To The Bone scene

"To The Bone"

photo: Instagram/To The Bone Movie

With movies like this year’s “To the Bone” and TV shows like last year’s “Binge,” Hollywood is opening up the conversation about eating disorders (EDs) to a mainstream audience. And it’s a conversation we need to be having: some 20 million American women will suffer from an eating disorder in their lifetime.

But too often, this conversation focuses on — and occasionally glorifies — weight loss. Every poster for a movie about anorexia shows a skeletal female lead; most stock photos for “eating disorders” show a bony woman with a tape measure around her waist.

The reality of EDs isn’t so pretty. Internally, sufferers can develop an abnormally slow heart rate and low blood pressure. They can lose density in their bones, eventually leading to osteoporosis. In extreme cases, sufferers can experience multiple organ failure.

But there are other, notable changes on the outside, too. That’s why Revelist talked with Dr. Stephanie Setliff of the Eating Recovery Center in Dallas, about some of the outward signs of eating disorders — that aren’t extreme weight loss.

Unwanted hair growth:

Woman's arm
photo: iStock

“There's something called lanugo hair that’s grown as a result of not being able to maintain a steady body temperature,” Dr Setliff explained. “It’s fine hair that grows usually on the face, chest, arms, and back to trap air to stay warm.”

This side effect is also known as “the glow,” for the slightly eerie effect when light shines through the small hairs covering someone’s body. Basically, without body fat to keep them warm, the bodies of ED sufferers try to grow their own blankets.

Unfortunately this technique doesn’t work too well: People with severe eating disorders still suffer from lower-than-average body temperatures.

Hair loss:

hair brush
photo: iStock

At the same time as they are growing hair on their bodies, many ED sufferers start losing the hair on their heads. That’s because when the body is protein deficient, it saves its resources for super crucial things — like, say, the heart muscle. Nonessential functions, like hair growth, stop.

What’s troubling to many doctors, however, is that women usually start losing their hair long after more serious, internal issues have already begun.

“The thing that's frustrating and hard for people like us is that on the inside these people are having these really significant changes,” Dr. Setliff told Revelist. “…We talk about things like that and nobody really cares, but once their hair starts falling out and gets thin, then it’s an emergency and they get treatment.”

Brittle nails:

finger nails
photo: iStock

Much like hair, our nails are also made of protein. When protein intake is restricted, the nails become brittle and break more easily.

Not only that, but women with severe eating disorders often see their nail beds turn blue. That’s because poor circulation (caused by inadequate nutrition to the heart) leaves them lacking in blood and oxygen.

According to one study, almost half of all anorexic women saw changes to their nails.

Dental issues:

photo: iStock

For those suffering from bulimia, frequent binging and purging can cause severe damage to their throats and mouths. Stomach acid in the mouth — from repeated vomiting — can erode enamel, and leave sufferers prone to cavities. Malnutrition can cause sores — known as cheilosis — to appear on the lips.

In the long term, the shame around purging behaviors can cause some sufferers to avoid professional dental care altogether.

“They have so much shame around it that they don’t go to the dentist,” Dr. Setliff explained. “Many girls know that a dentist can look in their mouths and see that the enamel on the back of their teeth is eroded.”

Poor healing:

photo: iStock

A final effect of malnutrition is that the body heals more slowly. Energy and nutrients are used to keep essential organs running — not to heal scratches or bruises.

“They put themselves in a position where there bodies are starving to death so their immune system gets suppressed,” Dr. Setliff explained. “...It’s an inability to heal because of how malnourished they are.”

Women in the throes of an eating disorder can grapple with unseemly cuts, or other injuries, for months on end.

If you believe you or someone you know is suffering from an eating disorder, call the National Eating Disorders Association hotline at (800) 931-2237.

For additional information about Eating Recovery Center, call 877-789-5758, email, or visit to speak with a Masters-level clinician.