Brittany Miles, like many women, had a complicated relationship with food. By the time she reached high school she was a size 18 and miserable. So she decided to become "the farthest thing from fat possible," she told CNN, and began strictly restricting her calories and exercising excessively.
Miles had an eating disorder—but nobody else saw it. Since she never dropped below a size 4, people assumed she wasn't skinny enough to be sick. "Just because my bone structure stopped me from being the size 00 everyone pictures, doesn't mean that I wasn't in an incredibly unsafe and unhealthy place," she said.
Relying solely on a person's weight or physical appearance can not only lead people to overlook other signs of an eating disorder but can also cause people to unfairly accuse naturally thin women of being sick, as was seen earlier this year when Yale student Frances Chen was nearly expelled for being unable to gain weight. In addition, eating disorders like binge eating and bulimia can cause people to gain weight.
"Weight can be an indicator of an eating disorder, but it certainly isn't the only one or even the best one," says Lynn Grefe, president and CEO of the National Eating Disorder Association (NEDA), adding that using weight as the only criteria for an eating disorder is incredibly damaging and demeaning to sufferers.
And it's not just friends and family who can be confused when someone doesn't match the scary-slim images we often see on the news. Even doctors can miss telltale signs. "It used to be that a girl had to miss her period for a certain amount of time to be considered anorexic, but that is no longer true," Grefe says.
The hallmark of at eating disorder, she explains, is the mental component. "A lot of it is being consumed by your weight or thoughts of food and dieting." It's also common for someone suffering from an eating disorder to show signs of depression, anxiety, and/or obsessive compulsive disorder. The final component is behaviors. "Does she talk about eating all the time? Is she single-focused on working out? Is she skipping other things like school or social activities to exercise? Does she isolate herself?" Grefe says.
Miles' story highlights an emerging epidemic of "hidden" eating disorders, where sufferers don't fit the stereotypical mold of what people think they should look like. Thankfully hers had a happy ending: Eventually she got help, gained weight, and says she is now happy and healthy. But with more than four million Americans suffering from eating disorders, there are many like her that still need help, and that starts with looking for other, perhaps less immediately obvious, signs.