Atypical Anorexia Nervosa: The Hidden Crisis in Larger Bodies

Atypical anorexia nervosa (AAN) shares the same severe symptoms as classic anorexia nervosa, yet those affected maintain a 'normal' or higher body weight. This lesser-known condition often goes unnoticed by doctors because patients do not appear underweight. Research now suggests AAN may be more common than traditional anorexia but remains underdiagnosed in medical settings. AAN was formally recognised in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) under the category of Other Specified Feeding or Eating Disorders (OSFED). Unlike typical anorexia, where extreme low weight is a key feature, people with AAN experience dramatic weight loss while staying within or above the 'normal' BMI range. Despite this, they face the same dangerous health risks, including malnutrition, heart problems, bone loss, and hormonal imbalances.

Symptoms mirror those of classic anorexia: intense fear of weight gain, extreme food restriction, distorted body image, and serious physical decline. Studies even indicate that medical and psychological complications in AAN can be as severe—or worse—than in underweight anorexia cases. A 2022 review found that 25–45% of patients in inpatient eating disorder units were in larger bodies, reflecting a growing demand for specialised care. The condition is frequently overlooked. Doctors may dismiss warning signs because the patient’s weight does not seem alarmingly low. A 2021 analysis also revealed that AAN might be more widespread than low-weight anorexia, yet it appears far less often in treatment records. This gap highlights the need for better awareness and screening among healthcare providers.

AAN poses the same life-threatening risks as other eating disorders but often slips under the radar due to weight-based assumptions. With rising numbers of people in larger bodies seeking help, experts stress the importance of recognising symptoms beyond weight alone. Early detection and treatment remain critical to preventing long-term damage from malnutrition and related complications.