A blog post by Pepetoe.

“Don’t look sick enough.”

It’s a sentence that gets said out loud far too often, and thought silently even more.

Nearly four years into recovery, this thought still finds its way back into my mind. I look healthier now. I look happier. I look “better” than I once did. And yet, there are moments (and more than not at the moment) where the old eating disorder voice resurfaces and tells me that because I am not as visibly unwell as I was before, I must not deserve help in the same way. That I don’t deserve to gain weight, that I don’t deserve to get better.

That belief is not rational. It is not kind. And it is not unique to me. The idea of not being “sick enough” is one of the most dangerous and persistent myths surrounding eating disorders, and it keeps far too many people stuck.

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Eating Disorders Don’t Have a Look

One of the most damaging misconceptions about eating disorders is that they are visible. That you can spot someone struggling just by looking at them.

You can’t.

Eating disorders:

• Do not have a specific body type
• Do not require someone to be underweight
• Do not disappear when weight is restored
• Do not begin or end at a certain BMI

Some of the most mentally unwell periods of my life happened when I looked the most “normal.” I was functioning. I was achieving. I was being complimented. From the outside, everything appeared stable.

That external stability made it easier to dismiss what was happening internally. When people tell you that you look well, healthy, or better, it can reinforce the narrative that nothing is wrong, even when your thoughts are chaotic.

Eating disorders are mental illnesses. The physical symptoms are only one piece of a much more complex psychological struggle.

The “Not Sick Enough” Thought Is Part of the Illness

The belief that you are not sick enough is not just insecurity; it’s often a core symptom of the disorder itself.

Many people with eating disorders experience relentless comparison and minimisation. There is always someone “worse.” Always a benchmark that feels more legitimate. Always a reason to delay seeking help.

The internal rules can sound like this:

• You haven’t lost enough weight
• You haven’t been hospitalised
• You’re still functioning
• Other people are struggling more

This thinking creates a moving goalpost. No matter how unwell someone becomes, it rarely feels sufficient. And that mindset can keep someone trapped for years.

I’m not saying here that more people than you think have eating disorders, and I’m certainly not invalidating those of us with eating disorders. This is more to help those already struggling with EDs, diagnosed or not yet diagnosed. And it’s to help those of us who struggle with this daily comparison and invalidate our own feelings around our recovery journey. And it becomes even louder the further we go down the recovery path, because we might look better, but we certainly don’t feel it.

For A Lot Of People, Recovery Does Not End at Weight Restoration

There is another layer to this conversation that is rarely discussed: long-term consequences.

Although eating disorders have been recognised for decades, research into their prolonged physical effects is still developing. Many people assume that once someone reaches a “healthy weight,” they are fully recovered.

In reality, the body can continue to experience complications long after visible symptoms improve. And I’m only just discovering these now in my journey, and in my GP appointments.

These may include:

• Cardiovascular strain
• Reduced bone density
• Hormonal disruption
• Ongoing digestive issues
• Metabolic instability
• A body that remains physiologically cautious after prolonged restriction – and still doesn’t trust you years later

Four years into recovery, I am still navigating some of these consequences. What has been particularly confronting is realising that looking healthier does not automatically mean the body has fully healed.

At one stage, not too long ago, I believed I was doing well. I had gained weight. I was eating consistently. I had returned to playing hockey. I felt stronger. Then I was advised to stop exercising due to concerns about my physical health.

That moment challenged my assumption that visual progress equals medical stability (because it does not). It reinforced something important: you can look well and still require care.

The Limitations of BMI as a Measure of Recovery

Within many healthcare systems, particularly in the UK, BMI is still heavily relied upon as a marker of recovery. When someone reaches a “healthy BMI,” they may be discharged from services.

However, BMI does not measure:

• Psychological distress
• Obsessive thoughts about food
• Compulsive exercise
• Fear around weight gain
• Underlying physical complications

Plus a whole load more thoughts and feelings we struggle with on a daily basis. Recovery is not a number. It is not a single threshold. And it is certainly not a guarantee of long-term stability. To be honest, I could go on and on about what recovery actually means, but I won’t because that would take me years to write, and all of our journeys are unique.

While weight restoration can be medically necessary, it is only one aspect of recovery. A person can meet BMI criteria and still require substantial physical and psychological support.

You Might Not Realise You’re Still Struggling

One of the more confusing aspects of recovery is that progress can mask ongoing vulnerability. It is possible to feel better than before and still not be fully well. It is possible to normalise subtle warning signs because they no longer seem extreme. It is possible to overlook fatigue, hormonal changes, or exercise dependence because things are “not as bad as they were.”

Sometimes, it takes professional intervention to recognise that more support is needed. That realisation does not mean failure. It means listening more closely to what the body is communicating.

You do not need to deteriorate to justify care.

Eating Disorders Affect More Than Stereotypes Suggest

Another reason the “not sick enough” narrative persists is because public understanding of eating disorders remains narrow.

Eating disorders affect:

• All genders
• All ages
• All ethnicities
• All body sizes
• All socioeconomic backgrounds

They are not limited to teenage girls.
They are not limited to underweight bodies.
They are not limited to one presentation.

I know I talk a lot about anorexia, and sure, I may fit the “white girl stereotype” of that. But I am also talking about so many other eating disorders. Anorexia and being “skinny” is not what an eating disorder is. It comes with a lot more bearing than that, and can affect absolutely anyone at any point in their life. Remember that.

Stereotypes create blind spots. When we expect illness to look a certain way, we overlook those who do not fit that image. That oversight delays diagnosis, support, and validation. Moving beyond outdated stereotypes is essential if we want earlier intervention and more inclusive care.

You Do Not Have to “Look Sick” to Deserve Help

If you are struggling with the belief that you do not look sick enough to seek support, it is important to understand that this thought is common, and misleading. You do not need visible deterioration to justify intervention. You do not need to meet someone else’s threshold of seriousness. And you do not need to wait until your condition worsens.

Eating disorders are complex, multifaceted illnesses. They are psychological, physical, and behavioural. Their severity cannot be assessed by appearance alone. Support is not something you earn by looking unwell. It is something you deserve the moment your health (mental and/or physical) is compromised.

You’d go to the GP for any other health issues, wouldn’t you? The moment your physical health is compromised? Like a cold, an unusual mole, tightness in your chest. So, why ignore the other warning signs?

And this is true at any stage of the illness, including and especially recovery when your body still doesn’t quite trust you yet.