Are Eating Disorder Diagnoses Missing the Bigger Picture?

When it comes to eating disorders, you might assume that a diagnosis is based purely on behaviours, thoughts and patterns around food.

But in reality, it often comes down to something else entirely: weight.

We wanted to open up an important conversation around this, because it’s something we see far too often—and it can have a real impact on the support people receive.

Same behaviours, different diagnosis

In theory, eating disorder diagnoses are guided by clinical criteria. But in practice, things aren’t always so clear-cut.

Many people experience:

• A deep fear of weight gain

• Constant thoughts about food

• Strict, rigid rules around eating

• Cycles of restriction and overeating

• Compensatory behaviours like exercise or further restriction

And yet, despite these shared experiences, the diagnosis someone receives can differ significantly depending on their body size.

How weight can influence labels

Let’s look at a common pattern.

Someone might:

• Restrict their food intake

• Avoid certain foods in the name of “health”

• Experience episodes where they eat more than planned

• Compensate by exercising more or restricting further

Now here’s where it changes:

• If their BMI is considered low, they may be diagnosed with anorexia or orthorexia, with a focus on restriction

• If their BMI is within a “normal” range, they may be diagnosed with bulimia or OSFED, with a focus on bingeing and purging

• If their BMI is higher, they may be diagnosed with binge eating disorder, with focus placed on overeating

Same underlying patterns.Completely different labels.

Why this matters

A diagnosis doesn’t just describe what’s happening—it often shapes the advice someone is given.

For example:

• Anorexia or orthorexia → “You need to eat more”

• Bulimia or OSFED → “Let’s manage emotions to stop the purging”

• Binge eating disorder → “Let’s manage your intake”

But if the behaviours driving these diagnoses are fundamentally similar, why are the solutions so different?

This mismatch can leave people feeling confused, unsupported or even stuck in the very patterns they’re trying to break.

When diagnosis becomes subjective

Even when clinical guidelines are used, interpretation can vary.

For instance, someone may be diagnosed with bulimia despite not fully meeting the frequency criteria for bingeing episodes. Meanwhile, the only reason they aren’t diagnosed with anorexia could be that their weight doesn’t fall into a certain category.

This happens more often than many realise.

And it highlights an uncomfortable truth: diagnosis isn’t always as objective as we might hope.

The real issue: restriction

At the core of most eating disorders—regardless of label—is restriction.

This isn’t just about physically eating less. It also includes:

• Mental restriction (“I shouldn’t eat that”)

• Food rules and conditions

• Avoidance of certain foods or situations

• Fear-driven decision-making

When restriction is present, it often fuels cycles of overeating, guilt and compensation.

Which means adding more restriction is rarely the answer.

A more helpful way to look at recovery

When you step back from labels, recovery across different eating disorders starts to look surprisingly similar.

It often involves:

• Eating consistently

• Eating enough to meet your body’s needs

• Reducing food avoidance

• Taking action despite fear

• Rebuilding trust with your body

These principles apply whether someone has been labelled with anorexia, bulimia or binge eating disorder.

Final thoughts

Diagnoses can be helpful in some contexts—but they don’t tell the full story.

Focusing only on labels or weight can miss the underlying patterns that actually need attention.

Because ultimately, the real work isn’t about fitting into a diagnostic box.

It’s about healing your relationship with food, body and control—and addressing the fears that keep those patterns in place.