Can someone with an eating disorder be in a larger body?

Yes. More than half of Australians with eating disorders are in a larger body. Atypical anorexia nervosa, bulimia nervosa and binge eating disorder are all well-documented in people whose weight is above average. These diagnoses are frequently missed because GPs and patients both tend to associate eating disorders with thinness. Delayed diagnosis in people in larger bodies is associated with worse outcomes.

What are the signs of an eating disorder a GP might notice?

Physical signs include unexplained fatigue, dizziness, menstrual irregularities, dental erosion, low potassium, and cold intolerance. Behavioural signs include requests for weight-loss medication, rigid eating habits, and exercise that continues despite injury. Psychological signs include preoccupation with food or body image, mealtime anxiety, and perfectionist thinking. These signs can be present in someone of any body size.

What eating disorder support is available in Australia?

The Butterfly National Helpline is available at 1800 33 4673 (1800 ED HOPE). The InsideOut Institute GP Hub provides clinical guidance for GPs. MBS eating disorder treatment plans (up to 40 sessions with a psychologist) are available via GP referral, though access and use remain limited. Talk to your GP if you have concerns about your relationship with food, eating or body image.

Australia leads the world in eating disorder rates — and GPs are missing cases

A Global Burden of Disease analysis published in JAMA Psychiatry this week found that Australia has the world’s highest estimated age-standardised prevalence of anorexia nervosa and bulimia nervosa: 1,026 cases per 100,000, more than four times the global average of 225. Globally, an estimated 18.1 million people are affected — a 71% rise since 1990.

That figure will surprise some people. It shouldn’t. The surprise is partly a function of who we imagine when we picture an eating disorder.

Who actually has an eating disorder in Australia

The data is specific, and it matters. The analysis found that 69.4% of global eating disorder cases are female and 41.2% are aged 10 to 24. That demographic is real. But it has also calcified into a stereotype — the young, thin, white woman — that excludes most of the people who actually need care.

Over half of Australians with eating disorders are in larger bodies. Men make up nearly a third of cases globally and are consistently underdiagnosed. Binge eating disorder, the most common eating disorder overall, was not included in the JAMA Psychiatry analysis, which means the burden is likely significantly underestimated.

The eating disorders being missed are not rare edge cases. Atypical anorexia nervosa — characterised by all the psychological and behavioural features of anorexia but occurring in someone whose weight is average or above — is a well-established diagnosis that gets filtered out at the first assessment step because the GP, the patient, or both are looking for weight loss that isn’t there. Butterfly Foundation’s Danielle Dougherty says GPs need to hear this clearly: “Don’t assume that someone in a larger body isn’t struggling with an eating disorder. Eating disorders don’t have a ‘look.’”

Both-and: the evidence and the system

The evidence for why Australia sits at the top of this table is mixed. Part of the prevalence difference reflects genuine burden. Part may reflect data quality — Australian eating disorder surveillance is more robust than in many other countries, which can inflate relative estimates. The researchers note this limitation explicitly.

What is not in dispute is the access picture. Only about one in five people with an eating disorder in Australia accesses an MBS eating disorder treatment plan. Of those who do, about one in three uses no treatment sessions at all. About one in three needs care beyond the 12-month plan. The National Eating Disorders Collaboration has found that many medical, psychology, dietetics and nursing training programmes contain inadequate content on eating disorders — meaning the workforce reaching people earliest, including GPs, may not feel confident identifying or managing what they find.

This is the structural condition in which that 1,026 per 100,000 figure lives: high estimated prevalence, low treatment access, and a clinical and social filter that sorts patients by appearance before it sorts them by symptoms.

What GPs are being asked to do differently

The Medical Republic report, drawing on experts from the Butterfly Foundation and clinical specialists, outlines the physical, psychological, and behavioural signals GPs can watch for regardless of body size:

Physical: Fatigue, dizziness, fainting, cold intolerance, palpitations, menstrual irregularities, unexplained low potassium, dental erosion, recurrent sports injuries, and gastrointestinal complaints without a clear cause.

Psychological: Anxiety or depression presenting alongside preoccupation with food, body image, or weight. Rigid thinking about eating rules. Mealtime anxiety. Obsessive-compulsive features clustering around food.

Behavioural: Requests for weight-loss medication or appetite suppressants. Restrictive eating described as food intolerances or health-consciousness. Exercise that continues despite injury or illness.

For GPs considering starting a patient on a GLP-1 receptor agonist for weight management, these signals matter before prescribing. GLP-1 agents suppress appetite, and in someone with a restrictive eating disorder or atypical anorexia, prescribing one without screening first can reinforce dangerous restriction.

The InsideOut Institute GP Hub and the NEDC eLearning platform both offer short, practical training modules designed specifically for Australian general practice. The Butterfly National Helpline (1800 33 4673) is available for clinical consultation as well as patient support.

The system’s known gaps

Data published by Wandi Nerida, a residential eating disorder facility, found a median illness duration of 11 years among residents on admission between July and September 2026. Eleven years. That is not a figure that reflects early detection working. It reflects the opposite: a long period in which symptoms were present, may have presented to general practice multiple times, and were not identified or escalated.

The Butterfly Foundation and the Eating Disorders Alliance are calling for changes to MBS eating disorder items and greater government investment in intensive and residential care. Queensland Health funds 8 of Wandi Nerida’s 13 beds. Residential care is rare, expensive, and geographically concentrated. The pathway from a GP consultation to specialist eating disorder care is often unclear, long, and costly. For people without private health insurance or financial resources, access is effectively rationed.

2 cents

Australia being at the top of a global eating disorder prevalence table is not a distinction to absorb passively. It is a prompt to ask why — and the answer, to the degree we can trust the data, is a combination of genuine burden and inadequate early detection.

For anyone who has been managing a complicated relationship with food, eating, or body image: an eating disorder does not require a particular weight or body shape, and it does not require that food be the most urgent thing on your mind. If the signs above feel familiar in some way, it is worth raising with your GP, even if you do not think what you are experiencing is “serious enough.” The entry point to care is a conversation with a GP who is looking for the right things, not a referral that follows a crisis.

For people who know someone in this situation and do not know how to help: the Butterfly National Helpline at 1800 33 4673 offers support for carers and families, not only for people with eating disorders themselves.

Verdict: yes — the data is significant, the access gap is real, and the missed-diagnosis problem has practical implications for GP consultations this week.