Kendall Reagan Nutrition Center Atypical Anorexia Nervosa – Not so Atypical?

By Amity Warme

Eating disorders (ED) are more common than most people think. They are misunderstood and underestimated biopsychosocial issues that don’t have a “look”. Eating disorders affect people of all body shapes and weights, genders, ages, races, ethnicities, abilities, sexual orientations and socioeconomic statuses.

Anorexia nervosa (AN) is a well-known ED, but its lesser-known counterpart atypical anorexia nervosa (A-AN) is actually more common. Less than 8% of those struggling with an ED are actually “underweight”, and this includes individuals with A-AN. Making assumptions about an individual’s health and eating based on their weight or body mass index (BMI) leads to under-diagnosis and mis-diagnosis of serious EDs. An ED at a normal or above-average body weight is no less severe than an ED at a low body weight. Read on for more information about A-AN, a serious yet overlooked ED.

What is Atypical Anorexia Nervosa?

Just like AN, A-AN is an ED characterized by an intense fear of weight gain and extreme restriction of food and energy without extreme weight loss or very low body weight. Whether a person receives a diagnosis for AN or A-AN is based solely on their weight. A BMI below ‘normal’ is used to diagnose AN, but A-AN presents in people who fall into a ‘normal’ or ‘overweight’ BMI category. ‘Atypical’ implies difference from the norm, but that does not mean this diagnosis is any less severe. The fact that A-AN is more common than AN and that it is considered “atypical” depicts how this serious ED is commonly overlooked and misdiagnosed. Many individuals who have A-AN may not even realize that they are struggling with an ED because of weight stigma. Individuals with A-AN often do not receive the medical, nutritional, or mental health care they need and deserve, making this a life-threatening condition that needs greater recognition.

Signs and Symptoms:

• Inadequate calorie intake relative to individual requirements
• Drive for thinness, fear of weight or fat gain
• Continuous behavior to prevent weight gain
  • Restricted food intake
  • Excessive exercise
• Body weight or shape significantly impacts the individual’s self-worth
• Preoccupation with food
• Fear of certain foods
  • Restriction of food groups and types

Avoidance of eating in social settings or making excuses for not eating

Medical Complications Associated with Atypical Anorexia Nervosa:

Without treatment, chronic malnutrition caused by an ED can lead to dangerous health complications including:

• Fainting and dizziness
• Low bone mineral density
• Loss of fat or muscle mass
• Amenorrhea or other menstrual dysfunction
• Mental health conditions including anxiety, depression, and suicidal thoughts
• Anemia and other nutritional deficiencies
• Cardiovascular conditions including low heart rate or low blood pressure
• Gastrointestinal dysfunction
• Thinning or loss of hair

Get the Care You Need:

Though eating disorders have one of the highest mortality rates among all mental illnesses, with early intervention and appropriate treatment, the vast majority of those with eating disorders can recover. If you have concerns about your eating, please seek out support as soon as possible.

Are food, body image, and restrictive behaviors getting in the way of your life? Do you spend excess time and energy thinking about these things? Is your self-worth tied to your weight or shape? Do decisions about food cause pain or discomfort? Regardless of your body size or weight, if you answer yes to these questions or think you may be struggling with an eating disorder, get the care you need. Look for providers who practice Health at Every Size (HAES), weight-inclusive care, and/or specialize in eating disorders. Be honest with your provider about disordered eating behaviors and advocate for yourself if you recognize restrictive or compulsive behaviors around food and exercise. Try not to fall into the “I’m not sick enough trap.” You deserve to get help!

If you have concerns that your eating behaviors may be disordered, get connected with a specialist as soon as you can. KRNC registered dietitian nutritionists can help you recover and make peace with food and your body. Call or email us today at (970) 495-5916 or nutritioncenter@colostate.edu.

For more immediate assistance, you can contact the NEDA hotline by texting or calling (800) 931-2237.

Get to Know our Author:

Warme grew up in Loveland, Colorado, but currently lives in a van that she and her husband converted to a mobile home. They base out of the Front Range and Washington but spend the majority of their time traveling around the western U.S. to various rock climbing destinations. Warme graduated in December with her master’s degree in Sports Nutrition from the University of Colorado at Colorado Springs. Currently, she is completing a dietetic internship, the next step toward becoming a registered dietitian. Warme is our KRNC Spotlight for February 2022.

More Information

For additional resources for healthy eating, check out these programs from our registered dietitian nutritionists. Find delicious and healthy recipes on our Recipes page! More health tips are also available at the College of Health and Human Sciences Pinterest board. Lastly, don’t forget to sign up for the KRNC monthly newsletter!