Camille Lowe has always loved to dance, but she starts to cry as she recounts one fateful ballet lesson from her childhood.
WARNING: This article contains content about eating disorders that may be distressing for some readers.
"I remember my ballet teacher pushing my bum in and my stomach in to make me thinner, in front of everybody," she said.
The formative memory added to the chorus of voices, from extended family to complete strangers, telling her to shrink.
Camille started to engage in what she once thought was "yo-yo dieting"— oscillating between strict diets and losing weight, only to stop and gain the weight back again.
Especially after the birth of her third daughter, she was heavily restricting her food, doing gym classes back to back and was constantly dizzy.
She vividly recalls crying and pleading with a doctor for appetite suppressant medication, behaviour she said should have sounded alarm bells, but didn't because she has a larger body.
Camille was later diagnosed with two eating disorders: binge eating disorder and atypical anorexia, which shares the same behaviours as anorexia nervosa, but without the low body weight.
Suddenly, two decades of her life had an explanation.
"It was a complete bombshell, but I was glad," Camille said.
Often unrecognised and left untreated
Half of all people with eating disorders in Australia have a larger body, and that cohort is growing faster than any other, according to the experts.
The ABC has spoken to several people with larger bodies and while their individual journeys differ, they have had similar experiences — some have had doctors accuse them of lying about their diagnosis while others were encouraged to continue with eating disorder behaviour if it meant they lost weight.
Stories like these have helped inform guidelines by the National Eating Disorders Collaboration (NEDC), a research and advisory organisation funded by the Federal Department of Health, that educate medical professionals about identifying and supporting eating disorders in people with a higher weight.
NEDC research lead Angelique Ralph said weight stigma was a major contributing factor to the fact that "despite the high prevalence, eating disorders in people with higher weight have been consistently under-recognised and under-treated".
"People with a lived experience of an eating disorder who are of higher weight report being misdiagnosed, dismissed by health professionals and sidelined or excluded from eating disorder treatment services," she said.
Eating Disorders Victoria chief executive, Belinda Caldwell, said medical staff sometimes struggled to recognise eating disorders.
"Health professionals are no different to the rest of us in seeing eating disorders as only occurring in smaller-bodied people so we tend to see really long, often decades going before people get a health response that is appropriate," she said.
"We wanted awareness among a greater range of health professionals that eating disorders occur in people with larger bodies.
"We want to see people get a prompt response if there are concerns around their eating ... and be thinking when someone turns up for weight management, think there may potentially be an eating disorder."
A spokesperson for the Australian Psychological Society said it shared the concern around weight stigma and was committed to ensuring all patients got the care they needed, including providing its members with free, up-to-date eating disorder training.
'I wasn't feeding myself properly'
Claire Trevena, 20, describes her teenage self as a perfectionist and a bit competitive, so when she put her mind to losing weight over the summer break when she was 14, she had to do it "perfectly".
"Once school started and everyone saw me in a different body, that really pushed me to keep going … people started treating me differently and I really liked that," she said.
While the compliments rolled in, she had never felt worse and was struggling to concentrate at school.
"I didn't put two and two together and realise I was getting sick because I wasn't feeding myself properly ... I didn't want to accept that," Claire said.
Her parents grew worried and took Claire to a psychologist.
The psychologist said she had atypical anorexia, but she didn't have a low enough body mass index to have anorexia nervosa, so she couldn't be treated.
She lost the further weight within a week.
"For me, it was like a new goal, it was something that was exciting," she said.
"I really don't know how that psychologist came to that conclusion, to see someone so young sitting in the chair across from them clearly so physically sick and to tell them to go home and come back next week and not access the treatment they so desperately needed."
After a long and hard stint in a hospital program, she was starting to heal.
"But then I came in just for a weigh-in to see how it was going and track a few things and she said you've actually reached too high of a weight and we would like you to drop some weight," Claire said.
That sort of advice is "absurd", according to Queensland University of Technology nutrition and dietetics lecturer Fiona Willer.
"When you give someone a weight goal, that washes away all of the social context, nutrition context, everything that's important to a person's life," she said.
GPs learning about the problem
For some people in larger bodies, weight stigma has defined many aspects of their lives for as long as they can remember, but it has only started to gain traction as an issue among key healthcare organisations in recent years.
Catherine Bacus, a Melbourne weight loss specialist, used to head up the Royal Australian College of General Practitioners (RACGP)'s obesity special interest group.
She said attitudes had shifted to better recognise how addressing issues related to weight can affect patients.
"The RACGP is focused on educating its members to maintain the focus on good health and wellbeing rather than simply a number on a set of scales," she said.
But in patients with eating disorders, Dr Bacus said it was still best practice to address the disorder at the same time as pursuing weight loss.
"People can present with obesity and disordered eating at the same time so it's incumbent upon us to manage both of those … the two go hand in hand," she said.
Dr Willer, who also runs a nutrition consultancy, said the pursuit of smaller-sized bodies itself was driving weight stigma.
"You cannot do both effectively at the same time and it speaks to the bias of clinicians who try to offer those services together," she said.
"Everyone's heart is in the right place, but the issue around healthcare for larger-bodied people is that often there's this assumption that if we can make a larger-bodied person smaller they'll automatically be healthy."
"But that's absolutely not what's supported by the evidence."
Improving treatment for people with larger bodies
Camille and Claire have both progressed well in their recovery.
Claire is studying to be a vet nurse and working in a cafe, while Camille is using her personal passion in her job with Eating Disorders Victoria.
They both said their body image was an ongoing battle, but life was good.
Another thing they agree on is why they wanted to speak out: so people in larger bodies are treated better.
"To have to go through such a major eating disorder and then to be told to drop more weight, I don't want anyone to hear that," Claire said.
"It doesn't mean that you're less-than."
