You Don't Have To Be Underweight To Be Starving

Rethinking What Starvation Looks Like

When you hear the word "starvation," what image comes to mind?

Most of us envision someone extremely thin, frail, and visibly wasting away. It's a powerful image, and for many years, it has shaped how we understand eating disorders and malnutrition. But that image is dangerously misleading.

Starvation isn't defined by appearance. It's defined by biology: a prolonged lack of adequate energy intake to meet the body's needs. This state can occur in bodies of any size, including people in medium or large bodies who are dieting, fasting, or unintentionally undernourished due to stress, mental illness, or disordered eating.

In this blog post, we want to challenge the widespread myths about starvation, explore the dangers of "atypical" eating disorders, and highlight why inclusive, weight-neutral care is essential. If you've ever felt like you were "not sick enough" to deserve help—this is for you.

What Starvation Actually Means

From a clinical standpoint, starvation refers to a physiological state in which the body isn't receiving enough calories (or energy) to perform its basic functions. This can affect everything from metabolism and hormone production to brain function and organ health.

It doesn't matter what your body looks like. If you're not eating enough to fuel your body, you are in a state of energy deficiency.

Key symptoms of starvation can include:

• Persistent fatigue

• Obsessive thoughts about food

• Mood changes (irritability, depression, anxiety)

• Gastrointestinal issues

• Cold intolerance

• Hair thinning

• Hormonal imbalances (missed periods, low libido)

• Difficulty concentrating

These symptoms can occur in people with larger bodies, average-sized bodies, and thin bodies alike.

Why the Stereotype of Starvation is Harmful

The image of starvation as only affecting people who are visibly underweight causes real harm in how eating disorders are diagnosed and treated.

Many individuals in larger bodies are actively experiencing starvation but are not identified as such. Instead, they may be congratulated for their "discipline," encouraged to continue restrictive eating, or told they are simply pursuing a healthy lifestyle.

This results in:

• Delayed diagnoses

• Missed opportunities for treatment

• Worsening physical and mental health

• Reinforcement of disordered behaviors

Weight stigma leads to a system where some bodies are believed to "deserve" restriction, while others are seen as inherently unhealthy and in need of shrinking. But bodies do not exist on moral scales. All bodies need fuel. And all people deserve care.

Atypical Anorexia Nervosa: Just as Serious

In recent years, clinicians have recognised a subtype of anorexia nervosa called atypical anorexia nervosa. It includes all the same criteria as traditional anorexia—restriction of energy intake, intense fear of gaining weight, body image disturbance—but without the low body weight requirement.

Research shows that individuals with atypical anorexia can experience similar health consequences as those with traditional anorexia. But because they may not "look sick," their illness is often minimized.

The consequences of this include:

• Increased medical complications

• Higher likelihood of requiring hospitalization by the time of diagnosis

• Deepened feelings of shame, isolation, and invalidation

At Eat At Ease Counselling, we often hear clients say, "I don't think I'm sick enough for help," or "I'm not underweight, so it must not be that serious." Let us be clear: if your relationship with food is harming your physical or emotional health, you are absolutely sick enough.

The Role of Weight Stigma in Missed Diagnoses

Healthcare providers, mental health professionals, and even family members often use weight as a shortcut to determine who needs help. This approach is not only flawed—it's dangerous.

Weight stigma contributes to misdiagnosis and under-treatment in countless ways:

• Individuals in larger bodies are less likely to be screened for eating disorders

• Providers may praise weight loss even when it's a sign of serious restriction

• People may internalize the belief that their suffering isn't valid

• Treatment may be denied or delayed based on BMI alone

We need to move beyond weight-centric thinking. Health is not determined by size, and disordered eating doesn't discriminate.

Medical Consequences of Chronic Undereating

Starvation affects every system of the body. Whether someone is restricting due to an eating disorder, dieting, or another reason, the effects can be profound:

• Metabolic slowing: The body conserves energy by lowering your metabolic rate, making you feel cold, sluggish, and mentally foggy.

• Cardiovascular stress: Malnutrition can cause low blood pressure, irregular heartbeat, and other cardiovascular issues.

• Organ dysfunction: The kidneys, liver, and other vital organs may not function properly when deprived of nutrients.

• Hormonal disruptions: Prolonged restriction affects reproductive hormones, thyroid hormones, and stress hormones.

• Cognitive impact: Brain fog, impaired concentration, poor memory, and obsessive thoughts about food are common.

These aren’t minor inconveniences. These are serious medical concerns that deserve attention regardless of someone’s size.

Healing Starts with Recognition

It’s hard to seek help when the world keeps telling you you’re not sick enough. But we want you to know:

• You don’t have to be underweight to be starving.

• You don’t have to prove your pain by shrinking.

• You don’t have to wait until it's worse to deserve support.

At Eat At Ease Counselling, we specialize in helping individuals from all body sizes and backgrounds rebuild a peaceful relationship with food. Our approach is weight-inclusive, non-judgmental, and deeply rooted in understanding the full spectrum of disordered eating.

Whether you’re struggling with food obsession, restriction, bingeing, body image distress, or just feeling out of control - we’re here.

What Inclusive, Weight-Neutral Care Looks Like

Too often, treatment programs still rely on weight metrics to determine access to care. This model leaves too many people out.

At Eat At Ease, inclusive care means:

• Listening to your lived experience first

• Validating your pain without size-based assumptions

• Centering nourishment, not restriction

• Recognizing eating disorders in all bodies

Our team is trained in trauma-informed, weight-neutral, and compassionate care. We understand the nuances. We see the full picture.

You Deserve Nourishment

Starvation doesn’t always look the way you think it does. It doesn’t need to be extreme to be real. And you don’t need to shrink to be worthy of help.

If you’re constantly thinking about food, if your eating feels chaotic or stressful, or if you’ve lost trust in your body - that’s enough. That’s valid.

And we can help.

Reach out to Eat At Ease Counselling to start your healing journey. You deserve a peaceful relationship with food and a life free from the chains of restriction and shame.

You deserve to be nourished.