This Is Us Shows Why You Should Never Assume You Know What An Eating Disorder Looks Like

On last night's episode of This Is Us, Kate goes to an Overeater's Anonymous (OA) meeting. During the meeting, a slender woman clad in head-to-toe athleisure, named Madison, tells a story about successfully avoiding her favourite hors d'oeuvres at a cocktail party. Kate shoots dirty looks at her, and once Madison finishes, Kate stands up and starts berating and belittling her.

"Do you know why no one's defending you? Because you don't have a problem," Kate shouts. "The people that come here have problems. Real problems with real issues. What do you come here for, anyways? So you can feel better about yourself because you're not as screwed up as we are?" While it's implied that Madison and Kate have sparred in the past, Kate's point of view represents a common and harmful misconception that in order to have a legitimate eating disorder, you also have to "look the part." This applies to all types of eating disorders, but in Kate's case, she's relying on the stereotype that all people with binge eating disorder are also overweight.

If you've never heard of binge eating disorder, that may be because it's relatively new (in name), and was officially added to the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 2013. Technically, binge eating disorder is defined by recurrent episodes of eating large quantities of food, usually quickly and to the point of discomfort, according to the DSM. During a binge, someone might feel a loss of control, and afterward they might experience shame, distress, or guilt. But unlike bulimia, people with binge eating disorder don't purge to counter what they've consumed.

It's estimated that 70% of those who suffer from binge eating disorder are obese, but of course not everyone who has it is. "The diagnosis is based on behaviours, not weight, and the 'cure' is not to lose weight," says Kristina Saffran, cofounder and executive director of Project HEAL, a non-profit organisation that offers recovery support for people suffering from eating disorders. In fact, prescribing weight loss strategies as a treatment can further entrench the disorder, Saffran explains.

Binge eating disorder is believed to be the most common eating disorder in the United States, according to National Eating Disorders Association (NEDA). A 2007 study found that an estimated 3.5% of women and 2% of men in the U.S. have had binge eating disorder during their lifetime, making it three times more common than anorexia and bulimia combined. (And that was before it was in the DSM, so the number's likely higher now.) In studies of disordered eating, as many as 30% of obese adults seeking weight-loss treatment showed signs of BED.

That said, people with binge eating disorder can be underweight, obese, or any size in between, according to NEDA. Often when an eating disorder is portrayed in mainstream media, it's painted as something that only affects emaciated young women — and that can be problematic because it discounts other very valid experiences. "One of the reasons eating disorders are so challenging to treat is that sufferers often feel that they are not 'sick enough' to warrant help," Saffran says.

In This Is Us, Kate straight up said that she didn't think Madison was sick enough for treatment, which plays directly into this fear, and could make someone like Madison less likely to seek and receive help in the future. But the show is still making great strides by even including bodies and narratives that you don't usually see relating to eating disorders (or on TV at all) — even if it is via a somewhat problematic and abrasive rant. Ultimately, Madison and Kate do bond with one another; let's hope we get to see their relationship unfold, and become more supportive, as the season goes on.