3 MIN READ | Clinical Psychology

Why an Anorexia Diagnosis Needs to Be More Than BMI

Beth Anne Fletcher

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When we think about anorexia nervosa and the people who suffer from it, we generally conjure up an image of a thin person right? A severely underweight or even skeletal figure? Because that’s what we’ve always been shown and told. But is it at all possible that someone in a larger body could also be suffering from anorexia? And if they are, should their weight dictate whether they have access to what can often be ‘life saving’ treatment?

Approximately 1.25 million people in the UK are suffering from an eating disorder, according to the charity Beat. Do they all have an actual diagnosis? No they don’t, so let’s look at why.

What is anorexia?

If you checked out the symptoms of anorexia on the NHS website you would read the following:


  • If you’re under 18, your weight and height being lower than expected for your age
  • If you’re an adult, having an unusually low body mass index (BMI)
  • Missing meals, eating very little or avoiding eating any foods you see as fattening
  • Believing you are fat when you are a healthy weight or underweight
  • Taking medication to reduce your hunger (appetite suppressants)
  • Your periods stopping (in women who have not reached menopause) or not starting (in younger women and girls)
  • Physical problems, such as feeling lightheaded or dizzy, hair loss or dry skin

So only two of those factors actually focus on physical weight. If you delve a little deeper and click on ‘read more about the symptoms and warning signs of anorexia’ you will discover that people with anorexia are often engaging in behaviours such as binge eating and purging (self-induced vomiting), laxative or diuretic abuse to avoid putting on weight, strict eating rituals, obsessive compulsion to exercise, reduced sex drive. You can read the full list here. It’s pretty long and detailed, yet so many people are reporting that when they present themselves and their symptoms to their GP, they are simply being told they are not thin enough.

I was one of them. Back in 2016 I visited my GP and expressed my concerns with my own behaviour. I was restricting my calorie intake dramatically. I was abusing laxatives. I was occasionally vomiting after eating and I was overly concerned with my body image, so much so that I couldn’t focus on every day tasks. I remember telling my doctor that I was worried something awful might happen to me while I was caring for my son, who has special needs and therefore wouldn’t be able to get help.

In response to all of this, I was weighed and measured. I was given my BMI and told that I was in the healthy range for my height and that unfortunately help wouldn’t be available at this stage. I was also told at what weight I ‘would be’ considered ‘underweight’. I found the whole experience to be humiliating. But more worryingly, I found it triggering. I now knew exactly what I needed to do and what weight I needed to get down to, to qualify for help. If I didn’t drop down dead first of course.

What needs to change?

I think initially, the biggest and greatest change that could happen for the eating disorder diagnostic criteria is to remove the emphasis off the size of the body. Any medical professional should not be focused on body size but on symptoms and/or behaviours. Body size really has nothing to do with anorexia, or in fact bulimia, binge eating disorder or Ednos. If you are a person who has a medically deemed ‘healthy-sized’ body yet you are displaying the signs, symptoms and behaviours of anorexia,  then you have anorexia.

In this day and age, the BMI scale is not an accurate measure of health. BMI is in fact just a measurement of height versus weight. It doesn’t actually tell us anything about what is happening internally. Besides, everybody is different. We aren’t all meant to be ‘one size’. Therefore someone existing in a larger body can be in the throes of an eating disorder. This idea is supported by a recent UCLA study, which found out that the use of BMI actually resulted in the mis-labelling of health in 54 million Americans.

If I’m worried I have an eating disorder what can I do?

The advice, wherever you look is always to visit your GP. But as detailed in my own personal experience, this won’t always result in positive action immediately. If I could go back and do it again I would probably have told myself to go in to my appointment better prepared.

Back in 1999 Professor John Morgan at Leeds Partnership NHS Foundation Trust designed the SCOFF screening tool for non-professionals. This simple questionnaire does not mention weight or BMI at all. A score of just two or more positive answers is considered to be a positive screen.

If you are concerned about your behaviours then perhaps fill out the SCOFF questionnaire and go armed with this when you meet with your GP. Confide in a family member or close friend and ask that they attend the appointment with you for support. You can also speak to the Beat UK Helpline who can further advise people on how to approach their doctor at the initial stage.


Beth Anne Fletcher is a photographer and mental health blogger based in Derbyshire, UK. In 2016, at age 32, Beth Anne was diagnosed with an eating disorder.

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