Some people with bulimia do have the same puffy face look as crack addicts because of the vomiting, and some of them do push into the overweight category at the beginning of recovery because the behavior doctors are most concerned about is the purging, not the bingeing.  It doesn't stay that way for long though. Just depends on your method of purging. You can only vomit so much of your food--there are always calories you miss. In any case, you can tell that she didn't actually have an eating disorder. One, her hair looks really healthy and thick (lots of fat in her diet...). I've lost between 50 and 66% of my hair volume in the last three years. My nails crack and bleed. I even had a toenail fall off from malnutrition. She's getting plenty of "nutrition".