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September 6, 2011 / missmarymax

Logic Worn Thin: On Obesity as an Eating Disorder

It’s no secret that I heart semantics. I’ve written before about why “anorexic” is not a synonym for emaciated, why “asexual privilege” is inherently a misnomer, and why “fat” does not work as a verb. It’s true that I tend to twitch a bit, purely for English nerd reasons, when I catch language being misused. (My own tendency to misuse it aside. — Gasp! She’s human!  Look away!)  But I don’t dwell on semantics to police the way people communicate. I dwell on semantics to call attention to the ideas our words represent. Errors in the way we use language can — and often do — convey errors of logic and errors of ethics. And it’s those missteps I wish to challenge, when I’m (ostensibly) challenging our linguistic missteps.

So, today: obesity as an eating disorder.

Increasingly, among eating disorder activists and their mainstream appropriators, there’s a trend toward thinking we should fight fat stigma by treating “the obese” as we do those with EDs.  But the treatment of obesity as an eating disorder is fundamentally flawed.  In fact, it’s a perspective I firmly believe is influenced by the anti-fat stigma it claims to address.

For starters, “obese” (which I have to put in quotation marks, given its basis in BMI, a system with little to no medical value) — describes a physical body type, — while anorexia, bulimia, EDNOS, and BED describe behaviors and pathologies. How does one compare a body type to an illness, exactly?  Generally, by assuming that the fatness in question was caused by unhealthy eating behaviors. (To be blunt, people assume Fat People Are Fat ‘Cause They Binge, despite the fact that — as many of us in the ED community know — people of all sizes can binge.)

There is a valid comparison between “eating disorders” — like anorexia, bulimia, and EDNOS– with their fellow eating disorder Binge Eating.  Comparing these disorders — and discussing when and how it’s ethical/ logical to treat one of the four disorders the way you would treat another — makes sense.  When we do so, we begin important conversations about what our models — of treatment, of activism, even of illness — look like and how they might need to be changed.  Bringing Binge Eating into the equation helps us to question, for instance, our diagnostic criteria for eating disorders, what we consider healthy eating, and what we consider healthy food. All of this makes sense.

What does not make sense is to compare a set of behaviors or thought patterns — say, all the pathologies associated with anorexia — to a body type — for example, the “obese” frame.  This does not make sense because many, many people who have healthy relationships with food remain “overweight” or “obese” by BMI standards. In part because BMI is a statistical measure developed based on a limited sample, then generalized to populations its development didn’t consider, and applied in a medical context in which it appears to have no predictive value. (In other words: it’s being used to predict health concerns, a purpose it wasn’t designed for, for people it wasn’t designed to address. Science fail.)

Treating obesity like an eating disorder also presumes that all people who do not binge are thin. (He’s fat because he binges; she’s thin because she doesn’t.)  We know this isn’t true.  We know, increasingly, that shoring it up facilitates fat stigma and fucks with the lives of living, breathing, fat people. And yet, when we decide to be Totes!Progressive by treating obesity as we would anorexia, we support this perspective in doing harm.

Even those in the ED community who aren’t yet on board wth Fat Acceptance and Health at Every Size — (joinnnnn usssssss)– can recognize that not all people with eating disorders are thin.  The notion that having an ED — epecially anorexia — inevitably means being thin is one that many of us find painfully cumbersome.  So why reify it?  Because — honestly? — that’s what we’re doing.  We cannot compare obesity to an ED without suggesting that obese people cannot *have* eating disorders, as we normally understand them. For instance, “obese” people cannot have anorexia. If we believed “obese” people could be anorexic, we would not be discussing a “comparison” between situations at all. Because the situations would not strike us as “different” enough to compare. We never search for common ground without first assuming difference.  When we look for similarities between obesity and anorexia, we’re suggesting the two require that bridge of comparison. We’re presuming they can’t overlap (or co-exist) on their own.

We’re presuming, in short, that fat people aren’t anorexic. Because no anorexic people are fat. And all fat people (only) binge.

Even if we can’t see the anti-fat and eliminationist ideas guiding the “treat obesity as an eating disorder” comparison, we should– as people who know eating disorders — see that bias exposed when we flip the logic:  Would it make sense to us to force all thin people into eating disorder treatment?  Would we accept that approach as logical and offer our support?  Of course not.  Because we know that not all thin people have eating disorders.  We even know, sometimes, that thinness isn’t inevitably the result of eating habits.  What we don’t always know — to our detriment and to the detriment of fat people specifically — is that fatness is not often the result of eating habits, either.

We owe it to ourselves, and to those we seek to serve, to understand that people of all sizes can eat in a healthy way — and grow, shrink, or remain as they are, size-wise, regardless.  Anything short of that — anything that sets up fat people as the Other, anything that minimizes their ability to be (much like thin people) sick or healthy — is not an ethical approach.

And until we quit supporting — through action and through language — this understanding of Fat people as Other — Ima continue to throw this-here bitchfest.  This hissyfit.  This [whichever word best describes my shaking head, my crossed pair of arms.]

And I’m hoping you’ll throw it with me.

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21 Comments

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  1. Scarlett / Sep 6 2011 7:33 pm

    I absolutely agree that the treatment of obesity as an eating disorder is destructive toward both ED’d individuals and the obese. I know quite a few overweight and obese people who are healthy and have perfectly normal eating habits. As I’m sure you know, research has found little evidence to suggest that being “overweight” decreases life expectancy; you have to be well into the “obese” range to approach the decreased life expectancy seen at the very TOP of the “underweight” category. BED and COE are very real problems–but just as not every thin person is anorexic, not every overweight or obese person has an eating disorder.

    I do however, disagree with the “anorexia comes in all shapes and sizes” approach. While the weight guidelines may seem arbitrary, several health risks increase sharply in probability around BMI 17.5 (the current DSM “requirement” for a dx of AN). The upcoming edition of the DSM will likely revise the wording, but will still contain a weight-based criterion. While this requirement does stipulate that an obese or overweight person must be restricting his or her caloric intake for longer than a person of average weight in order to be dx’d, there are consequences of reaching a certain weight and a certain bodyfat percentage–meaning that despite the seriousness of anorexia-level restriction in persons of ANY weight, the label of “anorexia nervosa” remains inappropriate for most people at weights significantly above the established level.

    Rather than fighting for an adjustment in the criteria for AN (which seems a hot topic these days), I wish the health and ED community would fight for greater recognition and more serious treatment of EDNOS. People tend to write EDNOS off as “not as dangerous” or “subclinical AN/BN”, when in reality studies suggest EDNOS may actually have the highest mortality rate of any ED. People with restrictive eating disorders not meeting the weight or amennorrhea requirements of AN, or people vascillating between AN and BN behaviors without meeting full criteria for either, should not need to feel ashamed or “not really sick” because they are EDNOS rather than AN or BN.

    Apologies for the endless comment, and thank you for a well-written post. 🙂

    • missmarymax / Sep 7 2011 11:59 am

      Thanks so much for the comment, Scarlett! (I actually quite like the “endless” variety of comments. This reply is likely to be very similar! :))

      I firmly agree with what you said about BED and COE being incredibly real problems that can’t be conflated with “obesity.” I also certainly agree that we need to work to recognize EDNOS as a condition serious as any “specified” disorder. This is important work, definitely, but I still question your suggestion that it’s an “alternative” to adjusting the criteria for AN, rather than something we can work on — while adjusting the criteria.

      Let me explain. Obviously, if EDNOS is taken more seriously, it’s less important to “broaden” the criteria for diagnosing anorexia, because those who don’t “qualify” for that diagnosis can still receive treatment. The problem I see is twofold: for starters, I truly believe that anorexia can exist (and devastate) people of any size; I think the other comment speaks to that. If, however, there are complications that are specific to a lower weight, I wonder why anorexia must be allowed to get to that point, instead of being diagnosed on the basis of behaviors, which may well lead there. (Or that could lead there in a person whose body responded differently to restriction.) The complications of anorexia for that person with the lower BMI are dangerous and often irreversible; why should anyone need to get to that state before their illness is taken seriously enough for them to receive a diagnosis and treatment? Why should a person of a larger size, or currently of a larger size, who is struggling enough to use these behaviors — regardless of the results — not receive similar care? For me, it’s a matter of early intervention: if we’re willing to work with people before it gets to that point, we are going to save more lives. If we’re only willing to work with people who have reached (or “can” reach) that point of emaciation, we’re going to let some very valuable people suffer without help. I think enough of us valuable people are suffering already.

      I suppose, ultimately, i take your point that there are complications specific to emaciation. But I firmly believe they are *complications* of a *disorder* better defined by thought and behavior patterns. In the meantime, I balk at the notion of only treating people with anorexia under a certain BMI, in much the same manner I’d balk at only treating cancer patients when the disease progresses to stage 4. We all deserve help: as quickly and fully as possible.

      I’m curious, if you’re willing to share, why you think it’s best to limit care to those experiencing complications? I’m struggling to see how that would improve the care of those who are emaciated, and I’d like to better understand where you’re coming from. Thanks again for sharing.

      • Scarlett / Sep 7 2011 2:33 pm

        I don’t believe care should be limited to those experiencing complications–I believe that anyone who wants help for an eating disorder or disordered eating (of any variety and duration, and at any weight) should be able to receive it and should qualify for insurance assistance as long as he or she is dx’d with SOME form of disorder. I simply think that keeping the criteria as they currently are would be simpler and clearer, medically and diagnostically speaking. BN implies a frequency of purging and the likely complications that would bring about; AN implies a level of weight/bodyfat and the likely complications that would bring about; EDNOS–specifying restrictive, binge-purge, or mixed, and indicating duration–should imply the exact situation the individual is in. Working with a restrictive EDNOS client where healthy eating/thought patterns must be restored but concerns about immediate weight restoration are not an issue is different than working with a critically emaciated anorectic who MUST undergo weight restoration in order to have even a chance at responding to therapy.

        Everyone who wants treatment deserves it, but keeping (and improving) clear diagnostic criteria is important for the medical and research communities.

        It’s semantics, essentially, and I’m inclined to think that the reason people are so eager to broaden the criteria for anorexia is because anorexic is publicly viewed as the most “serious” eating disorder. Changing the DSM so the public will take heavier anorectics “seriously” shouldn’t be the point–the public and the media will likely continue thinking everyone with anorexia is skinny, anyway, and it really doesn’t matter what they think. What matters is improving understanding and treatment within the medical, research, and psychiatric communities, and accuracy and relevance of case and diagnostic information is essential for this to happen.

      • Tana / Feb 12 2012 3:52 pm

        Thank you to both of you for your very insightful and articulate remarks. For about four years I have been slowly discovering that I may be experiencing an EDNOS. It actually makes it easier for people like me to hide our destructive patterns by not fitting into some of the diagnostic criteria for AN and BN. (I, for example, am an apparently healthy 23yr, size 6/8. But I know that I eat maybe one normal sized meal a day despite being very hungry, that I often black out upon standing as a result of low blood pressure, and that I no longer function the way I used to. But I don’t fit all of the criteria for AN, BN, or even the commonly stated EDNOS. I also don’t have body dysmorphia and I don’t want to lose weight. Like Scarlett said so well, “it was about self-regulation, eliminating weakness and need, and compartmentalization.” I think for me it started with money issues.)

        Although I have never sought professional help due to personal denial coupled with a fear of being labelled with a problem, I daresay that I would find little understanding among professionals and peer support groups if I did. How could you feel sorry for someone who looks normal?

        Ok, I’ve become distracted trying to give an account of how some individuals can fall through the cracks and never get the help they need, sometimes because they don’t even know that they need it. I wholeheartedly agree that healthcare professionals need pay close attention to patterns of thought and behavior in addition to visible warning signs.

        Thanks again for your honest, nonjudgmental thoughts and your forum. I hope I didn’t bore you with my story. This is actually the first time I have ever shared it publicly.

      • missmarymax / Feb 13 2012 5:34 pm

        Tana, I actually really appreciate you opening up about your experience, and I hope you’re starting to take your behaviors more seriously. You’re right that there’s a lot of discrimination and misunderstanding toward treating people of average size, but that does not mean it’s impossible. There are good, smart professionals available to help, regardless of your size, and I hope you’ll seek that care out soon, for your sake. I have a good network of ED professionals and activists I can check with, if you’re interested in getting more (vetted) information about the care that’s available in your area. Feel free to e-mail me, and please keep taking care of you.

  2. Amelie / Sep 6 2011 9:42 pm

    Thank you for this post. I think it is important to separate out what obesity is and see how it does not fit in to the eating disorder spectrum. I am considered obese by the BMI standard and I also suffer from anorexia. I have come across many people who can only see me as obese and do not realize that my issue is not eating rather than needing to lose x amount of weight. Even today, my specialist (rheumatology) prescribed me a weight loss pill because she doesn’t think that I would want to have this type of “body frame.” What she does not realize is that she triggered eating disorder thinking by seeing me only as obese.

    • missmarymax / Sep 7 2011 12:04 pm

      Amelie- I want to thank you, first, for your openness here. The experience you describe is devastating, and I’m shaking my head just reading it. The extent to which anti-fat stigma has a home in medicine — those awesome, awesome doctors out there aside — is really sad to me, and it definitely can exacerbate eating disorder issues, particularly in those, like you, who don’t fit the doctor’s sense of “what someone with anorexia looks like.” I firmly believe that we all deserve help and recovery, and that experiences like this reflect the doctor’s failing, not anything about our disorder being less serious or less worth treating. I hope you have other good care and will continue fighting the anorexia — and the medical establishment that fails so hard to understand your needs. Best.

  3. Harriet Brown / Sep 7 2011 12:40 pm

    Good post, Mary, and very on the mark.

    –Harriet Brown
    Author, “Brave Girl Eating: A Family’s Struggle with Anorexia”

  4. Deb Burgard, PhD / Sep 7 2011 3:55 pm

    Thank you Mary, and I think you and Scarlett are having a fascinating conversation. I have made all sorts of suggestions to the DSM-V committee: 1)Rename the category “Disorders of the pursuit of weight loss,” 2)Omit any references to weight in the criteria and instead diagnose based on behaviors of restricting, purging and/or bingeing, and psychological processes (fat phobia, social phobia, body dyphoria, OCD, alexithymia, etc. 3)Create staging based on intensity of symptoms and medical complications. Get rid of the “small, medium, large” implications of AN, BN, BED – weight change, not just weight, would be a part of staging but not an essential aspect of the diagnosis since it is an epiphenomenon of the diseases. An attempt would be made to assess the individual’s set point range and the displacement of their weight from that range (NOT BMI categories) would inform treatment.

    • rachel (@wickedrache) / Sep 7 2011 7:41 pm

      Although I especially appreciate your final point, I must disagree with your point #1, Deb. Doesn’t that carry a similar problem to the one I suspect you are trying to avoid by moving away from the focus on eating? I feel that there is a problem [not to dredge out problems, there are many, in the treatment of such a diversely manifested affliction] in making it about weight: there are so many for whom “weight loss” is REALLY not the ‘pursuit’ who are terrorising their bodies with “eating disordered” behaviours and their minds with “eating disordered” thoughts.
      I know people who are tortured to the point of lifelessness, who will probably not die, because they are not underweight … they are just terribly, terribly sick, deeply immersed in a pathology. Occasionally they get diverted into obsessing over weight or numbers, because that’s an expected manifestation of their affliction, and they are over-socialised people after all… but it is not about weight. I feel there are obstructions in the way of addressing people who are suffering from a less…contemporarily expected … manifestation of the “eating disorder” phenomenon. It is (as you know) a psychological, emotional affliction.
      Apologies for the tangent, just some thoughts that your suggestion brought out.

    • Scarlett / Sep 7 2011 8:52 pm

      I agree with the idea of adjustments based on set point, although it could prove impractical. I developed AN at 14, for example, and was likely not yet at my set point; additionally, when I was first evaluated for treatment, the fact that my mother was very thin impacted the target weight the doctors set. Not surprisingly, my mother maintains her borderline-underweight BMI through questionable eating patterns of her own (she would fall into the proposed category of orthorexia), but would not admit this. As EDs have a genetic component and often present during adolescence, set points would likely skew in “favor” of the client: anorectics, many of whom may have restricted or overexercised prior to onset (I did both) would be able to “get away with” lower weights, while those with BED would likely have had issues with overeating or emotional eating prior to the onset of the full disorder and could pass as “naturally” bigger.

      It’s very interesting to consider the ideal way of diagnosing, categorizing, and treating eating disorders–and although there will never be a perfect solution, there is absolutely room for improvement, and hopefully we’ll all see progress. 🙂

      I’d like to add that I agree with Rachel in keeping the focus on eating rather than weight. My eating disorder was NOT driven by weight or a desire to lose it; it was about self-regulation, eliminating weakness and need, and compartmentalization. I only began to use weight as a measurement of “progress” in response to my treatment team’s focus on weight restoration. Likewise, when my disorder shifted to bulimia, I wasn’t bingeing and purging to lose weight–were that the goal, I’d have simply continued restricting. The act of purging became a release (where restricting only numbed) and an escape (where restricting forced a tighter focus). Again, it was not at all driven by weight, body image, or appearance.

      Perhaps “eating” doesn’t do full justice as a descriptor, but in my experience (and considering eating disorders in a historical context rather than as a 20th/21st-century phenomenon), it comes closer than tying everything to weight…which seems to be what we’re ALL looking for a way to avoid, albeit in a variety of ways! 🙂

      • sannanina / Sep 27 2011 5:09 pm

        I have mulled over this post and the replies to it since Mary first posted it three weeks ago. This part of your reply, Scarlett, really, really made me want to write a reply on my own, but I am not sure I can adequately express what I want to say:

        As EDs have a genetic component and often present during adolescence, set points would likely skew in “favor” of the client: anorectics, many of whom may have restricted or overexercised prior to onset (I did both) would be able to “get away with” lower weights, while those with BED would likely have had issues with overeating or emotional eating prior to the onset of the full disorder and could pass as “naturally” bigger.

        .

        I can’t say that much about anorexia since I have no first-hand experience – I do, however, have first-hand experience with BED, and I believe that your statement really, really demonstrates a common but quite harmful mistake when it comes to understanding what BED is.

        BED is not the opposite of anorexia. I have never heard of a person with BED who actually wanted to gain weight – in fact, I and everyone I have heard of who has BED desperately wanted to lose weight, and the desire to lose weight as well as the intense shame that followed each and every episode of binge-eating seemed to be a major driving force in the maintenance of the disorder. I have to admit, though, that my sample is quite limited, and that everything I heard from other people who were diagnosed or self-identified as having BED was through online sources – so it might not be representative. However, from the limited information I have I do not think that a “goal weight” should ever have any role in BED treatment. While I get that weight restoration is important for people with anorexia I think that setting a certain lower weight as a goal in BED treatment is totally, totally wrong-headed.

        There is another reason for this, and in this case I actually have seen data from actual studies: To my knowledge there is no evidence whatsoever that long-term major weight loss is possible for the majority of people with BED, even if they recover from their eating disorder. Yes, some people lose part of their “excess” weight during recovery, but they usually do not lose all of it. It is my impression that many people end up at a weight that is higher than what would have been “natural” for their body if they never had engaged in eating disordered behavior. For example, I have pretty much not binged in – oh, I don’t know, half a year or so. The few times I “overate” to some degree were easily matched by the times that “underrate” in this time span. Yet, my weight has not decreased at all (it has stabilized, though). For some reason human bodies really seem to have a tendency to keep any body fat that they acquired at some point.

        What is more, I and to my knowledge many other people with BED actually have a history of dieting and in my case even very “successful” dieting when it comes to short-term weight loss. I have always cycled between phases of BED and phases of severe restriction lasting often for months, and actually the restriction came first. Making weight loss a goal and setting a target weight would actually mean to go back to that cycle. Weight loss – at least intentional weight loss – would most likely not be a sign of recovery, but a sign of continued disordered behavior in my case. I do think, though, that weight maintenance can be sign and a goal of recovery for people with BED, although it certainly should not be the main goal.

      • missmarymax / Sep 28 2011 10:01 pm

        I really appreciate you taking the time to raise this point. This has been my observation as well. Whether the diagnosis is BED, EDNOS, or (um) “dieting” — the pattern I see more often than not is a relationship between bingeing and restricting. The restricting triggers the bingeing — or vice-versa — and the shame (often shored up by cultural notions that restriction is good but bingeing is not) helps sustain the (vicious) cycle.

        One sticking point, for me: while I agree that the relationship between bingeing and restricting makes it important to challenge the idea that AN and BED are “opposites” — I’m a little eeked out by your point that people with BED don’t seek to gain weight (the way anorexics seek to lose it). On the one hand, it’s worth noting that weight loss can (and does) drive weight gain as often as not. But I think the notion that the driving need in anorexia is the desire to lose weight is another misconception. Often, especially initially, those I’ve known with anorexia aren’t particularly invested in weight. They may have aversions to food, anxiety about dining situations, etc, that eventually develop into the anorexia of which weight obsession is part. But the notion that “it’s about wanting to be skinny” has actually kept many I know from recognizing their restriction as anorexia. I think that’s another similarity, really, between AN and BED, but I’m still a bit hesitant to talk abot weight loss as the goal of anorexia. I suspect you simply mean that it becomes a goal, as the disease progresses, but so often it’s represented as the cause or desire that *sparks* the disease that I wanted to point out that sometimes, even as things get serious, that’s not the case.

        Rhetorical nitpicking aside…I’m wondering: Do you think there are specific ways that we set up anorexia and BED as opposing? I’m curious to better identify what those are, so we can resist them more actively.

  5. rachel (@wickedrache) / Sep 7 2011 7:42 pm

    * bad form on my part, “because they are not underweight.” that is not why they will probably not die.

  6. VoiceinRecovery / Sep 8 2011 6:29 am

    Excellent post Mary. Truly well spoken, clear and important piece.

  7. Rachel A. Hanson / Sep 16 2011 2:57 pm

    Excellent post, thank you so much for writing about this. I particularly liked that you pointed out that anorexia (and other ED’s) can be present in people of a variety of body types.

    • missmarymax / Sep 17 2011 5:14 pm

      Thanks so much, Rachel. It’s always great to hear a post has resonated. 🙂 (p.s. Sorry if you got a weird email from me. This is the kind of thing that happens when I try to respond to comments on my iPod. :P)

  8. AcceptanceWoman / Sep 23 2011 2:23 pm

    This is my first time visiting your blog — I got here through your vlog of “Big Big Love.” and you are fabulous. You restore my faith in human kind.
    I love your vlogging style. I will watch more another time when I’m not already running late (perhaps tomorrow morning, even).
    I’m not a geek when it comes to English (although I not only tolerate these kinds of geeks, but love them), but I am a geek when it comes to proper definitions. If you are so inclined, would you consider taking on the concept of “obesity as a behavior”?

  9. sannanina / Sep 27 2011 5:43 pm

    Hi Mary – I originally came to your blog via that Fat Studies email list. I already wrote half a novel in my previous reply that I posted a few moments ago, so I am going to try to keep this relatively short. 🙂

    First of all: Thank you for writing this. It needs to be said again and again and again. While I actually AM a fat binge eater the idea that “obesity” itself is an eating disorder (or at least always and in every single case the result of an eating disorder) is ironically enough one of the major obstacles I encounter on my road to recovery. What is more, I am pretty sure that this kind of thinking – that all fat people are eating disordered – actually played a role in developing BED in the first place in my case.

    Second, concerning this:

    Even if we can’t see the anti-fat and eliminationist ideas guiding the “treat obesity as an eating disorder” comparison, we should– as people who know eating disorders – see that bias exposed when we flip the logic: Would it make sense to us to force all thin people into eating disorder treatment? Would we accept that approach as logical and offer our support? Of course not. Because we know that not all thin people have eating disorders. We even know, sometimes, that thinness isn’t inevitably the result of eating habits. What we don’t always know – to our detriment and to the detriment of fat people specifically – is that fatness is not often the result of eating habits, either.

    I just wanted to mention another example why absolute weight/ BMI might not be a really good diagnostic criterium for anorexia – it sometimes leads to health professionals taking problematic diagnostic short cuts. I have two friends who are underweight according to BMI and whom doctors suspect to have anorexia all the time – and this actually harms them. One of them has always been very thin and was teased for it when she was in school. The other one has a very severe chronic illness from which she will probably die some day and which has changed her body in many ways. She has been on the thin side before the illness but the illness also caused her to lose some weight so that she is at the moment at a body fat percentage low enough to stop menstruating. For both these friends their weight IS actually a health concern to some degree (though it is clearly a bigger concern for the friend with the chronic illness). My naturally thin friend is at least statistically at greater risk for certain complications in case she gets ill, my chronically ill friend actually is at a point when her low weight is an additional acute threat to her health right now. The thing is, this does not change that neither one has anorexia and treatment that would be appropriate for someone with anorexia is therefore not appropriate for them. I really do understand the need to screen for eating disorders – in fact I really wish doctors would do it more and not less often. But for people who are already self-conscious because of their weight and/ or the appearance of their body having a health professional openly suggest that they might have anorexia before looking at all available data actually can add to body anxiety. In both cases any doctor would need two minutes of asking them about their weight/ health history to realize that they most likely do not have an ED. All that would be needed is a) to ask for chronic illnesses and/ or look them up on my friend’s chrat and b) ask about long- and short-term weight history.

    • missmarymax / Sep 28 2011 10:09 pm

      This is such a great point. It never ceases to amaze me how much the misconceptions around what EDs are (and what they “look like” on a body) damage people in all directions. (Especially when they’re held by doctors). I know so many people who are encouraged in disordered eating because they are fat (sometimes to the point of developing an eating disorder), who worry they cannot really be sick because their weight is “high” or “normal,” and who encounter all the hate that people with EDs encounter (despite not having one) simply because they are thin. The more we can educate people to look at behaviors and thought patterns (and to stop promoting behaviors for people whose bodies they deem “excessive”), the more we can get everyone (only) the treatment that they need…

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