Modern Metabolic Health with Dr. Lindsay Ogle, MD

Restriction Causes Harms At Any Size: Atypical Anorexia

• Lindsay Ogle, MD • Episode 6

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Most people picture anorexia as a body that looks frail. We pull back the curtain on a form that hides in plain sight: atypical anorexia—true restriction, real medical risk, and a brain consumed by food rules, occurring at any body size. With registered dietitian Isabelle from Bamboo Nutrition, we unpack how emotional eating can mean both eating to self-soothe and restricting to numb, why culture normalizes harmful patterns, and how those habits can quietly harden into an eating disorder or a relentless diet cycle.

We walk through the practical difference between emotional eating and a clinical disorder, then flip the script on “you can go days without eating” myths that put larger-bodied patients in danger. Physiology doesn’t care about size: restriction stresses the heart, hormones, and mind in everyone. You’ll hear clear signs to watch for—dizziness, cold intolerance, missed periods, hair changes, obsessive food thoughts—and why waiting for the “right” label can delay the care that prevents complications.

Ready to seek help but overwhelmed by options? Isabelle shares a simple, reliable path: contact an eating disorder treatment center and ask for their vetted outpatient providers. We outline how a team-based, weight-neutral approach works in practice—therapist plus dietitian, steady re-nourishment, skills for distress, and medical monitoring—to restore safety and rebuild trust with food. If you’re in Missouri, Bamboo Nutrition offers coordinated therapy and nutrition care; if not, use their strategy to find local specialists who truly understand atypical presentations.

If this conversation challenged your assumptions or gave you language for your experience, share it with someone who needs it, then subscribe and leave a review so more people can find evidence-based, compassionate help.

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Dr. Lindsay Ogle, MD:

Welcome to the Modern Metabolic Health Podcast with your host, Dr. Lindsay Ogle, Board Certified Family Medicine and Obesity Medicine Physician. Here we learn how we can treat and prevent modern metabolic conditions such as diabetes, PCOS, fatty liver disease, metabolic syndrome, sleep apnea, and more. We focus on optimizing lifestyle while utilizing safe and effective medical treatments. Please remember that while I am a physician, I am not your physician. Everything discussed here is provided as general medical knowledge and not direct medical advice. Please talk to your doctor about what is best for you. Welcome to Metabolic Health with Dr. Lindsay Ogle. Today we are going to talk about an often overlooked diagnosis, but an extremely important diagnosis to review, and it's called atypical anorexia. And I have an expert here to talk about atypical anorexia. I have Isabelle, who is a registered dietitian. She is also the owner of Bamboo Nutrition in Columbia, Missouri, and Rochester, Minnesota. She specializes in eating disorders and um her bamboo nutrition clinic. It started off with just dietitians, but they actually expanded into an interdisciplinary clinic and included therapists. And with their dietitians and therapists, they approach patient care through a non-diet weight neutral approach to help improve behaviors and thinking around food and body image. So I couldn't think of anyone better to have here today to talk about atypical anorexia than Isabel. So thank you for being here.

Isabelle Bouchard, RD:

Absolutely. Thanks for having me on your channel. This is really fun and um something I'm very passionate to talk about. So looking forward to it. Let's dig in.

Dr. Lindsay Ogle, MD:

Absolutely. Well, before we talk about atypical anorexia, let's talk about um emotional eating, which is extremely common. And I think we all do emotional eating at some point. So can we define what emotional eating is?

Isabelle Bouchard, RD:

So I'm going to use my own definition because I know anybody can just Google this and find a definition that they're looking for. So when I'm in particular working with clients, which I mostly work with individuals like you alluded to with eating disorders. However, we do find individuals who come to our office and clinic who are unsure, do I have an eating disorder? Is this something I need to be worried about? Um, people often have a concrete image in their mind of what an eating disorder looks like. So when they don't fit that mold, they're confused. But they can definitely identify with this concept of emotional eating. And for some people, emotional eating might be when they're feeling emotional, when they feel sad, when they're having a rise in emotions that they can't control. Um, and oftentimes this might look for somebody they're in their car and they want to go through a drive-thru, or they are at home and they raid the pantry. Um, so it it can sometimes feel like as an emotional, I eat to excess, I eat to the point of overfulness, it's uncomfortable. Um, but what sometimes we don't think about is emotional eating can also be different emotions. It can be for numbness, it can be depressive episodes where it can be more related to um anger or or um just long-term episodes of anxiety. Uh, so it's not necessarily an extreme emotion, but it can also be used for numbing. It could be um, it could also sometimes look like not eating. So even though in the term emotional eating, you're assuming you're doing the verb eating, but sometimes you're not. Sometimes you're emotional and you're avoiding food. Um, so that's that's how I would best describe the definition of emotional eating, is it can look different for everybody, but also to just kind of break with the concrete ideas some people have in their heads of what that looks like. It's not always black and white.

Dr. Lindsay Ogle, MD:

Yeah, thank you for going over that. And I love how you brought up it's not always those extreme emotions, um, because I think that that's like you said, most commonly thought about are those extreme emotions. Um, and I think it's really important to bring up the um numbing aspect because I do see that quite a bit in my practice and just with talking with people about um emotional eating. I think that that's extremely common. Um, and it can get into a point, I'm sure you see this in your practice as well, that it just gets into a habit that we don't even realize that we are are doing it, are using food for numbing. And I think that that's why your clinic is so wonderful because not only do you have the dietitian perspective, but you're working very closely with the therapist to help, you know, bring out those emotions that have been numb for so long when somebody isn't even you know realizing that they're doing those behaviors.

Isabelle Bouchard, RD:

Absolutely. I think most of the time you're unaware of it, or it's normalized in society of um, yeah, you're upset. Of course you're gonna go get a milkshake, whatever, you know, or of course you're gonna eat a bag of chips. Um uh or it's it's common to see on commercials, you especially commercials that are selling medication for um depression, a lot of times you see lots of food around, you see garbage piling up. And so it's just kind of normalized that if I have this condition, this is what I do. So you immediately go to treat the condition, but you're not thinking about the symptoms too, which is complicated because food, I tell my clients, you do food, you do food, you eat food, you make choices about food up to six plus times a day on average. So if you're if you're going to ignore the symptom of emotional eating or how you're eating your food, the behaviors around that, this is a problem that it's gonna create negative habits, in which even if you did treat the depression or whatever the condition is you're struggling with, the emotional piece, you could still have these lingering negative behaviors with food that could eventually turn into an eating disorder, or at least entrap you in this dieting spiral where your confidence with food, your confidence with your body image, your confidence eating around other people can be really poor.

Dr. Lindsay Ogle, MD:

Yeah, and that brings us to the next question. What is the difference between somebody who is emotionally eating or maybe following like a strict diet versus a true like definition of an eating disorder? How do you go about um deciphering between those?

Isabelle Bouchard, RD:

There are sometimes online quizzes. I think as a provider, as a treatment, as a treatment professional, I am probably going to treat you the exact same, whether you come to me with a diagnosis or without, which side note, dietitians cannot diagnose. So if you go see a dietitian hoping that they can tell you, you know, specifically, do I have an eating disorder? If so, what kind do I have? What is my diagnosis? Well, we can't even do that first all, first off. So we don't even try. But does it change my treatment? Probably not, because even if I'm not going to treat you like somebody with anorexia nervosa who's maybe even needing a higher level of care, maybe you're not that extreme on an eating disorder where I'm really worried about your medical stability. Um, I could still use a lot of the same tools that I use with depending on what your behaviors are. There's binge eating disorder, there's anorexia, there's bulimia, there's um some things like in between there where it would fall under this diagnosis of other specified feeding and eating disorders. So there's all these treatment tools in my toolbox that I could use for you, no matter if it's a real diagnosis or not. The bigger thing is proving it to yourself, because we have clients who I would say are definitely ambivalent to treatment. Um, and it could also be because they're in denial of the problems that they themselves are encountering. So it's more proving it to you than myself.

Dr. Lindsay Ogle, MD:

Yeah, well, that's wonderful. And I I love that approach because, like you said, even if you don't have a clear diagnosis or you haven't been able to find the right um physician or nurse practitioner or you know, PA or the, you know, somebody who can make that diagnosis, you as a dietitian and your, you know, your other dietitians and your therapists can still provide excellent care. Um, and I think that that's really important, especially because there are not a lot of eating disorder specialists in the, you know, on the medical side to make those diagnoses. And, you know, our hope is that primary care doctors and obesity medicine doctors are trained and qualified to make those diagnoses, and most are, but not everybody has had that specific training. And I know, you know, during my residency in failing medicine, I um chose to do an elective um with uh at an eating disorder uh center, and so I had that additional training, but that was something that I sought out myself. It wasn't really built in um into our curriculum. So um it's not something that everyone is comfortable with. So um, like you said, you might not, you know, present to the dietitian um with that diagnosis, but that's wonderful that you're still able to, you know, help all those patients, even if they don't have that clear diagnosis when they come to you.

Isabelle Bouchard, RD:

Yeah, and I I appreciate you saying how eating disorder training is really something that the provider has to seek out. And it doesn't make you a better provider or a worse provider if you have that experience. It just helps maybe give you a different, different set of tools in your toolbox that you can help clients with. Um that's how I would yeah, describe that. But yeah, absolutely.

Dr. Lindsay Ogle, MD:

Yeah, and that brings us ultimately to atypical anorexia, because this is something that is often overlooked. Um, so let's just start with what is the definition of atypical anorexia?

Isabelle Bouchard, RD:

So again, my definition would be if I were to describe this to somebody, it's someone who's in a larger body. So when you think of an eating disorder, I feel like most people are thinking of anorexia nervosa. They think of someone who is skin and bones, who looks very, very sick. It's obvious they're not eating, they're restrictive. Um and it it's the medical and medically unstable person that they're thinking of. Um, it's clear that there's something going on with food. But what we don't think about is someone in a larger body who's maybe doing the exact same thing and who's also medically unstable. And one of my least favorite things, so trigger warning to anybody um who's in a larger body and maybe has been given this advice, is the medical professional from what is it, 600-pound life. I think I can't remember the specific name of the show. And he tells people in larger bodies, I don't care if you're hungry, you don't need to eat, you can go days without eating because of your body. And that drives me crazy because I feel like those words in itself are reasons why people in larger bodies who are restrictive don't seek care because they think my body can handle it. I've heard that messaging before. This is what other people believe about my body is that I should be able to go days without eating because of my size and my fat stores on my body. And that cannot be further from the truth. Um, I will say, to that man's credit, there is medical monitoring going on for a lot of those patients still. So if they're going days without eating, I hope that they're still being medically monitored. But for the person in outpatient who is going days without eating, and they're doing this secretively and they're not sharing that with anybody, they're not being medically monitored. And your body is still going to react to restriction the same way someone in a normal um classic form of anorexia nervosa's body is going to respond to that. So that is my long about definition of atypical anorexia is you still have the same symptoms. You are just at a higher um body size point than somebody with typical or classic anorexia nervosa.

Dr. Lindsay Ogle, MD:

Yeah, and that's the same definition that I have. And I know that there is a lot of discussion about whether the term atypical anorexia is even an appropriate definition because it is still true anorexia. Um, there's we just have the atypical because, like you said, it's not what what society or classically we expect somebody to look like. Um, but they are it's the same disease process. You still are excessively restricting to the point where it's causing physio physiologic changes in your body that can cause harm and that truly do need medical attention and supervision. Um so there's discussion about that definition and what it should be should be, I guess, termed, um, or if it should even have its own terminology. Um, but I do think that having the some sort of you know identifier like atypical, or if it you know has a different name later on is helpful just to remind us to look out for this because it is, again, so often overlooked in the medical world. Um, you know, obesity medicine is becoming such a more popular field. And I do know someone who's gone through that training that we get educated on this topic, um, which I think is really important, um, so we're not missing that. But um, other providers who are maybe are not board certified in obesity medicine are not getting this training, and this may be something that um more commonly gets overlooked. Um, if somebody has this diagnosis um or suspects that they may have this diagnosis, um what would your recommendation be for you know moving forward with treatment?

Isabelle Bouchard, RD:

Yes, so good question. So often as a dietitian, I get asked, who do I need to see first? Is that a therapist or a dietitian? And my answer to somebody who's unsure if they have this diagnosis, what to do is to just start talking to somebody, some professional ideally, who has understanding in the space. I wouldn't just go see a therapist who has no knowledge on atypical anorexia. I wouldn't even speak to a medical provider who has no understanding of eating disorders because that's what you're trying to understand about yourself. So go to somebody who can really help ask you more questions, inspire deeper thoughts to identify maybe this isn't a full-blown definition or you meet criteria for this diagnosis, but there's clearly something going on here. And it's wonderful that you are concerned and wanting to talk about it and want to address it because it doesn't need to be a diagnosis for it to be a problem. And I think we need to make sure that everybody understands that when it comes to eating behaviors, is it is still a problem, even if it doesn't meet diagnosable criteria. There's so much talk about throwing out diagnoses here and there. I have ADHD, I have ADD, I have depression, I have anxiety, I have, you know, all these things. And just to name the biggest ones that come to my mind. And we just, you know, when we're worried about what are your behaviors, what are your symptoms? How is this impacting your life? Is this a disturbing thing for you? Is this a um a big problem in your relationships and and your social relationships? Or is this just something that you think about here and there and but it's not a big deal? So I would first try to just seek somebody to go to who can help ask you those those questions and inspire deeper thought. And then you might end up seeing both a therapist and a dietitian because oftentimes this is kind of a two-sided coin where you have the mental health problems associated with the eating behaviors, but you also need a dietitian, someone who's knowledgeable about nutrition and your entire body, how that's affecting you, whether you're eating or not eating, the medical part of that. So you might be referred to another specialist. And that does, that should not provoke fear or um concern on your part. It's just considering that you're getting a full hug, you know, the therapist on one side, the dietist on the other side. We're just giving you a complete hug and treating you as a whole person and treating both symptoms of the coin.

Dr. Lindsay Ogle, MD:

Yeah, I I love that. And I love that you touch on, you know, the not always the exact diagnosis. It doesn't, I guess, matter too much. And again, to highlight these diagnoses and definitions are constantly evolving. I mean, I've haven't been practicing, I've only been practicing for a few years, like outside of residency and in medical school, and I've already seen some definitions of these diagnoses change. And so we're always, you know, redefining and refining our um, you know, diagnostic criteria. Um, so those will evolve over time, but the treatment principles uh remain the same. And so I think that that's really important to highlight. And I I always emphasize the importance of building a team around you that's going to support you, and that'll look different from person to person. Um, but I think that that's so helpful to just have multiple people that you can reach out to and you know support you on a journey, and it's something that is going to be on the span of months and years and sometimes decades. It's not something that is immediately resolved with one appointment. And so having multiple people can just help ensure that you succeed. So I appreciate that. And I wonder if you, you know, you talked about finding like it sounds like like safe spaces and providers. Do you have any tips for somebody who is looking for maybe an eating disorder specialist? Um, what can they is there like a website they can go to where they're listed, or are there certain things that um someone should maybe watch out for on websites, like particularly wording that is you know included on websites or um you know, flyers or social media for somebody who is looking for help in this area?

Isabelle Bouchard, RD:

So here is my quick and sure-to-work answer for anybody is find a treatment center, an eating disorder treatment center. Those are much easier to find than individual providers. So I would find the treatment center and then I would contact them and say, Who are your outpatient providers that you refer to? Because they have, they take the time to do the networking. They take the time to find the safest people, the smartest, the most dedicated eating disorder professionals in the community to refer to. So I could tell you, you know, go to this website, go to this website, look for this wording, you know, on this person's profile in psychology today, look for this wording on the website for the dietitians, but that gets so complicated. And I am so exhausted by seeing people say that they work with eating disorders and I don't know about them. They just pop up, they they think that it's okay to just put that on their resume of yes, I do eating disorder work, but they have no training, they don't know how to work on a team, they don't know the medical science behind eating disorders and the fatality statistics behind it and how serious and grave it is. So I'm done with telling people that's how to do things. Now I say go to the treatment centers, contact them and say, I want a list of your outpatient providers. Because some of these people at treatment centers oftentimes have their own private practice too. So they're really good because they have seen all levels of care, they've been well trained, um, or they uh contract with the treatment center. Or again, it's just the treatment center itself has done a very extensive job of finding the right providers in the area. So I know without a doubt, if anyone in Missouri were to go to a treatment center and say, I am located in this area, can you please help me find an outpatient dietitian or therapist? I know that I'm on that list because I I care. I've networked with all of them because this is my niche. But the other person down the street from me who says that they do eating disorders, this is a true th who says that they do eating disorders, but really they don't, I know that they likely have not networked with that treatment center because they don't actually work with eating disorders. They just say that they do. So um, so that's how I would go about that.

Dr. Lindsay Ogle, MD:

Yeah, that's awesome. And that takes a lot of pressure um off of the, you know, patient or client who is looking for help because, like you said, that eating disorder center has already done the vetting for them. And you can just get that list and you know, you know, find who takes your insurance or who's closest or whatever you're looking for, um, and can find some a trusted provider that way. So that's really great advice. Thank you for sharing that.

Isabelle Bouchard, RD:

Yes, the insurance piece too. I didn't even think about that, but they have all that written down. So absolutely.

Dr. Lindsay Ogle, MD:

Yeah, that's amazing because it can be very overwhelming to find somebody. Um, and if it's somebody is trying to find you or your practice, how would they go about doing that?

Isabelle Bouchard, RD:

So we're located in Missouri. We are hoping to branch out to a few other states because we have part of our team located in California. We have, I'm in Minnesota currently. Um, so we're we're trying to branch out. But right now, where majority of us are licensed is in Missouri. So if you are not a Missouri client, you can still reach out to me and I can also do my best. You can treat me like a treatment center and I can do my best to find you the right resources. Um, but for anyone in Missouri who's seeking care for an eating disorder, our practice is called Bamboo Nutrition. And we do have therapists, so it's bamboo nutrition and therapy, but the website is bamboo nutritionrd.com. And um people reach out over the phone, over Google, they email us, they complete the form on our website, um, any avenue, just do whatever is easiest. And I also tell people just because you submit that contact form or you reach out one time does not mean you are signing up for nine months of treatment. You are just starting the process to get to know about it. And that's fine if you back out or if it's not the right time for you.

Dr. Lindsay Ogle, MD:

Yeah, thank you so much. And you have wonderful staff in your clinic. And I always include your link to my new patient so they know about your resources and they can sign up whenever you know they're ready to take that step forward. So thank you for all that you do, and thank you for taking the time with me to talk about emotional eating and atypical anorexia. It's such an important topic. Um, do you have any you know last minute thoughts or anything that you'd like to share before we end this conversation?

Isabelle Bouchard, RD:

I just want to thank you too. I mean, you always get to have the final say on these and praise people, but you deserve praise too. You're a wonderful provider. And the fact that you have the knowledge and understanding on both sides, you know, what it's like to be metabolically healthy and then working with people in larger bodies, but also having the understanding of eating disorders and holding space for both of those things is so, so tricky. And it takes a very capable and kind and empathetic provider to be able to hold both of those things at a time. So I want to praise you for that. And thank you for inviting me to come here and speak. Sorry for baby babbling in the background. If anyone's listening to this and wondering what that noise is, that is a six-month-old baby who is loud. But thank you so much for working through that with me. I appreciate it.

Dr. Lindsay Ogle, MD:

Yeah, anytime. And hopefully later on we can get together again and talk about another topic. I'd love that. Thank you. Thank you for listening and learning how you can improve your metabolic health in this modern world. If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous misinformation that is out there. Please subscribe and write a review. This will help others find the podcast so they may also improve their metabolic health. I look forward to our conversation next week.