‘But you look fine’: Why appearance and eating disorders aren’t always linked

Words by Allie

Nov 25

Written By Allie

Trigger warning: This post discusses specific behaviors that are consistent with a diagnosis of bulimia nervosa. Please read with caution.

I’ve recently been watching episodes of the 90s TV series Beverly Hills 90210, a series I wasn’t allowed to watch as a kid because it was “too risqué,” but now I find it to be hilariously cheesy with implausible storylines, which probably is what made it so popular in its heyday. But I digress.

In true after-school special fashion (even though this show was a primetime drama), eating disorders were a micro-topic in a handful of episodes over the course of the 10 seasons. They were depicted more as minor afflictions that could be solved within one hour-long episode: A female character would be struggling with some form of disordered eating but would miraculously come to terms with it and get help by the end of the episode, and then the topic would never be spoken of again.

But one scene actually caught my attention for a very specific reason. Let me set the stage.

In season 9, a character named Gina is shown on her own, bingeing food, and purging through vomiting. This behavior only lasts for an episode or two before someone confronts her about it. But until that happens, she keeps the behaviors a secret.

She visits a dentist to get a broken filling repaired. As the visit is wrapping up, the dentist, who also happens to be the father of one of the main characters, tells her about a procedure called “bonding,” which will help restore the enamel she’s lost from purging. The viewer can tell she’s startled because she now knows she’s been caught in her behaviors, but she shrugs off his suggestion as it wasn’t something she had come to see him for in the first place. As Gina is getting her things to leave the office, the dentist brings it up again, this time more directly:

**“How long have you been bulimic?”**

She replies with something like, “I don’t know what you’re talking about,” so he goes on to say that obviously, she has an eating disorder. When a person vomits, stomach acid strips the enamel from teeth, and, ostensibly, this dentist has had the proper training and education to keep an eye out for such damage. (Huge nod to the writers for making this dentist so informed!)

Gina tries to change the subject to her payment plan, but the dentist insists she sees an internist to check for esophageal damage, vitamin deficiencies, and other life-threatening issues.

She hurries to leave, muttering “I’m fine," and the dentist comes back with a zinger:

“You look fine, but you could drop dead tomorrow from heart failure.”

I remember worrying about this very thing, wondering whether I would make it through each night. Wondering if, when I went out for a run, I would make it back home. But on the outside, I thought I looked fine. And by some treatment facility standards—ones that only accepted patients if they were below a certain weight—I was fine.

But the truth is, there is so much we can’t tell about someone’s health based on their physical appearance. And despite the fact that for decades, much of society has associated eating disorders with body shape, they’re actually not as closely linked as we think.

How to tell if someone has an eating disorder

Despite what the media have shown us over the years, eating disorders cannot be diagnosed just by *looking* at someone. Not everyone who seems “too thin” restricts their food, and not everyone who is in a larger body has self-control issues around food. These narratives might help some of us make sense of the world around us, but I’m here to tell you these narratives are antiquated, incorrect, and dangerous.

*So, how can I tell if someone is struggling with disordered eating?*
**You can’t.**

The only way to know is for that person to be evaluated by a medical professional who specializes in eating disorders.

In the example above from 90210, Gina’s friends had no idea she was engaging in behaviors that were depleting her electrolytes and possibly guiding her body toward heart failure. But a dentist who has been properly trained to notice that purging can cause enamel issues can point out these problems before they become deadly.

What is the relationship between body image and eating disorders?

Disordered eating isn’t always directly related to body dissatisfaction or body dysmorphia. Often, behaviors are symptoms of a deeper problem and can arise after some kind of trauma like loss, bullying, or a serious illness. In these cases, the individual might transfer their negative feelings about the event to food, exercise, and their body, using these as an outlet for their anger, anxiety, grief, etc.

In this way, eating disorders are less about food and more about feeling. And, according to the National Institute of Mental Health: “People with eating disorders may appear healthy, yet be extremely ill.”

So even when people in recovery who were once dangerously thin gain weight, it doesn’t mean their mind is healed. They may still have a lifetime of work in front of them.

The dangers of eating disorders stereotypes

To sum up, eating disorders are much more than how they present. Food, body image, exercise, and other behaviors are manifestations of something deeper, something that can’t be seen.

Labeling people as “fine” because, to you, they “look” fine (which is incredibly subjective in and of itself) only perpetuates the misguided stereotypes surrounding eating disorders.

People in small bodies can be depressed. People in larger bodies aren’t always trying to lose weight. Instead of looking and making unfounded conclusions, start talking. Get to know the person for who they are, not what they look like.

Oh, you may be wondering what happened to Gina. A few episodes later, she ends up being wheeled into the ER for a severe electrolyte imbalance. Once home and recovering, she confesses to her boyfriend, for the fist time in her life, that she has bulimia.