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Cultural shifts toward extreme thinness can increase body dissatisfaction and eating disorder risk.

Concern about visible changes is not the same as shaming or diagnosing someone.

Eating disorders occur across the weight spectrum and cannot be identified by appearance alone.

As a psychotherapist specializing in eating disorders and body image concerns, I have been hearing the same question in different forms lately: How do we talk about the return of extreme thinness without body-shaming women or making assumptions about someone’s health? Patients, family members, and colleagues are noticing that extremely thin bodies seem to be showing up more often in celebrity culture, fashion, advertising, and social media, and they are unsure what to make of it or how to talk about what they are seeing.

These questions often overlap. The renewed appeal of extreme thinness affects how people think about bodies in general, while concern about someone we know comes with much more context than a photograph or video can provide. In both situations, what we see may raise questions, but it is only part of the picture.

Eating disorders affect people of all genders, and body image distress is not limited to women. I am focusing here on women because much of the current conversation about the return of extreme thinness has centered on female celebrities, models, and influencers, and women’s bodies continue to receive an enormous amount of public scrutiny.

When Extreme Thinness Starts Looking Normal Again

Beauty standards are reinforced by what we see again and again. When very thin bodies are the ones being photographed, praised, dressed by designers, and held up as desirable, thinness can become linked with attractiveness, control, success, or acceptance. For someone vulnerable to an eating disorder, restriction may look less alarming and compulsive exercise more like discipline. The contrast feels especially noticeable now because there has been somewhat greater visibility of body diversity in mainstream media in recent years.

I see this rationalization often in my outpatient practice. Someone may say she is trying to be healthier, eat more cleanly, get toned, or take better care of herself while she is also eating less, eliminating more foods, avoiding meals with other people, or spending increasing amounts of time thinking about exercise and her body. None of those phrases sounds especially alarming because they are so familiar in our culture, but the behavior underneath them can tell a different story.

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