When Jess Quin started to lose weight her high school peers congratulated her.
Having what she described as a “naturally large build”, Jess just wanted to ditch a few kilograms.
At 158 centimetres, Jess is not tall, so when her weight dropped to 48 kilograms it didn’t alarm her parents or teachers. She still looked like a healthy 15-year-old girl.
But Jess wasn’t healthy, and eventually she was diagnosed with atypical anorexia nervosa.
“At the time, I didn’t think that I was sick,” Jess says. “I didn’t think I had an eating disorder or anorexia because I wasn’t skinny yet.”
While she wasn’t starving herself or over-exercising, she was obsessed with counting calories. Afraid of most foods, her diet largely consisted of vegetables and plain rice.
People of any weight, not only those with severe emaciation, can struggle with the serious eating disorder.
Melbourne University researchers examined 171 adolescents at the Royal Children's Hospital between 2005 and 2013.
They found one-third had atypical anorexia nervosa.
Those patients met all the other diagnostic criteria for anorexia nervosa, except they were not underweight.
“Our observation on the ward was that [atypical anorexia] patients were exactly the same in every way, except they had come from higher weight and had not got down low enough to be diagnosed with anorexia nervosa,” leading researcher and dietian Melissa Whitelaw said.
“There’s a bit of a perception among people in the community that atypical anorexia is probably not as serious. But it can just be as medically serious and life threatening as anorexia nervosa.”
Patients with atypical anorexia can experience the same health complications usually associated with anorexia, including a low pulse rate, low systolic blood pressure and low phosphate levels.
Even if a person loses as little as 10 per cent of their body weight quickly, their heart rate can slow down to conserve energy, putting their health at risk.
Mrs Whitelaw says medical professionals need to rethink eating disorders, because "they can emerge at any weight".
She says adolescents who have lost large amounts of weight should be assessed for a possible eating disorder, no matter their size.
“My recommendation is if an adolescent is wanting to lose weight, they need to be assessed by a medical person,” she says.
“Then, they need regular follow ups with someone just checking in and seeing what they’re eating and seeing how much they’re exercising.”
She proposes that weight loss, as well as weight, should be included in future revisions of the diagnostic criteria for anorexia nervosa.
Jess' GP failed to pick up on her condition because she was in a healthy weight range for her height.
However, she developed osteopenia in her spine, a precursor to osteoporosis, and stopped having her period.
After being referred to a specialist and diagnosed, Jess visited the Monash Health Butterfly Eating Disorder Day Program, where she worked towards recovery for four days a week for three months. Now 18, Jess has recovered, but is yet to meet anyone else who has suffered from atypical anorexia.
“I don’t think it’s actually uncommon. I just think it’s not often diagnosed because it kinda goes under the radar a bit more,” she said.
“People can be stuck having atypical anorexia for years and years, even their whole lives, because no one really notices.
“If your friend is a healthy weight and they skip a meal, you don’t think much of it. Not because you don’t care but because you don’t know someone can have an eating disorder and still be a normal weight.”
Anyone needing support can contact the Butterfly Foundation Helpline on 1800 334 673.