Anorexia in Higher-Weight Bodies: Hidden Restriction, Misdiagnosis, & What Gets Missed

Why do so many people with anorexia go undiagnosed simply because of their body size? In this episode of the Dr. Marianne-Land podcast, eating disorder therapist Dr. Marianne Miller explores anorexia in higher-weight bodies, restrictive eating disorders, weight bias in healthcare, and the dangerous myths surrounding “atypical anorexia.” This conversation unpacks how restrictive eating can become normalized, praised, or completely overlooked when someone does not fit the stereotype of anorexia. What Is Atypical Anorexia? Dr. Marianne explains why the term “atypical anorexia” can be misleading and why anorexia is not defined by weight alone. She explores how food restriction, fear around eating, compulsive control, and intense preoccupation with food can occur in bodies of all sizes. The episode also examines why so many people struggle to recognize their own eating disorder symptoms when culture continually tells them they are “healthy” or “doing well.” Restrictive Eating Disorders in Higher-Weight Bodies This episode takes a deeper look at hidden restriction, chronic dieting, skipped meals, rigid food rules, and the restrictive eating spectrum. Dr. Marianne discusses how eating disorders in larger bodies are frequently missed by healthcare providers, loved ones, and even the individuals experiencing them. She also explores how praise for weight loss can reinforce dangerous patterns and delay support. Medical Risks of Anorexia in Larger Bodies Anorexia in higher-weight bodies carries real psychological and medical risks. Dr. Marianne explains how undernourishment affects the body regardless of size, including impacts on heart rate, hormones, cognition, bone health, anxiety, and nervous system functioning. This episode challenges the harmful assumption that someone must appear underweight before restriction becomes medically serious. Weight Bias, Misdiagnosis, & Eating Disorder Stigma Weight stigma and anti-fat bias continue to shape eating disorder treatment and diagnosis. Dr. Marianne explores how medical gaslighting, diet culture, and stereotypes about anorexia contribute to delayed diagnosis and inadequate care. She also discusses how intersectionality, neurodivergence, disability, race, and gender identity can further complicate recognition and access to support. Neurodivergence, Restriction, & Eating Disorders This episode also examines how sensory sensitivities, executive functioning differences, autism, ADHD, and nervous system regulation can influence eating patterns and restrictive behaviors. Dr. Marianne discusses why neurodivergent people may experience eating disorders differently and why individualized, affirming care matters. Eating Disorder Recovery Without Stereotypes Recovery begins with recognizing that eating disorders do not have one look. This conversation encourages listeners to move away from appearance-based assumptions and toward a more nuanced understanding of anorexia, restrictive eating, and body diversity. Dr. Marianne also shares why support matters before symptoms escalate and why people in higher-weight bodies deserve compassionate, specialized eating disorder care. Related Episodes Anorexia in Higher-Weight Bodies: Rethinking “Atypical Anorexia” & the Restrictive Eating Spectrum With Dr. Jennifer Gaudiani, MD @gaudianiclinic on Apple & Spotify. Atypical Anorexia Explained: Why Restriction Happens at Every Body Size on Apple or Spotify. Atypical Anorexia: Mental & Physical Health Risks, Plus How the Term is Controversial on Apple or Spotify. Work With Dr. Marianne Miller Dr. Marianne Miller is a Licensed Marriage and Family Therapist (LMFT) specializing in eating disorders, ARFID, binge eating disorder, anorexia, bulimia, OCD, and neurodivergent-affirming care. She offers eating disorder therapy and coaching for adults in California, Washington, D.C., and globally through coaching services. Visit Dr. Marianne’s website to learn more about therapy, coaching, ARFID support, and eating disorder recovery resources.