As we move further into January, we are entering the peak season for promoting dieting, wellness and fitness plans. In the midst of this media frenzy, it is vitally important to maintain a critical lens on “diet culture” and to remember that eating disorders come in all shapes and sizes. Many fad diets are not actually sustainable or healthy — and some can lead to unhealthy obsessions and dangerous eating disorders.

A quick social media search of terms like “body positivity” suggests that we are making progress toward greater body diversity and acceptance. As a society, we have come a long way since the nonfat, heroin-chic, scary skinny media rages. Or have we?

While there are currently more size-inclusive clothing options for higher-weight people currently, and many of us are more skeptical of the dangers of extreme dieting fads, a quick review of 2022 shows that we might not be as enlightened about body acceptance as we would hope. And critically, the majority of people living with eating disorders today do not fit the cookie-cutter stereotype of people with eating disorders.

From Ye’s fat-phobic comments about Lizzo’s weight ushering in “demonic” promotions of obesity to recent controversy over Ashley Graham taking “fat positivity” too far, it is clear that we have a long way to go before all bodies are treated with gentleness, inclusion and respect. Many have started to speculate that the ultra-skinny body ideals of the 1990s are coming back in style. Aesthetic trends supporting this skinny ideal are gaining in popularity, including buccal fat removal surgeries and off-label use of weight-suppressing drugs, which have resulted in drug shortages for many with diabetes. 

While cultural shifts in beauty ideals are normative, with centuries of art history showing the connection between historical events, cultural attitudes and beauty norms, these changing beauty standards also illustrate how society embodies norms of stigma. This systematic valuing of some bodies as “good,” “beautiful” or “healthy” results in other bodies getting labeled as “bad,” “dangerous,” “unhealthy” or “burdensome.” And this hierarchy of bodies contributes to damaging social stereotypes that promote discrimination (at the societal level) and dangerous obsessions and behaviors (at the personal level).   

As a researcher, mental health clinician and eating disorder survivor, these regressive trends toward the ultra-skinny body ideals of the 1990s are incredibly worrisome; they have been noted to contribute to body image concerns and eating disorders. Eating disorders have continued to be common among American adolescents, with some studies suggesting that around 10% of U.S. male adolescents and 20% of U.S. female adolescents have engaged in unhealthy dieting behaviors (e.g., extreme fasting, purging, or laxative abuse) throughout the study period alone. And these trends are not limited to young people. Among adults, people previously thought to be the least at risk for eating disorders — such as men, people over 45 years old and lower-income individuals, have demonstrated the most significant increases in eating disorders.

But not everyone who suffers from an eating disorder is a thin, young, white teenage girl.

Research suggests a higher weight puts people at increased risk for an eating disorder and makes it more likely that they will also face the societal pressures of weight stigma. Being higher weight can also make it less likely that an individual is screened for an eating disorder or referred for treatment. As part of my doctoral research at the University of Washington, I found that higher-weight people with eating disorders waited more than 11 years for treatment, a hugely important finding, given that we already know early intervention is critical to good treatment outcomes.

In other words, there is no one “look” for someone who has an eating disorder. And staying on the lookout for eating disorders — even among people you do not expect to struggle with one — is critical to identifying these dangerous illnesses and getting people treatment.

As an eating disorder survivor, many parts of my story fit the eating disorder stereotypes. As a child, I was creative, spunky, athletic and a perfectionist. I grew up in the fat-free 1990s and learned early on (from media and the adults in my life) that controlling my weight and diet were important. I was a thin child — but not overly so — and no one noticed when I started opting for nonfat foods and Diet Coke instead of the foods I had previously enjoyed. By seventh grade, I avidly read all my food labels, eschewing foods with higher calories. I skipped breakfast, packed low-calorie instant potatoes for lunch, and began calisthenic regimens in my bedroom to supplement my cross country, basketball and volleyball practices.

In the coming years, my food rules multiplied. I began purging, and I slowly lost nearly all of my life to the eating disorder. I was eventually diagnosed with anorexia nervosa by my pediatrician at 15 years old. My family was confused — to the outside world, I was a successful, straight-A student athlete — polite, driven and cheerful. But my inner world was dominated by a relentless, cruel voice. At the time, I didn’t believe I was thin enough or sick enough to have an eating disorder, but thankfully, the adults and professionals in my life realized I was facing a life-threatening disease. My journey with my eating disorder was long, and I struggled to get treatment during a time when eating disorder treatment programs were few and far between, and health care lacked mental health parity. I continued to struggle and was in and out of treatment for years.

Finally, in my junior year of college, my eating disorder reached a breaking point. After I was diagnosed with a cardiac condition brought on by my starvation, I lost athletic clearance. Shortly after, I was put on a mandatory medical leave. Though getting treatment was extremely challenging financially, my treatment providers were eager to help me. No one second-guessed my diagnosis. My doctor explained the damage to my heart, kidneys, fertility and gastrointestinal systems; she told me how my body had sacrificed all “unnecessary” functions to sustain itself and had begun metabolizing its own organs. I was constantly reminded that my eating disorder would kill me if I didn’t fight it. And slowly, I became willing to do whatever it took to recover.

Renourishing my body was a multiyear process. My body slowly began to heal; gradually my heart and kidneys began to function more normally, I could regulate my own blood pressure, menstruate and eventually, participate in athletics again. Despite my fears that I would “gain weight nonstop,” my body did eventually stabilize — but it stabilized at a higher weight than anyone expected. Though I was healthier than I had been in more than a decade, my body was now considered “obese.” It seemed I had, in effect, recovered “wrong.”