When you think of an eating disorder, you might picture someone dangerously thin. But that’s not the full picture. In fact, less than 6% of people with eating disorders are medically classified as underweight. Anorexia, bulimia, and binge eating disorder don’t always show up on the scale-they show up in silence, in skipped meals, in obsessive thoughts about food, in the shame that keeps people from asking for help.

Here’s the hard truth: one in ten Americans will live with an eating disorder in their lifetime. That’s 28.8 million people. And every 52 minutes, someone dies from one. Anorexia nervosa has the highest death rate of any mental illness-six times higher than in people without it. Bulimia doubles your risk of early death. These aren’t lifestyle choices. They’re life-threatening illnesses with deep biological, psychological, and social roots.

What Anorexia and Bulimia Really Look Like

Anorexia nervosa isn’t just about not eating. It’s a brain disorder where fear of weight gain overrides hunger, even when the body is starving. People with anorexia often have a body image so distorted they see themselves as fat when they’re skeletal. About 1% of the population has it, and while it’s more common in women, the number of men diagnosed has risen sharply in the last decade. Many don’t lose weight quickly-they lose it slowly, over years, while doctors and family members miss the signs because the person still looks "normal."

Bulimia nervosa is quieter. People with bulimia binge-eat large amounts of food in a short time-and then try to undo it. Vomiting is the most common method, but laxatives, diuretics, fasting, and excessive exercise are also used. One in ten people with bulimia develop painful swelling in their cheeks from repeated vomiting. Their weight often stays in the normal range, which makes it easier to hide. That’s why it takes an average of 7 years for someone with bulimia to get help.

And then there’s binge eating disorder-the most common type. It affects 3.5% of women and 2% of men. No vomiting. No fasting. Just bingeing, often in secret, followed by guilt and shame. Half the risk is genetic. It’s not about willpower. It’s about brain chemistry, trauma, and emotional pain.

The Hidden Medical Damage

People think eating disorders are "just mental." They’re not. Every organ in the body suffers. The heart slows down, muscles waste, bones become brittle. Electrolytes drop to dangerous levels. The stomach can stop emptying. Kidneys fail. Teeth dissolve from stomach acid. One in ten people with anorexia develop osteoporosis before age 20.

Refeeding syndrome is one of the most dangerous risks when someone starts eating again after long-term starvation. It happens when the body suddenly gets flooded with calories and can’t handle it. Potassium, phosphate, and magnesium crash-leading to heart failure, seizures, even death. That’s why medical supervision isn’t optional-it’s life-saving. Yet, only 38% of treatment centers keep documentation that meets basic clinical standards.

And the mental toll? Depression hits 76% of people with bulimia. One in three with any eating disorder has tried to end their life. People with anorexia are 18 times more likely to die by suicide than those without. Substance abuse is common too-up to half of all eating disorder patients misuse alcohol or drugs, often to numb the pain.

What Actually Works: Evidence-Based Care

There’s no magic pill. But there are proven treatments. And they’re not what most people expect.

For teens with anorexia, the most effective approach is Family-Based Treatment (FBT). Parents take charge of meals. They help their child eat, even when the child resists. After 12 months, 40-50% of teens recover with FBT-twice the rate of individual therapy alone. It’s not about blaming parents. It’s about giving them the tools to be part of the healing.

For adults with bulimia or binge eating disorder, Enhanced Cognitive Behavioral Therapy (CBT-E) is the gold standard. It’s not just about changing thoughts. It’s about breaking the cycle: binge, purge, feel shame, binge again. CBT-E helps people understand triggers, build coping skills, and reconnect with hunger and fullness cues. After 20 sessions, 60-70% of people stop bingeing and purging. And if treatment starts within three years of symptoms appearing, remission rates jump to 65%.

In 2023, the FDA approved lisdexamfetamine (Vyvanse) for binge eating disorder-the first medication ever approved for any eating disorder. In clinical trials, it cut binge episodes in half. But it’s not a cure. It works best with therapy. Medication without support is like putting a bandage on a broken bone.

Why So Few People Get Help

There are 30 million people in the U.S. with eating disorders. Only 35 specialized residential treatment centers exist. Total bed capacity? 1,200 beds. That’s less than 0.004% of the population served each year.

Insurance denies care. A 2022 survey found 68% of people with eating disorders had at least one claim denied. One woman spent 27 months waiting for treatment-9 months for outpatient therapy, another 18 for an intensive program. She had a BMI of 14.5. She was dying. Her insurance said she wasn’t "severe enough."

Even when people get care, it’s often not the right care. Only 43% of treatment centers use evidence-based protocols. Only 12% track outcomes using tools like the Eating Disorder Examination Questionnaire (EDE-Q). Clinicians need 120 to 180 hours of specialized training to deliver FBT or CBT-E properly. Most don’t have it.

And then there’s geography. In rural areas, 78% of counties have zero eating disorder specialists. Telehealth helps-but only if you have reliable internet, transportation to a quiet space, and the energy to turn on your camera when you’re too exhausted to speak.

What Recovery Really Feels Like

Recovery isn’t linear. One person on Reddit wrote: "I gained 15 pounds in 30 days at Monte Nido. My body shook from hunger. My mind screamed that I was becoming fat. But for the first time, someone held my hand while I ate. I didn’t die. And that was enough."

Another, after seven years of bulimia, said: "Twelve sessions of CBT-E cut my binge-purge episodes from 14 a week to 2. I didn’t suddenly love food. But I stopped hating myself every time I ate."

Recovery means learning to sit with discomfort. It means eating a cookie without checking the calories. It means saying "I’m full" and believing it. It means forgiving yourself for years of self-punishment.

And it’s possible. But only if we stop treating eating disorders as a personal failure and start treating them like the medical emergencies they are.

Where to Start

If you or someone you love is struggling:

• See a doctor who understands eating disorders-not just any GP. Ask for a referral to a specialist.
• Get a full medical workup: blood tests, EKG, bone density scan. Physical health comes first.
• Look for providers trained in FBT (for teens) or CBT-E (for adults). The Academy for Eating Disorders has a provider directory.
• Don’t wait for "it to get worse." Early treatment doubles your chances of recovery.
• If insurance denies care, appeal. Document everything. Use templates from Treatment Access Matters. Many denials are overturned with legal help.
• Support groups help-but they’re not treatment. Find one that’s trauma-informed and evidence-based.

Recovery isn’t about becoming thin. It’s about becoming whole. It’s about eating without guilt. Living without fear. And knowing you’re worth more than your weight, your calories, or your reflection in the mirror.

What’s Next

The numbers are grim: 93% more youth are being hospitalized for eating disorders in 2023 than five years ago. Treatment centers are overwhelmed. Insurance companies still treat mental health as a second-class concern. But change is happening. Telehealth is expanding access. New medications are emerging. More clinicians are getting trained. And more people are speaking up.

Recovery isn’t about perfection. It’s about showing up-even when it’s hard. Even when you’re scared. Even when the world tells you you’re not sick enough. You are. And you deserve care.