It’s More Than a Diet: What We Still Get Wrong About Eating Disorders
- TK
- 7 days ago
- 11 min read
I want to start with something that took me a long time to understand: eating disorders are not about food. I know that sounds like exactly the wrong place to begin an article about eating disorders, but stick with me, because I think this single misunderstanding is responsible for the majority of harm compared to anything else surrounding this topic.
We talk about eating disorders like they are dietary problems that got out of hand. It makes it sound like someone went on a diet and simply forgot to stop, or developed a "toxic relationship with food," a phrase I have seen thrown around so casually that it has lost almost all meaning. The reality is significantly more uncomfortable. Eating disorders are serious mental illnesses. They have the highest mortality rate of any psychiatric condition. And every 52 minutes, somewhere in the world, someone is killed because of one.
That statistic stopped me cold when I first came across it. It should probably stop more people from airing out their views without educating themselves. This has become increasingly obvious with the age of social media. A lot more people are comfortable becoming keyboard warriors attacking behind the screen without learning.
What Are Eating Disorders.
There are several distinct eating disorders, and lumping them all together is one of the reasons people misunderstand them so badly. Here is a rough breakdown of the main eating disorders..
Anorexia Nervosa, involves severe restriction of food intake driven by an intense, often terrifying fear of weight gain and a distorted perception of one's own body. People with anorexia will frequently look in a mirror and genuinely see something that nobody else in the room sees. It is not vanity. It is not performance. It is a disorder of perception that is extraordinarily difficult to treat and extraordinarily easy to misread as a personality trait. Anorexia has the highest mortality rate of any psychiatric disorder, and that includes depression.
Bulimia Nervosa, involves cycles of binge eating followed by compensatory behaviors — purging, fasting, laxative use, compulsive exercise. Critically, many people with bulimia are at what the medical establishment calls a "normal" weight. This is one of the reasons it goes undetected for so long. Nobody looks at a person and thinks they might be seriously ill, because the illness isn't written on their body in the way people expect.
Binge Eating Disorder (BED), is the most common eating disorder, and probably the least talked about in serious terms. It involves recurrent episodes of eating large amounts of food very quickly, usually alone, usually followed by significant shame and distress, and crucially, without the compensatory behaviors associated with bulimia. It is not simply "having no self-control." It is a recognized psychiatric condition, and treating it like a moral failing is both wrong and actively harmful.
ARFID — Avoidant/Restrictive Food Intake Disorder — is less well known but increasingly diagnosed, particularly in children and teenagers. It involves extreme food avoidance based on sensory sensitivities, or fear of choking, or genuine lack of interest in food. Importantly, it has nothing to do with body image. A person with ARFID is not trying to be thin; they are managing a deeply distressing relationship with eating itself.
OSFED (Other Specified Feeding or Eating Disorders) is the category that catches everything that doesn't fit neatly into the boxes above. People sometimes hear "OSFED" and assume it means a milder version of a "real" eating disorder. It does not. The suffering and the medical consequences are just as serious.
It Is Not a Western Problem.
If I had to pick one thing about eating disorder discourse that genuinely frustrates me, it is the assumption that this is fundamentally a Western phenomenon. A rich, white, Western one at that. It is an assumption that causes real harm, because it means that when someone in Lagos or Seoul or São Paulo develops an eating disorder, the people around them — and sometimes the clinicians treating them — are less likely to recognize it.
The Americas
The United States has the most extensive research base, which can give a distorted impression that eating disorders are uniquely an American problem. They are not; America just has more funding. An estimated 28.8 million Americans will develop an eating disorder in their lifetime, and even that number significantly undercounts cases in non-white communities, where diagnosis rates are dramatically lower despite comparable rates of illness.
In Brazil, body image is so deeply culturally loaded that researchers studying adolescent girls in urban schools have found rates of disordered eating attitudes comparable to those in Western Europe.
In Mexico and Argentina, eating disorders are increasingly documented in clinical settings, frequently entangled with questions of femininity, family, and the collision between traditional culture and globalized beauty standards.
Europe
Europe has been studying eating disorders clinically for longer than anywhere else, which gives us a more complete historical picture. Scandinavia reports some of the highest documented rates of anorexia nervosa in the world.
The UK has put considerable research investment into demonstrating that eating disorders cut across class, ethnicity, and geography, dismantling the "middle-class white girl" stereotype from within its own healthcare system, albeit slowly.
Southern Europe presents something particularly interesting: countries like Italy, Spain, and Greece have deeply food-centered cultures where eating together is a social foundation, and yet disordered eating is well-documented there too, often concealed precisely because restrictive habits can be reframed as discipline or health consciousness in a way that attracts admiration rather than concern.
Asia
Japan documented cases of anorexia nervosa in the 1960s, long before Western media had any significant foothold in Japanese culture. That fact alone should settle the debate about whether this is a Western export.
South Korea has one of the most intense diet cultures in the world, one where cosmetic surgery is normalized to a degree that is genuinely staggering if you are encountering it for the first time, and where the pressure on young women and men to conform to a very specific physical ideal is relentless and institutionalized.
Studies from South Korea, China, and Hong Kong consistently show sharp rises in disordered eating over recent decades, tied to academic pressure as much as beauty standards.
In India, the Philippines, and Indonesia, binge eating and compensatory behaviors are increasingly reported, sometimes in contexts of poverty and food insecurity, which dispels the notion that eating disorders are disorders of abundance.
Africa
Africa is the most under-researched region, and that gap is not because eating disorders are rare there, it is because global mental health research has consistently deprioritized the continent, which is a different problem entirely.
Studies from South Africa, Nigeria, Egypt, and Ethiopia have all found clinically significant rates of disordered eating and body image disturbance.
South Africa is particularly interesting given its history: the country's complex and painful relationship with race, body, and beauty has shaped how eating disorders present and how they are received.
Across parts of sub-Saharan Africa, larger body sizes have historically been socially valued, which offered some cultural protection against thinness-driven disorders.
That is changing with urbanization and shifting media exposure. In many African contexts, eating disorders are frequently misattributed entirely — to poverty, to spiritual causes, to gastrointestinal illness — meaning the person never receives an accurate diagnosis or appropriate care.
Who Are At Risk
Almost anyone. That is genuinely the most accurate answer, and the one that gets diluted most in public conversation.
An estimated 1 in 3 people with an eating disorder is male. Male eating disorders are chronically under-diagnosed partly because of stigma — men are less likely to seek help and less likely to be asked about it — and partly because even clinicians carry the unconscious assumption that this is a women's illness. It isn't.
Eating disorders occur at every body size. A person can be critically ill with anorexia while still within a "normal" BMI range. A person can have BED without being visibly overweight. Weight is genuinely not a reliable indicator of whether someone has an eating disorder, and the habit of looking for thinness as proof of illness causes people to be dismissed constantly.
The Modelling Industry
The fashion industry gets a lot of airtime in eating disorder discussions, and some of that attention is justified. Studies of professional models do show higher rates of disordered eating than in the general population, which is not surprising given that some agencies have historically set weight and measurement requirements that are physiologically impossible to sustain without restriction.
Models have spoken publicly about being told by agents to lose weight before castings, about fitting rooms where the entire atmosphere is one of bodily surveillance, about watching peers disappear and return visibly smaller and being congratulated for it. If someone already carries a genetic or psychological vulnerability to an eating disorder, that environment can be the thing that tips them over.
At the same time, not every model develops an eating disorder. Protective factors matter: a stable sense of identity outside of appearance, supportive relationships, access to mental health care, working within agencies that take size diversity seriously.
France, Israel, and Italy have introduced legislation requiring models to hold medical certificates confirming a healthy BMI before working; the effectiveness of this approach is debated, but it signals at least an acknowledgment that something needs to change structurally.
The thing I want to push back on is the tendency to make models the face of eating disorders entirely. Every time eating disorder awareness content centers around runway imagery or dramatically thin bodies, it quietly reinforces the idea that eating disorders have a specific look, a specific context, a specific type of person. They don't.
The person with BED who binge eats in their car after work does not see themselves in that imagery. The male athlete using restrictions to make weight doesn't either. The university student who has gone from eating three meals a day to eating one, and who everyone assumes is "just stressed about exams," isn't represented. Making this about the fashion industry, exclusively, is a comfortable narrative that lets most people off the hook.
School, Work, and the Signs People Miss.
Eating disorders don't announce themselves. They tend to arrive quietly, tangled up in things that look like something else entirely.
In academic settings, the overlap with achievement and anxiety means they are genuinely hard to spot. A student who is restricting food severely enough to impair cognitive function will present as distracted, disengaged, struggling to concentrate — not as someone who is ill.
The student who used to eat lunch with friends and now always has somewhere else to be, who frames it as being "too busy," who has developed elaborate systems for avoiding the cafeteria, may be managing something serious while appearing merely organised. Binge eating episodes cluster around high-pressure periods: exams, deadlines, the particular misery of January.
A student whose eating feels completely out of control in week ten of term, in a way that compounds their existing anxiety and shame, is not going to self-identify as having an eating disorder. They are going to think they have no self-discipline, and feel worse, and not tell anyone.
Declining academic performance in a previously high-achieving student can be directly tied to the physical effects of restriction: concentration impairs, memory falters, processing slows. Teachers and tutors rarely connect these dots.
In workplaces, the pattern is similar but with added layers. High-functioning adults with eating disorders often pride themselves on being the last person anyone would suspect. They come in early, stay late, decline lunch "because they have a call," exercise for two hours before work, and appear to be managing everything brilliantly right up until they aren't. Presenteeism — being at work while genuinely unwell — is very common. The collapse, when it happens, looks sudden from the outside.
Athletes deserve a specific mention here. The overlap between athletic discipline and disordered eating is significant and underacknowledged. The line between training hard and using exercise compulsively as a form of restriction or punishment is not always visible from the outside, and in cultures that celebrate relentless athletic dedication, it is often not visible from the inside either.
The broader point is that eating disorders are almost always wrapped around something else: perfectionism, anxiety, a need for control, a response to trauma, a way of managing emotions that have nowhere else to go. Changes in someone's relationship with food rarely appear in isolation. They tend to come alongside changes in mood, social withdrawal, shifts in concentration, a subtle pulling away from life. Noticing the whole person matters more than waiting for a dramatic physical sign.
The Warning Signs
There are signs to watch for, in yourself or in someone you care about.
Behavioral signs:
Avoiding meals, always having a reason not to eat with other people
Rigidity around certain foods or eating rituals that wasn't there before
Disappearing to the bathroom after meals consistently
Exercise that feels driven by anxiety or guilt rather than enjoyment
Wearing clothes that hide the body, even in warm weather
Pulling back from social events that involve food
Making frequent, negative comments about their own body
Declining to eat in the canteen, at the work lunch, at the family table
Binge episodes that they seem ashamed of and hide carefully
Physical signs:
Noticeable weight changes in either direction
Dizziness, fainting, consistent fatigue
Hair thinning
Dental erosion
Swollen jaw or cheeks
Feeling constantly cold
Digestive problems
Difficulty concentrating or persistent brain fog
Emotional signs:
Preoccupation with food, calories, or their body that takes up significant mental space
Fear of weight gain that seems disproportionate or fixed
Seeing their body very differently from how others see it
Anxiety or irritability around mealtimes that isn't explained by other things
Self-worth that seems almost entirely tied to their body or their eating
Shame and distress after eating that is intense and recurring
Perfectionism and self-criticism that extends far beyond food
No single sign is a diagnosis. A pattern of several of them, particularly when daily life is being disrupted, is worth taking seriously.
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Eating Disorders Are Not
They are not a choice. Nobody decides to have one. They develop from a combination of genetic vulnerability, neurological factors, psychological tendencies, and environmental pressures. The behaviors that maintain them are compulsive, not deliberate.
They are not vanity. This cannot be said enough. Eating disorders are not about wanting to look a certain way. They are about managing internal pain that has found an outlet in food and the body.
They are not a diet that went too far. Diet culture can be a trigger, yes. The disorder itself is something categorically different from deciding to eat less.
They are not rare. Seventy million people globally. One of the most common mental health conditions in young women in many countries, and significantly underdiagnosed in virtually everyone else.
They are not untreatable. Recovery is real and it happens. Early intervention makes a meaningful difference, which is one of the reasons awareness matters.
They are not a Western illness. They exist on every continent, in every demographic, in every economic context. Culture shapes what they look like. Culture does not determine who gets them.
How to Help
If you are worried about someone, the most important thing is to approach them without making it about their body. Comments on appearance, even well-intentioned ones, almost always make things worse.
Say something along the lines of: "I've noticed you seem really stressed lately and I wanted to check in." Lead with care, not alarm. Listen without trying to immediately fix anything. Encourage them to speak to someone qualified. Don't tell them they don't look sick. Don't tell them you're sure it's not that bad. Don't suggest they just need to relax around food.
If they are a student, many universities have counseling services with staff who have experience in this area. If they are hesitant, you can offer to help them find resources or to go with them to an initial appointment.
Take care of yourself in this too. Supporting someone with an eating disorder is genuinely hard, and you are allowed to find it difficult.
Finding Help
Recovery almost always requires professional support: a therapist with specific eating disorder experience if possible, a dietitian who works from a non-diet framework, medical monitoring, and sometimes more intensive levels of care.
If you or someone you know needs support:
The National Alliance for Eating Disorders Helpline: 1-866-662-1235 (US)
Beat Eating Disorders (UK): 0808 801 0677
The Butterfly Foundation (Australia): 1800 33 4673
Your country's national mental health helpline for local referrals
If you are in crisis, please contact an emergency service or crisis line in your area.
Conclusion
When I started writing this my mind was open to see new points of views. This was because I kept seeing eating disorder content that felt like it was talking about a very specific, very narrow group of people, and I kept thinking about everyone that framing was leaving out. The person in Nairobi, my city. The teenage boy who doesn't understand what is happening to him. The forty-year-old who has never once been asked about his relationship with food by a clinician. The student who is doing fine, academically, while quietly falling apart.
Eating disorders find people in every context, on every continent, in every kind of life. They are not about food, and they are not about vanity, and they are not about weakness. They are about pain that has found a very particular place to live.
If you recognise yourself or someone you care about in anything here, that recognition matters. Please don't let it stop at recognition.
If this was useful, share it. Awareness genuinely does reach people who need it.
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