Atypical anorexia nervosa (AAN) is often treated as a footnote in conversations about eating disorders, a quieter, less visible counterpart to what many still imagine as the “classic” presentation of anorexia nervosa. But in reality, this diagnosis does not indicate a lesser illness. It reflects a deeper and more systemic issue: the role of weight stigma in how we recognize, label, and respond to eating disorders.
When someone exhibits all the psychological and behavioral symptoms of anorexia but is denied diagnosis or care because of their weight, the problem isn’t that the illness is atypical. The problem is the system.
If you’re looking for an overview of atypical anorexia, including signs, symptoms, and treatment approaches, you can review that here. Instead, this is a closer examination of how the diagnosis itself—its history, its categorization, and the experiences of those who carry it—exposes the harm of weight-based thinking in healthcare. Atypical anorexia becomes a lens through which the wider failures of weight stigma come into focus.
Who Gets Seen, Who Gets Missed
One of the most insidious effects of weight stigma is diagnostic invisibility. AAN is defined by the presence of restrictive behaviors, fear of weight gain, rapid or significant weight loss, and psychological distress—in other words, all of the same criteria that are seen with “typical” anorexia nervosa—but without the individual falling below a certain weight threshold. The assumption that thinness must accompany severity means that people in larger bodies are often overlooked or even praised for the very behaviors that indicate a life-threatening illness.
For many individuals who develop atypical anorexia, the seeds of disordered eating are sown early. Messages about weight, often framed as health concerns, begin in childhood. Praise for dieting and assumptions about willpower and discipline are common. These messages can be amplified by providers who view larger bodies as inherently unhealthy, unintentionally reinforcing patterns of restriction, and creating an increasing level of shame related to food and body. When those behaviors escalate, they may still go unrecognized, simply because the body doesn’t conform to the image of starvation.
Even when individuals do seek care, their experiences with the healthcare system are often shaped by disbelief, dismissal, or outright harm. Providers often minimize concerns and postpone or even deny screening. The consequences are measurable: delays in diagnosis, prolonged illness, and a deep erosion of trust in medical support. The experience of being told—directly or indirectly—that your suffering doesn’t count because of your size is one that many people with atypical anorexia carry for years, often long after they begin treatment.
The Weight-Based Barriers to Care
The way eating disorders are diagnosed and categorized continues to reflect entrenched ideas about thinness and illness. In the DSM-5, atypical anorexia is not listed alongside anorexia nervosa but is instead categorized under OSFED (Other Specified Feeding or Eating Disorders), a broad and often misunderstood catch-all. The only difference between the two diagnoses is weight; the emotional, behavioral, and psychological symptoms are identical. The medical consequences are comparable. But placement under OSFED reinforces a hierarchy of illness severity that is not supported by clinical evidence. It also creates confusion—among patients, families, and providers—about who is truly at risk.
This weight-based delineation has practical consequences. Individuals with AAN may be deemed ineligible for higher levels of care, and they may struggle to get insurance coverage for necessary treatment. They may be funneled into outpatient programs that lack the medical supervision or structure they require. Even within eating disorder treatment settings, people in larger bodies may be subject to multiple forms of bias: differing targets for weight restoration, mixed messages about body acceptance and weight loss, furniture that doesn’t fit or support larger bodies, and environments that fail to fully affirm their experiences.
The label “atypical” itself is part of the problem. It suggests deviation from a norm, despite the fact that current research indicates AAN may be as prevalent—or more so—than the low-weight form of the disorder. The term implies something less serious, less dangerous, less real. And that implication shapes everything from funding decisions to clinical priorities to the internal narratives of those affected.
The Internalization of Stigma
For people with atypical anorexia, weight stigma is not only external. It becomes internalized, shaping how they see their illness, and their worthiness to seek help. Many describe feeling that they are not “sick enough” to deserve treatment, even as they engage in severe restriction. This belief is not irrational. It is reinforced by repeated experiences of being told that their body does not match the stereotype of suffering.
The shame that comes with this misalignment between internal pain and external perception can be profound. It discourages disclosure. It undermines self-advocacy. It can delay treatment for years. And in some cases, it drives individuals deeper into disordered behaviors in an effort to be seen. The need for validation can become another dangerous form of perfectionism, where worsening symptoms feel like the only way to “prove” that the illness is real.
Clinicians who treat eating disorders in higher-weight individuals have spoken about the conflicting pressures they navigate: helping clients restore nourishment and reduce compulsivity, while being aware that those clients may have spent years being told to do the opposite. This tension is especially visible in family-based treatment models, where caregivers may struggle to reconcile medical guidance with the messages they’ve absorbed about weight and health. In some cases, families receive the directive to encourage weight gain while simultaneously being warned about the risks of weight-related health conditions. The result is confusion, inconsistency, and lost ground in treatment.
The Case for Removing “Atypical”
The proposal to eliminate the term “atypical” from anorexia-related diagnoses is not about semantics. It is about clinical accuracy, treatment equity, and the dismantling of a framework that has consistently excluded those who do not fit a narrow physical mold. There is no need to segment diagnoses based on weight when the presenting symptoms are the same. Doing so only upholds a visual standard that has little bearing on medical severity and actively harms those most vulnerable to being overlooked.
The act of naming matters. Language informs perception. When diagnostic labels reinforce weight bias, they contribute to systemic barriers that delay care and compound stigma. By recognizing anorexia for what it is, regardless of the body in which it appears, we move closer to a model of care that centers lived experience over appearance and behavior over assumptions.
Toward Inclusive and Affirming Care
Weight stigma does not exist in isolation. It shapes every layer of the treatment experience: from initial provider interactions to long-term recovery environments. Inclusive care means more than offering treatment to people in all body sizes. It means actively interrogating the frameworks that have historically excluded them. It means building clinical training that reflects the full range of eating disorder presentations. It means replacing weight-based criteria with comprehensive, behaviorally anchored assessments. And it means creating spaces where clients are not asked to prove the legitimacy of their suffering before they are allowed to heal.
For those seeking care, finding a provider who understands this dynamic is essential. HAES-aligned clinicians and fat-positive treatment programs are not only safer for people with AAN, they are more effective. When individuals are treated with respect and affirmed in their bodies, they are more likely to engage in treatment and sustain progress. Resources exist for those searching for this kind of support, and it is worth taking the time to seek out providers who demonstrate a deep commitment to weight-inclusive practice.
Moving Forward
Atypical anorexia is not atypical. It is a mirror, held up to a healthcare system that still equates thinness with sickness and invisibility with wellness. If we take seriously the reality of eating disorders in larger bodies, we must also take seriously the responsibility to build a system that no longer demands thinness as proof. Weight stigma is the outlier. It’s time to treat it as such.
If you or someone you care about is struggling with an eating disorder, know that help is available, and recovery is possible. Reach out to get started today.
References:
Harrop, E. N., Hutcheson, R., Harner, V., Mensinger, J. L., & Lindhorst, T. (2023). “You don’t look anorexic”: Atypical anorexia patient experiences of weight stigma in medical care. ScienceDirect. https://www.sciencedirect.com/science/article/abs/pii/S174014452300058X
Raykos, B. C., Watson, H. J., Fursland, A., Byrne, S. M., & Nathan, P. R. (2021). Exploring the experience of being viewed as “not sick enough”: a qualitative study of women recovered from anorexia nervosa or atypical anorexia nervosa. Journal of Eating Disorders. https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-021-00495-5
