A ‘Look’ At Eating Disorder Delusions

When people picture someone with an eating disorder, they may imagine a visibly underweight person, dramatic weight loss or a frail appearance. But this narrow image can obscure a much more complicated reality: eating disorders do not have a particular body type, size or appearance.

The assumption that someone must “look sick” to be struggling can mean that symptoms go unnoticed, concerns are dismissed and people delay seeking professional help. Experts say that eating disorders are psychological and physical health conditions that cannot be diagnosed by appearance alone.

“Eating disorders are often misunderstood because we associate them with a particular body size or visibly extreme weight loss,” says Saumya Nijhara, Counselling Psycho-logist at Fortitude Health and Skin Clinic. “In reality, an eating disorder can affect a person of any body shape, weight or

gender, and appearance alone cannot tell us what someone is experiencing.”

Stereotypical Imaging

The stereotype is partly reinforced by the way eating disorders are portrayed in popular culture, where severe thinness is often used as a visual shorthand for illness. According to Dhara Ghuntla, Psychologist and Psychotherapist, an independent practitioner affiliated with Sujay Hospital, 7 Hills Hospital and Criticare Hospital, this creates a misconception that eating disorders only affect people who are extremely thin or visibly unwell.

A person can appear to have a “normal” or higher body weight while restricting food, binge eating, purging, exercising excessively or experiencing persistent anxiety about food and their body. When health is judged primarily through appearance, these behaviours can easily remain hidden.

The consequences can be significant. Someone who does not fit the stereotypical image of an eating disorder may begin to believe that they are “not sick enough” to deserve treatment, potentially delaying diagnosis and support.

Pressure Of Body Commentary

The problem extends beyond medical settings. In everyday life, comments about weight and appearance can carry consequences that are difficult to see. “We also live in a culture where appearance is constantly commented upon,” Nijhara says, pointing to social media comparisons, family expectations and casual remarks from relatives or strangers. Comments such as “You look so thin” or “You’ve gained so much weight” may seem harmless, but can affect someone already experiencing body dissatisfaction or difficulties around food.

“We often comment on someone’s weight, skin, hair or overall appearance without knowing what their relationship with food, their body or their mental health looks like at that moment,” she says.

For someone struggling privately, these observations

can reinforce shame, anxiety and an unhealthy preoccupation with appearance.

Look Beyond The Mirror

If eating disorders cannot reliably be identified by looking at someone, what should people pay attention to? Behavioural and emotional changes may offer more meaningful clues. Nijhara says these can include becoming increasingly preoccupied with calories, weight or body shape, avoiding meals, eating secretly, following rigid food rules, frequently checking weight or appearance, compulsive exercise or withdrawing from social situations involving food.

Emotional responses can also be important. Anxiety, guilt or distress after eating may signal that a person's relationship with food has become a source of significant difficulty. Physical symptoms such as fatigue, dizziness, gastrointestinal complaints or menstrual changes may also occur, although they are not present in every case.

Ghuntla similarly highlights behaviours such as suddenly eliminating food groups, becoming highly anxious around meals, disappearing after eating, frequently talking about being “fat” or needing to lose weight, mood changes and social withdrawal.

However, she stresses that one behaviour alone does not necessarily indicate an eating disorder. It is the broader pattern, alongside distress or disruption to everyday life, that matters.

Hidden Shame

Eating disorders can also be difficult to recognise because people may deliberately conceal what they are experiencing and sometimes may not fully recognise it themselves. Nijhara recalls a client who described turning to chocolates or junk food for comfort even when she was not physically hungry, followed by intense guilt and self-criticism. Because of the shame surrounding her eating habits, she found it difficult to discuss the experience with her partner or family.

Such experiences demonstrate why eating difficulties cannot always be understood through physical appearance. “An eating disorder is not a visual condition; it is a mental and physical health condition,” Nijhara says.

Changing The Question

For friends and family members who are concerned, experts recommend changing the way the conversation begins. Rather than commenting on someone's weight or asking why they are eating a certain way, gentle questions such as, “How have you been feeling lately?” or “Have you been able to eat your meals regularly?” matter.

Ghuntla recommends choosing a private, calm moment and saying: “I’ve noticed that you seem to be struggling around food lately, and I’m worried about you. Is there anything you would like to talk about?”

The goal is not to diagnose someone, police their eating or force them to change. It is to create an environment where they feel safe enough to speak.

Ultimately, challenging the idea that someone must “look sick” is about recognising that serious struggles can exist beneath an apparently healthy exterior. What we see on the outside is not necessarily an accurate reflection of what is happening internally.

Eating disorders are often misunderstood because we associate them with a particular body size or visibly extreme weight loss.”

— Saumya Nijhara, Counselling Psychologist

This creates a misconception that eating disorders only affect people who

are extremely thin or visibly unwell.”

— Dhara Ghuntla, Psychologist & Psychotherapist.