“I’m not sick enough” The Lie That Keeps People With Eating Disorders From Getting Help
One of the most common and most damaging thoughts people experience when living with an eating disorder is:
“I’m not sick enough.”
It can sound convincing. It might say you don’t look like the stereotype, you’re not underweight, your blood tests are “normal,” or other people seem worse than you. But this belief isn’t a reflection of truth or medical reality, it’s a symptom of the eating disorder itself.
Dr Jennifer L. Gaudiani’s book Sick Enough: A Guide to the Medical Complications of Eating Disorders and Undernutrition directly challenges this lie. Her work, grounded in decades of clinical experience and research, makes one thing clear: you do not need to be visibly unwell, underweight, or at crisis point to deserve support.
Why “I’m Not Sick Enough” Is an Eating Disorder Thought
The idea of not being “sick enough” thrives in comparison. Eating disorders encourage people to measure their distress against others; weight, behaviours, diagnoses, hospitalisations and to minimise their own suffering.
In Sick Enough, Gaudiani explains that medical risk is not determined by appearance or BMI. The body responds to restriction, purging, over-exercise, and weight suppression in complex ways that are often invisible until harm has already occurred.
Research consistently shows that:
People with eating disorders in higher-weight bodies experience similar psychological distress and medical instability as those in lower-weight bodies
Rapid weight loss, regardless of starting weight, is a major predictor of medical risk
Many people are medically compromised long before they “look” unwell
Yet stigma, including weight stigma within healthcare, often delays recognition and treatment, especially for people who don’t match outdated stereotypes of eating disorders.
Body Size Does Not Determine Illness Severity
Let me say this one louder. BODY SIZE DOES NOT DETERMINE ILLNESS SEVERITY. A critical message for eating disorder recovery and one especially relevant in Australia, where weight-centric health messaging is pervasive, is this:
Eating disorders occur across the full range of body sizes.
Conditions such as “atypical” anorexia nervosa meet all the psychological and behavioural criteria for anorexia nervosa, except for being under a certain weight. The term “atypical” derives from an old medical system that we find unhelpful in our professional practice. In fact, studies show that individuals of any body size can experience:
Bradycardia, hypotension, electrolyte imbalance
Cognitive impairment and severe eating disorder thoughts
Comparable levels of anxiety, depression, and distress
Dr Gaudiani emphasises that BMI is a blunt, inadequate tool for assessing health or risk in eating disorders. Two people at the same weight can have vastly different medical presentations depending on their history, behaviours, genetics, and degree of weight suppression.
You cannot see an eating disorder.
And you cannot measure the worthiness of care by body size.
You Don’t Have to Wait Until You’re “Sick” to Get Help
Many people delay seeking support because they believe:
“I’ll get help if it gets worse”
“Other people need services more than I do”
“I’m functioning, so it can’t be that bad”
But waiting has consequences.
Early support improves recovery outcomes
Evidence consistently shows that earlier intervention is associated with:
Shorter illness duration
Reduced medical complications
Better psychological recovery
Waiting until symptoms escalate often makes recovery more complex — not more valid.
Functioning does not equal wellbeing
Many people with eating disorders continue to work, study, parent, and “cope” while experiencing profound internal distress. High functioning does not negate suffering.
Support is not something you earn
You do not need to hit a breaking point to justify care. You are allowed to seek support because something feels hard, consuming, or out of alignment with the life you want.
Unfortunately, in Australia, access to eating disorder care often relies on:
Weight-based thresholds
Medical markers that may appear “normal” early on
Short GP appointments where eating disorders are under-screened
This system can unintentionally reinforce the belief that you must be visibly unwell to qualify for help.
But under Australian guidelines, any eating disorder, at any weight, is serious, and psychological support is appropriate whenever eating, body image, or food behaviours are impacting quality of life.
If you’re thinking “I’m Not Sick Enough”, Remember: That thought does not mean you are well. It means your eating disorder is protecting itself.
You do not have to wait to be sick to deserve care. You are allowed to choose support now, before your body forces the issue.
Recovery does not begin when you meet someone else’s threshold.
It begins when you decide you are worthy of help.
If you would like to speak to a compassionate psychologist who understands the complexities of eating disorder recovery we offer telehealth psychology to anyone in Australia. Click here to chat to one of us.
Note: The information provided in this blog is for educational purposes only and is NOT intended as medical /psychological advice. Please consult a healthcare professional for personalised guidance.
This blog post was created with the support of AI tools to help with clarity and structure. All content reflects the professional knowledge and clinical judgement of the authors.
