tallness epidemic”. We must develop a broader concept of health that encompasses metabolic health, flexibility, strength, and stamina, rather than a narrow focus on weight alone.
If you or a loved one is struggling with an eating disorder, taking action promptly is crucial. At Sanford Behavioral Health, we provide residential and outpatient treatment options for individuals of all ages. Our dedicated team will collaborate with you to create a customized plan tailored to your specific needs. When you’re ready to take that first step towards recovery, reach out to us. We will support you every step of the way and can help you recognize the signs of an eating disorder.
