Distorted view

This article discusses eating disorders. Scroll down for a list of resources if you or someone you know needs help.

Female. White. Young. Thin to the point of bones protruding.

Thats likely what you imagine when you think of someone with an eating disorder.

Thats only one severe aspect of many eating disorders, says Sarah Hails.

Despite eating disorders being a mental illness, the focus tends to be on specific physical manifestations, excluding a wide swath of those impacted.

It can look completely healthy. It can look morbidly obese. It can look just a little curvy here and there. Or you could still be really small and frail So it doesnt have any one look or another, Hails says.

An estimated one million Canadians meet the diagnostic criteria for a form of eating disorder, according to Statistics Canada. But these harmful tropes about what an eating disorder looks like mean some people may not identify as having one or are reluctant to get help.

Hails, a 27-year-old from Saskatoon, doesnt match the physical stereotype of someone with an eating disorder.

None of the people who volunteered to be photographed for this article do.

Eating disorders dont discriminate, says Sophia Khan, a registered dietician in Saskatoon. You cant always tell someone has an eating disorder just by looking at them.

Yet many people, including health professionals, base their initial assessment on size. Khan says this sometimes leads to people in larger bodies being missed.

There is the false thinking that those with eating disorders are thin, or there is the thinking that thinness equates severity.

For Julie Gobeil, the opposite was true. The 36-year-olds unhealthy relationship with food began at a young age and turned severe in her mid-twenties. She struggled with binge eating and purging. She lost weight as a result and was praised for it.

Concerned about the health consequences, she eventually stopped purging but continued to deal with binge eating and gained weight. She then worried people wouldnt believe she was facing an eating disorder.

We really need to unlearn our biases against fat people and equating thinness with health, which, in my experience, has not only not been true, but the exact opposite has been true, she says.

The thinner Ive been, the unhealthier Ive been.

Binge eating disorder is the most common form of the illness, yet it isnt reflected in the media nearly as much as anorexia or bulimia, says Sydney Luther. Like Gobeil, the 30-year-old from Saskatoon thinks that lack of understanding comes from prejudice against being overweight.

Luther says her eating disorder first cropped up when she moved away for university and had trouble adjusting. She started eating less to lose weight. That led to binge eating and subsequently gaining weight.

I think it took me a few years to realize that what was happening was an eating disorder, she says.

The evidence doesnt support the body size stereotype for those with eating disorders. A study of Canadian adolescents diagnosed with eating disorders found less than six per cent of them could be classified as medically underweight. A multi-country study of people with binge eating disorder found a quarter had a body mass index within the normal range.

Even someone in a smaller body can be impacted by the pervasive, narrow perception of what eating disorders look like.

As a young, white, female dancer, Ocean Tonn feels her experience echoes a common media portrayal of someone with the illness. At the same time, she says not being thin enough has stopped me from having people recognize my disorder.

The 18-year-old from Weyburn, Sask., says doctors pointed to her healthy weight and clean lab results when she was struggling the most with her disorder and sought help.

Your physical body doesnt show how sick you are. Eating disorders are a mental illness, not a physical illness, says Tonn. I feel like so many people view them as being a physical illness when really you can be insanely sick and in your worst, but your physical body doesnt change.

Jeffrey Grant Crawford doesnt think hes the kind of person people would expect to struggle with eating disorders. The main reason? Hes a man.

I think it made it less likely that I recognize that in myself and maybe for other people that cared about me to recognize it, Crawford said.

The 33-year-old from Saskatoon has faced an eating disorder since his last year of high school, when he developed an obsession with eating healthy. He also got into running and modelling, and has felt the pressure to fit a certain aesthetic as a gay man.

Men are woefully underrepresented in conversations about eating disorders, despite them constituting up to 20 per cent of those impacted, according to the National Eating Disorder Information Centre.

Part of the issue is a lack of research on men with eating disorders. What does exist has shown that the illness can express itself differently in men.

Physique ideals depicted in the media can lead to men developing a drive for muscularity: a desire to gain weight to increase muscle mass while decreasing body fat. So, if men are assessed based on common female symptoms, their eating disorder might be missed or mischaracterized.

When Aakashdeep Mundi moved to Canada from India as a teen, he was determined to fit in at school. He joined the football team and, insecure about his size, started eating to build muscle mass.

Years later, he got into climbing and his goals swung in the other direction.

In both cases, people praised his behaviour and physical changes, because they were perceived as choices made in the pursuit of athleticism and health. Crawford experienced the same, commended for his willpower.

My definition of an eating disorder, Mundi now realizes, is when your food only serves as a means to an end instead of something that you actually can cherish and enjoy as well.

Now 24, he says he didnt acknowledge he had an eating disorder until about a year ago.

If you dont even identify the problem, how will you ask for help fixing it?

Mundi said being a person of colour also made it less likely to see himself reflected.

Despite research suggesting the prevalence of eating disorders is consistent across ethnic groups, white people are overrepresented in studies and media on the topic.

Mundi noted the harmful effects on body image of how white, North American ideals dominate the conversation here. It ignores the fact that people from different ethnic and racial backgrounds have a variety of body types and are more easily (or not) able to change their body shape.

Hails, who is Black, didnt grow up around many people of colour, so their reference point was primarily white girls and they felt their body stood apart. Hails began to restrict their eating around the age of 15 to achieve an unattainable goal.

I was always just so angry at my body for existing in the shape that it was.

These arent the only folks missing from the conversation.

Older people are rarely reflected in depictions of eating disorders, yet community-based studies have found more than three per cent of women aged 60 and older experience them, the same percentage as women of all ages.

There have also been calls for more attention to LGBTQ people facing eating disorders, as studies have shown they are more prone to them.

These gaps in knowledge extend to the medical community.

There hasnt been a lot of urgency from medical professionals in treating it, says Luther, referring to her binge eating disorder. To me it feels like, Well, youre not dying of starvation, so its fine. And so Ive had to do a lot of advocating for myself.

Hails agrees that a fear of not being believed creates a barrier, but I know thats not healthy to work myself to be a certain size to access help.

These misconceptions can have serious consequences. According to the BridgePoint Center for Eating Disorders in Saskatchewan, only 10 per cent of people with an eating disorder seek help. Eating disorders also have the highest overall mortality rate of any mental illness.

Khan advocates for health professionals learning more about eating disorders in general, including who they affect and how the illness can express itself. Shed also like to see more diversity in the research conducted and whos working in the field.

The Canadian Eating Disorders Strategy calls for improving curricula for health-care professionals on eating disorders, better education of the public, addressing gaps in best practices and research for certain populations and disorder types, and developing culturally appropriate services for marginalized groups.

That education piece is really important so that people know that no matter what size I am, no matter what colour I am, no matter what my life experiences, if Im struggling with an eating disorder, I deserve care, I deserve support just as much as anyone else, says Khan.

Mundi wants men and the harmful effects of striving for the bodybuilder physique reflected more often in the media.

Luther would like to see a major television show feature a storyline about a bigger-bodied person struggling with an eating disorder.

And Gobeil encourages people to diversify who they follow on social media, especially when it comes to body size.

The younger generation, it does give me hope. I think theyre just less judgmental, more accepting, Gobeil says.

I do think there is a movement happening for more body acceptance and the concept of health at every size.

Consultant: Keara Lubchenko

Copy editor: Sean Trembath