Content Note: This story discusses the details of eating disorders.
Nearly a year after being diagnosed with anorexia nervosa, Tess Holliday shares the challenges of recovery — an often nonlinear process — in a new essay for TODAY. « I’m grateful to be tough enough to talk about it, but I’ve since taken a lot of steps back in my recovery. I’ve regressed. Didn’t eat today, » the model wrote. It’s 11 a.m. and I’ve had two sips of coffee, and I feel sick, and it’s been extremely hard on my mental and physical health.
Holliday first shared her eating disorder diagnosis in May 2021. « People said I was lying, » Holliday wrote in his essay. « There are people who believe I was saying that to get attention. Some people said to me, ‘You do this to stay relevant.’ I laugh because I know it’s wrong, but it’s so revealing of the magnitude of the problem.”
Eating disorders in tall people are probably severely underdiagnosed. A culture of fat prejudice and harmful stereotypes on the link between body weight and health tells us (wrongly) that all fat bodies are unhealthy, all people with eating disorders are thin. But harmful restrictive eating isn’t exclusively a problem for thin people — eating disorders can’t be generalized to a certain body type.
Doctors, even those with good intentions, are not immune to anti-fat bias. In one study 2018 published in the journal Frontiers in Psychology, researchers found that mental health trainees were more likely to diagnose a client with symptoms of an eating disorder with anorexia when the client was described as “underweight” or “normal weight” compared to “ overweight”. They also recommended fewer therapy sessions for clients described as overweight and normal weight than for the underweight group.
It is precisely this bias that makes it so difficult for people in larger bodies to get the help they need. « So many people who are into bigger bodies have messaged me and said, ‘I never thought I was restricting myself until you started talking about it,' » Holliday wrote. « It was very empowering, but it also made me incredibly sad… It’s hard when you hear the word anorexia and it is assimilated to only one type of image. It is detrimental to so many people, including myself.
Holliday shared that it was her dietitian who first broached the idea that she might have an eating disorder. « When she said anorexia, I laughed. I thought, ‘See how fat I am? There’s no way that word could ever be attached to someone my size,’ « And starving? Then I realized that bodies of all shapes and sizes are starving, » Holliday wrote.
When someone in a larger body restricts their diet in a harmful way, it can be diagnosed as atypical anorexia. « Despite official clinical recognition, atypical anorexia nervosa is underrecognized and widely perceived to be less serious than anorexia nervosa, » according to the Acute Center for Eating Disorders and Severe Malnutrition. Symptoms are the same as in typical anorexic patients, except « the individual’s presenting weight is within or above the normal range, » according to Acute. “Patients with atypical anorexia nervosa experience the same incidence of binge eating, purging, psychiatric comorbidity, psychotropic drug use, self-harm, suicidal ideation, severe depressive symptoms, and obsession/ compulsiveness than classic anorexia nervosa. »