Normally, the diagnostic criteria for anorexia requires that patients have an “extremely low body weight.” But many who engage in anorexic behaviors are overweight. In fact, while just 0.6% of Americans suffer from classic anorexia nervosa, it’s estimated that as many as 28% of Americans could qualify for a diagnosis of atypical anorexia, sharing all the same behavioral qualities but in a body that doesn’t show it.

Atypical anorexia was created to capture this subset of people who engage in anorexic behaviors as a means of losing weight, but aren’t yet so deathly skinny that they look malnourished. Because they don’t look anorexic to an outside observer, they often go longer before being diagnosed or receiving treatment, which can make the disorder more entrenched and harder to treat.

Some evidence suggests overweight anorexics are at similar risk for health complications. While they may not starve themselves to the point of looking like skin and bones, they nonetheless experience similar health problems such as slower heart rates and dangerously low blood pressure.

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