Title : Invisible eating disorders in normal-weight and higher-weight women: A clinical field perspective on underdiagnosis and weight bias

Background: Eating disorders (EDs) continue to be strongly associated with underweight presentations in both public discourse and clinical practice. This weight-centered perception contributes to the underrecognition of eating disorders in individuals with normal, overweight, or obese body mass indices, despite growing evidence demonstrating substantial psychopathology and medical risk across weight categories. Conditions such as binge eating disorder (BED), atypical anorexia nervosa (AAN), bulimia nervosa (BN), and other specified feeding and eating disorders (OSFED) frequently remain undetected when patients do not fit stereotypical expectations of thinness.

Objective: This presentation aims to examine the clinical underdiagnosis of eating disorders in normal-weight and higher-weight women, highlighting the role of weight stigma, diagnostic bias, and the limitations of BMI-centered assessment models in mental healthcare.

Discussion: Epidemiological evidence indicates that BED is currently the most prevalent eating disorder, affecting approximately 1.5–3% of the population, yet remains significantly underdiagnosed. Similarly, atypical anorexia nervosa may involve severe psychological distress and medical instability despite the absence of low body weight. Research consistently demonstrates that healthcare professionals may unconsciously rely on weight-based assumptions when assessing eating pathology, resulting in delayed diagnosis, reduced referrals, and poorer treatment access for higher-weight patients. Weight stigma within healthcare settings can reinforce maladaptive eating behaviors, particularly when pathological restriction or compensatory behaviors are socially rewarded through visible weight loss.

Drawing from contemporary literature and clinical field observations, this presentation explores the psychological functions of eating disorder symptoms, including emotion regulation, trauma-related coping, self-worth regulation, and interpersonal distress. Particular attention is given to the inadequacy of BMI as an isolated marker of severity and to emerging recommendations emphasizing behavioral symptoms, emotional suffering, and functional impairment over appearance-based indicators.

Conclusion: Eating disorders in normal-weight and higher-weight women represent a significant yet frequently invisible public health issue. Persistent associations between thinness and illness continue to contribute to underdiagnosis and treatment disparities. A paradigm shift toward a suffering-centered rather than weight-centered model of assessment is needed to improve detection, reduce stigma, and ensure equitable access to care for affected individuals.

Keywords: eating disorders, atypical anorexia nervosa, binge eating disorder, weight stigma, underdiagnosis, obesity, BMI bias, women’s mental health.

Dr. Eva Ein-Eli is a work psychologist specializing in work psychology and behavioral addictions. She holds a PhD in work psychology from Université Paris Nanterre and has extensive experience in research, teaching, and clinical practice. Her work focuses on workplace mental health, violence at work, and addiction mechanisms. She has presented at multiple international conferences and contributes to academic publications in psychology.