"You Don’t Look Sick:" How Stereotypes and Weight Stigma Create Barriers to Eating Disorder Recovery

Abbey Lefko, MA, LCMHCA

Psychotherapist

When you think about an eating disorder, what does it look like? Does your brain immediately render an image of an emaciated girl with pale skin and bones protruding? If so, you are not alone: many people think that they can visually identify an eating disorder. Yet, the data shows that only 6% of individuals diagnosed with eating disorders are medically underweight, meaning 94% of people struggling with eating disorders are at or above a ”normal weight” (Flament et al., 2015).

The narrative that eating disorders have a particular look prevents people who don’t fit into that specific box from seeking and receiving treatment. The boogie man here isn’t the eating disorder, but instead is the weight stigma that is so pervasive in our society that we are missing the eating disorder entirely. 

Weight stigma is the discrimination of people based on their body weight and size and it stems from the belief that being fat or overweight is a moral failure. It stems from the assumption that a person’s body size is fully within their control, therefore if they are fat it is their actions and inactions that caused them to be that way.

So, if you can’t tell if someone has an eating disorder by looking at them, how can you tell if someone is struggling with disordered eating? Below are some noteworthy signs, but please know this list is not inclusive of all warning signs.

Behavioral warning signs:

• Sudden changes in food preferences (refusing to eat certain foods, eliminating whole food groups, drastic diet changes)
• Going to the restroom immediately after eating
• Avoidance of situations involving food
• Repetitive body checking behaviors (pinching, frequent weighing of self, excessive time spent looking in mirrors)
• Social withdrawal
• Food rituals (eating foods in certain orders, excessive chewing, overuse of condiments, rearranging food, cutting food into small pieces, etc.)
• Continual denial of hunger
• Sudden changes in exercise behaviors

Psychological warning signs:

• Preoccupation with body shape, weight, and physical appearance
• Intense fear of gaining weight
• Preoccupation with food and activities relating to food
• Heighten anxiety or fear around meal times
• Moodiness and irritability
• ​Body image dissatisfaction/distorted body image
• Rigid thinking patterns (viewing everything as either “good” or “bad”)

Physical warning signs:

• Noticeable fluctuation in weight, both up and down
• Sensitivity to the cold
• Gastrointestinal complaints (stomach cramps, acid reflux, constipation)
• Lightheadedness/dizziness (especially upon standing)
• Fatigue
• Signs of frequent vomiting (swollen cheeks, red marks on knuckles, dental problems)

As a society we have to start working toward unlearning the harmful stereotypes about eating disorders because regardless of what some might think, eating disorders do not discriminate. Eating disorders impact people of all ages, genders, races, and body sizes, but if we think of eating disorders as only impacting the overly thin young white woman, we make it harder for those who don’t look like her to be taken seriously and receive the treatment they need to recover. Eating disorders will continue to be the most deadly mental illness, second only to opioid addiction, unless we stop perpetuating the narrative that there is a “look” that denotes the presence of an eating disorder.  

Recovery becomes more possible when we challenge the belief that eating disorders have a certain “look.” When we reduce weight stigma and listen with curiosity rather than assumption, more people are seen, believed, and able to access care. Eating disorder recovery is not measured by body size but by healing one’s relationship with food, body, and self. No matter how someone looks on the outside, their struggle is valid, and recovery is always possible.

February 23rd to March 1st, 2026 is National Eating Disorder Awareness week! To learn more visit NEDA’s website www.nationaleatingdisorders.org 

References
Flament, M. F., Henderson, K., Buchholz, A., Obeid, N., Nguyen, H. N. T., Birmingham, M., & Goldfield, G. (2015). Weight status and DSM-5 diagnoses of eating disorders in adolescents from the community. Journal of the American Academy of Child & Adolescent Psychiatry, 54(5). https://doi.org/10.1016/j.jaac.2015.01.020

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Author, Abbey Lefko, MA, LCMHCA is currently accepting new clients and welcomes individuals seeking support for eating disorder recovery and body image concerns. If you or someone you know could benefit from compassionate weight-inclusive care, reaching out is a meaningful first step. Book by clicking Abbey's name below.

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Abbey Lefko

Abbey Lefko, MA, LCMHCA is a Licensed Mental Health Counselor Associate who works with individual clients aged 13+. She has experience working with a variety of client concerns and has specialized training in the treatment of eating disorders. Abbey’s approach to therapy is affirming, relational, and holistic. She works collaboratively with her clients to help them gain awareness, insight, and skills to live a more fulfilled life. She firmly believes that healing comes from a place of deep understanding and insight and strives to get to know each client as a unique individual. Abbey draws from several different therapeutic modalities to individualize her interventions to the unique needs of her clients.