Bones, Body Image, and Beyond: Why Eating Disorders Are More Than Skin Deep

Eating disorders are something deeply personal to me. I struggled with anorexia as a teenager, and even now, as an adult, body image remains a constant battle—one that requires ongoing work and effort every single day. Luckily, I was able to recover quickly, and my lifelong commitment to staying physically active has played a crucial role in helping me save my bones. But I know firsthand how relentless this struggle can be, and how easy it is to focus on the immediate effects—drastic weight loss, malnutrition, and the emotional toll it takes. What’s often overlooked, and something I’ve come to fully appreciate through my own experience, are the long-term consequences eating disorders can have on our health. Especially on our bones. Those vital, living structures that support and protect us, suffer quietly when deprived of the nutrients they need. Over time, this can lead to conditions like osteopenia and osteoporosis, which can develop even in youth and linger long after recovery. The impact of disordered eating goes far beyond the surface, leaving lasting scars—particularly on our bones.

Let’s begin by looking at the statistics. In the U.S. alone, roughly 9% of the population will experience an eating disorder in their lifetime. Among young women, particularly adolescents, this number is even more startling: studies estimate that up to 3.8% of girls aged 13 to 18 suffer from anorexia nervosa, bulimia, or binge-eating disorder. And the risks to bone health are clear—90% of bone mass is developed by the time we reach our early 20s. When young girls starve their bodies or purge essential nutrients, they interrupt this critical bone-building period, often leaving their skeletons permanently weakened.

The toll doesn’t stop at adolescence. While eating disorders are often considered the domain of the young, perimenopause brings its own unique challenges, with a resurgence of disordered eating behaviors often reported in women in their 40s and 50s. As estrogen levels begin to decline during perimenopause, bone loss accelerates. Women who already have compromised bone density due to an eating disorder earlier in life are at an even higher risk of osteoporosis during this stage. In some cases, women who have never previously struggled with eating disorders develop new behaviors around food during perimenopause, often triggered by societal pressures to maintain a youthful appearance or by weight gain due to hormonal changes. The combination of estrogen decline and disordered eating during this period can be catastrophic for bone health.

We cannot ignore the modern landscape in which these disorders flourish: social media. Platforms like Instagram and TikTok, with their relentless flood of images of thin, seemingly perfect bodies, have become breeding grounds for unhealthy comparisons. Studies show that frequent social media use is directly correlated with body dissatisfaction, a key predictor of eating disorders. The effects are particularly stark for young girls: 70% of adolescent girls who regularly use social media report that they compare their bodies to those they see online. This constant exposure to filtered, idealized images fuels the desire to lose weight, often leading to dangerous behaviors like restricting calories, over-exercising, or purging—all of which wreak havoc on bone health.

But why exactly do eating disorders devastate the bones? To put it simply, when the body is deprived of nutrients—especially calcium, vitamin D, and protein—it cannot maintain the normal process of bone remodeling, the continuous cycle of breaking down and rebuilding bone tissue. In the absence of adequate nutrients, the body pulls calcium from the bones to maintain essential functions like heart and muscle contraction. Over time, this leads to bone thinning. In those with anorexia nervosa, research has found that up to 50% of bone mass can be lost within two years of severe illness, leaving sufferers with weak, fragile bones that are prone to fractures.

A crucial player in this process is estrogen, the hormone responsible for maintaining bone density by regulating the balance between osteoclasts (the cells that break down bone) and osteoblasts (the cells that build new bone). In girls and women with anorexia or other eating disorders, estrogen production plummets due to severe caloric restriction, leading to amenorrhea (the absence of menstrual periods) and accelerating bone loss. Without estrogen’s protective effects, bones are left vulnerable, breaking down faster than they can rebuild. It is important to note that while amenorrhea greatly increases the risk of bone loss, it is not necessary. You can still be experiencing monthly cycles and yet compromise your bones with extreme dieting.

The risks don’t end once a person reaches a healthy weight. Many women who have recovered from eating disorders continue to suffer from osteopenia or osteoporosis, sometimes decades later. Studies indicate that even after a woman regains weight and her menstrual cycle returns, her bone density may never fully recover. This is especially true for those who developed an eating disorder during adolescence, when bone growth is at its peak. Their bones were never given the chance to fully develop, leaving them with a lifelong deficit that increases their risk of fractures and other complications as they age.

The impact of eating disorders on bone health is not just a crisis for the young or the severely ill. Women of all ages, particularly during the transition to menopause, are vulnerable. The message of body perfectionism so often amplified by social media plays a profound role in shaping unhealthy eating patterns across the lifespan. For those in midlife, where bone health is already at risk due to hormonal changes, restrictive eating habits exacerbate the loss of bone mass, pushing many into osteoporosis much earlier than expected.

The good news? Awareness is the first step toward protection. If you or someone you know is struggling with an eating disorder, seeking help early on can prevent or minimize damage to bones. A diet rich in calcium, vitamin D, and protein—combined with appropriate medical support—can help stave off the worst effects, allowing the bones a chance to recover. Additionally, weight-bearing exercises, such as walking or resistance training, can stimulate bone remodeling and rebuild strength.

But recovery is only one piece of the puzzle. To truly protect the health of future generations, we need to address the root causes that lead so many girls and women into this struggle in the first place. Changing the societal pressures that push girls and women toward eating disorders is no small task, but it’s one we can all play a role in. This pressure is woven into the very fabric of our everyday lives—social media, advertising, even casual conversations—reinforcing narrow, harmful ideals of beauty. But change begins with awareness, and by taking intentional steps, we can help create a world where girls and women feel empowered, confident, and supported in their bodies, rather than pressured to conform to unrealistic standards.

First, we can start by changing the conversation. The way we talk about bodies—our own and others'—matters. Too often, we fall into the trap of commenting on weight or appearance as a default compliment, or we disparage our own. I am just as guilty of this as anyone. I’ve been making a concerted effort to change how I speak about myself, recognizing that the emotional violence of my inner monologue toward my body can inadvertently lead to real physical harm. It’s not always easy, but meditation helps me observe without reacting when waves of mental self-abuse threaten to overtake me. Instead, we can shift the focus to what truly matters—celebrating strengths, talents, and accomplishments that go beyond physical appearance. We should teach ourselves and those around us, especially young girls, that their value isn’t determined by the size of their waist or the number on a scale (I no longer own a scale). By normalizing conversations centered around health, self-esteem, and personal goals rather than looks, we can gradually dismantle the harmful mindset that equates thinness with worth.

We must also hold media and social platforms accountable. Social media is one of the most powerful tools shaping how girls and women see themselves, with platforms often flooded with unrealistic, airbrushed images of "perfection." This issue becomes even more pressing as we stand at the dawn of AI, where the pressure to live up to fully synthetic ideals puts our real, physical lives at risk. However, we have more influence here than we might think. By diversifying the images we consume—following influencers, brands, and content creators who promote body positivity and realistic representations of beauty—we send a powerful message about what we value. We can also challenge harmful content by reporting or unfollowing accounts that promote disordered eating or unhealthy body ideals. Each time we make an intentional choice about the media we consume, we help shift the narrative toward a healthier, more inclusive standard of beauty.

In addition to changing the media landscape, it’s crucial that we advocate for media literacy in schools and communities. Teaching young people how to critically evaluate the images they see on social platforms, TV, and advertisements can empower them to separate fact from fiction. Many of the images that cause insecurity are highly edited or unrealistic portrayals of beauty. When girls and women understand that what they’re seeing is often manipulated or curated, it becomes easier to resist the pressure to conform to these unattainable ideals. Media literacy programs can help them develop the skills to question these messages and to cultivate a sense of self-worth that is rooted in their unique identity, not in comparisons to others.

Moreover, we must create spaces where all bodies are celebrated. Whether it’s in schools, workplaces, gyms, or within our own social circles, we need to foster environments that emphasize inclusivity and diversity. We should strive to amplify voices and stories from people of all shapes, sizes, and backgrounds, making it clear that beauty comes in many forms. For example, encouraging fashion brands and fitness communities to showcase a wide range of body types can have a ripple effect on how society views beauty. When girls and women regularly see themselves reflected in positive, empowering ways, they’re less likely to feel the need to change themselves to fit a narrow mold.

Another powerful tool for change is education about health over appearance. We need to shift the focus from how bodies look to how they feel and function. This has been incredibly powerful in my own recovery. Encouraging healthy relationships with food, exercise, and self-care is essential. Health should be about nourishing the body, building strength, and fostering mental and emotional well-being, rather than achieving a certain body type. By promoting this holistic view of health, we help create a culture where girls and women strive for well-being rather than perfection. In schools, communities, and even families, we can emphasize that healthy habits—such as balanced eating and physical activity—should be adopted for the joy they bring and the energy they provide, not out of a desire to "fix" one's appearance.

We also need to change the conversation around aging and menopause. Too often, discussions about these natural stages of life are steeped in negativity and fear—treating aging as something to battle or conceal, rather than embrace. This mindset can be particularly harmful to women, as it reinforces the idea that youth and thinness are the ultimate ideals, fueling body dissatisfaction and, in some cases, disordered eating. I’ve seen friends who were perfectly healthy in both size and weight suddenly develop disordered eating patterns in their forties, severely cutting calories and eliminating entire food groups to the detriment of their physical, hormonal, and mental health. If we want to reduce the risk of eating disorders as women age, we need to start talking about menopause and aging in ways that celebrate wisdom, strength, and experience, rather than focusing on how to "look young."

First, we can shift the narrative by acknowledging the beauty and power in aging. Menopause is often portrayed as a loss—the end of youth, fertility, and vitality. But the reality is that this stage of life brings with it a new sense of self and freedom. Women in midlife have gained decades of knowledge, resilience, and life experience, all of which deserve recognition. By focusing on the personal growth, confidence, and independence that often come with age, we can help reframe aging as a powerful and natural part of life rather than something to be feared. This shift in perspective is critical in helping women embrace their changing bodies and preventing the pressure to conform to youth-centric ideals that can trigger or exacerbate disordered eating.

We should also move away from the language that paints menopause as a decline and, instead, embrace it as an opportunity for renewal and self-care. Menopause is a transition, much like adolescence, and while it brings changes to the body, these changes don’t diminish a woman’s value.  I have female friends who send me memes and reels depicting menopausal women as angry, emotionally unregulated, and gaining weight. While these are meant as self-deprecating humor, we unknowingly internalize these portrayals, reinforcing harmful stereotypes about aging that affect not only how we view ourselves but how society perceives us. This feeds into a damaging narrative about what aging means for women and contributes to the harm it causes. The two friends who share the majority of the aforementioned posts, both have eating disorders, or at least engage in disordered eating. Both are accomplished, kind, and brilliant women, yet unable to recognise their own worth in a landscape that is flooded with unrealistic and unhealthy standards for women. Rather than focusing on weight gain, hot flashes, or wrinkles, we should reframe the conversation to center on well-being—encouraging women to invest in nourishing their bodies, staying active, and fostering both mental and emotional health. This approach shifts the goal from trying to look young to feeling strong and vibrant, which can be incredibly empowering and can reduce the tendency toward disordered eating as a coping mechanism.

Just as we hold media accountable for promoting unattainable beauty standards for young women, we must do the same for content related to aging. Too often, the media's portrayal of older women centers around anti-aging products, procedures, and "fixes," reinforcing the notion that aging is something to be corrected. My own social media feed has become inundated with promotions for weight loss injections aimed at combating menopausal weight gain ever since I began researching and writing about the subject. And if it’s not injections, it’s fitness classes narrowly focused on body fat reduction for women over 40, often with little emphasis on overall health and rarely designed by someone with a true understanding of menopause. By promoting diverse representations of older women—in all their natural beauty, wisdom, and grace—we can start to dismantle the harmful ideals that equate aging with a loss of value. We need to see more women in midlife and beyond celebrated for their contributions, talents, and leadership, rather than how well they’ve managed to maintain a youthful appearance.

Education is equally important here. Just as we teach young girls about the manipulation behind the images they see in magazines and on social media, we need to talk openly about the realities of menopause and aging. Body changes like weight gain during menopause are normal and, in many ways, protective, as the body naturally redistributes fat to help regulate hormonal shifts. Instead of resisting these changes, we can teach women to understand them and make health-focused decisions based on how they feel rather than how they look. The more we normalize these conversations, the less likely women will feel the need to engage in harmful behaviors to try to reverse or hide these changes.

Lastly, we can support women by encouraging healthy, realistic self-care as they age. Much like in other stages of life, this means focusing on health rather than aesthetics. Exercise should be about maintaining mobility, strength, and energy, while nutrition should focus on bone health, heart health, and overall vitality. For me, running has become not just a way to stay fit but an incredibly important aspect of my social life. Long gone are the days when I would run fasted or obsess over how many calories I could burn; now, my priority is to fuel my body as best as I can. Without adequate fueling, injuries and infections would be the norm, rather than enjoying fulfilling outings exploring the world on foot with friends. Shifting the focus from aesthetics to health and function is key to preventing the development or reemergence of eating disorders in midlife. When we emphasize what the body can do, rather than how it looks, we help women develop a more positive and sustainable relationship with their bodies as they age.

Lastly, and perhaps most importantly, we must listen and support. Eating disorders thrive in isolation, and societal pressures often leave girls and women feeling like they’re not good enough. By opening lines of communication—by being the friend, parent, teacher, or mentor who listens without judgment—we create a lifeline. If we suspect someone is struggling with disordered eating, we can offer our support in ways that are compassionate and non-invasive, encouraging them to seek professional help if needed. Creating a culture where it’s okay to talk about struggles with body image or food removes the shame that so often accompanies these issues.

Before I finish, I want to bring the conversation back to bone health. It's important to recognize just how much can be prevented by addressing disordered eating and the societal pressures that contribute to it. Osteoporosis affects over 10 million Americans, and nearly 1.5 million hip fractures occur each year worldwide, many of which can be traced back to bone weakening that began decades earlier. If we can intervene early—by promoting body acceptance, encouraging healthy eating habits, and supporting strong mental health—we could significantly reduce the incidence of these life-altering conditions. Research suggests that up to 50% of fractures related to osteoporosis could be prevented with better early nutrition and lifestyle choices, underscoring the critical role we play in protecting our long-term health. By changing how we talk about bodies, aging, and health, we’re not just shaping a better present—we’re building a future where strong bones and strong women thrive for generations to come.

Together, we can challenge the harmful societal pressures that lead girls and women toward eating disorders. Change happens when we shift our focus from appearance to health, from perfection to acceptance, and from competition to community. Every time we choose to reject harmful narratives about beauty, we help build a world where all girls and women feel valued for who they are—not for how they look.

Sybille Hazward

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