By Kacey Clark

I remember back when I was a freshman in high school, all students were required to take a health and safety course, which was basically just fear-mongering around food and weight and exercise with some talk about safe sex and drug use thrown in. This was honestly not the best course for me to take less than a year after being discharged from the hospital for an eating disorder. The entire course was pretty basic and probably could have been learned by just observing the propaganda from “health” corporations, but the one thing that really frustrated me was the courses hyper-focus on BMI.

We were weighed once a week, for a month; once weighed we would consult with the BMI charts posted around the classroom. It disturbed me to see that beneath the underweight category, “athletic” was listed as a category. This made no sense to me since so many athletes are in medium to large-sized bodies and carry a significant amount of muscle. Seeing “athletic” categorized below “underweight” was confusing. Even more frustrating was the category below “athletic,” which was “anorexic”.  I looked at the chart and my eyes grew wide as I made this observation. Were they really trying to diagnose someone as having a mental illness based off of physical criteria? Is that really how eating disorders work? I was stunned. Partly because I knew I was still struggling with an eating disorder, yet here I was, on the low end of the “healthy” category of the BMI and far from being healthy.

I use this story as an example of how our healthcare system and society continue to view eating disorders. The truth is that eating disorders are mental health conditions. It doesn’t matter what BMI you are, if you have an unhealthy relationship with food and body image that interferes with your well-being, you have an eating disorder. It doesn’t matter what how “healthy” you look, if you starve yourself to lose weight, you have an eating disorder. It also doesn’t matter what size you are, if you over-exercise and under-eat or over-exercise and over-eat or essentially exercise and eat in a way that is supposed to micromanage how your body looks, then you have an eating disorder.

At its simplest, an eating disorder is a disordered relationships with food and body image. There’s is no magic number on the scale or chart that can tell you what’s going on in your head and whether or not you are in a good state mentally. That’s just not the way mental illness works. And while mental health can manifest itself in a physical way, it doesn’t have to.

I was recently admitted into a partial hospitalization program at an eating disorder recovery center that would have been completely covered by my insurance company. However, I first needed a referral from my health insurance to get the treatment. And of course, I was denied a referral. First, I needed to go through an intake process that involved assessing vitals and my physical state. Then, I needed to go through my health insurance company’s Intensive Outpatient Program (IOP). The same IOP program I had been through right after I was discharged from the hospital for my eating disorder.

I left that program after three weeks. Partly, because I didn’t feel like I was “sick enough” to be there; I was restoring weight at a good pace and everyone else was not. I was able to finish my meals and everyone else was not. When I voiced that I didn’t feel like I needed to be there, the head of the program trusted me–a person with a mental illness diagnosis–and agreed to discharge me. While it was not my choice to begin the program, I was given the choice to leave when I wanted. So, I left. I felt undeserving to be there and at the same time, I couldn’t admit I had an eating disorder. It would take at least another year for me to realize and acknowledge my illness.

Our healthcare system needs to assess the wellness of ED sufferers based on their inner turmoil, their thought patterns, their limiting beliefs–their mental health–not random markers of physical health like the BMI, how much weight they’ve restored, or how they look physically. We need a system that assesses recovery from a physical and a mental health perspective.

This stereotype of the white, emaciated female is not the epitome of a person with an eating disorder. Sure, there are plenty of women who fit this archetype, and there is nothing wrong with that. Their struggle is just as valid as anyone else’s. But eating disorders are often an invisible illness. They affect people of every shape, size, race, ethnicity, nationality, gender identity, sexual orientation, ability, and socioeconomic status, whether we believe it or not. In order to recognize eating disorders, to treat them, and speak out about them, we have to look beyond the visible into the dark spaces that are seldom seen on the surface. In those dark spaces, that’s where true health and wellness can thrive if given the chance to.