Living With Anorexia as a Fat Person: Changing How We Treat Anorexia Nervosa

Courtesy of Pixabay

When you hear, “anorexia,” what comes to mind? A very slim person with visible bones and sunken eyes? Someone who looks sick, emaciated even? That’s the visual most people will come up with. But what about fat people? Do fat people not struggle with eating disorders?

Let’s talk about this very serious issue that both society and healthcare perpetuates: Fat people with anorexia are not diagnosed with anorexia, and we need to change that.

There is a lot to unpack, so we must first look at what the DSM-V diagnostic criteria for anorexia nervosa looks like:

“A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.

B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.

C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.”

As we can gather from the qualifying criteria for an anorexia diagnosis, the recurring theme is that the patient must be underweight for their age and body type in order to be diagnosed with, and acknowledged as, someone with anorexia nervosa. This is not only harmful for people of average weight and higher weight brackets, it’s dangerous for those with anorexia of the underweight bracket. Being at a noticeably dangerous low body weight when suffering from anorexia could signify the person nearing the late stages of the disease due to starvation. Anorexia must be recognized and treated before it gets to this point.

When a person with anorexia nervosa reaches the point of severely low body weight, or rather the visual representation of starvation, their body begins to succumb to the nutrient, mineral, and water deprivation it has been withstanding long term. In late stages of starvation, the body has burned as much glucose, fat, muscle, and tissue as it can before the organs start to shut down, eventually leading to, most commonly, heart attack.

Consider now, that someone in a higher weight bracket, struggling with anorexia, has deprived their body of nutrients, vitamins, appropriate electrolytes, etc. in the same way someone of average or low body weight has. The difference here, however, is social reaction. Although internally the heavier person has deprived their organs of protein, water, vitamins, minerals, and nutrients, their outward appearance may not traditionally indicate this. Yes, you may notice the dark, sunken circles under their eyes due to dehydration and exhaustion, but they may be the same weight, or perhaps have noticeably lost weight. The situation in which the person has lost weight, bringing them closer to a weight considered “average,” is what we need to highlight.

Yes, thin people struggling with anorexia are being reinforced because they hear that they “look great!” or, perhaps, fit into the clothes they dreamt of “pulling off;” but we need to talk about how reinforcement affects heavy people with anorexia. Imagine how someone who is used to being overweight, or considered overweight by others, feels when their weight loss due to starvation starts to become noticeable. They’ll hear from multiple sources the exact thing that fuels anorexia: “Wow! You look great! You’ve lost so much weight!” A thin person may deal with the same praise, but they are hearing from doctors and professionals that they do not need to be any thinner — that the fat they see on their bodies is healthy, it’s needed. Yet, doctors and professionals may see their overweight client losing that weight and praise them; they may even encourage them to “keep it up.” We see then, that this is a very real issue not only in society, but in the offices of healthcare professionals.

As it has been throughout modern Westernized society, fat is equated with unhealthiness. Unhealthiness is then equated with one’s worth. As many fat people, especially women, will tell you, they experience degrading comments daily: “Oh, you’re unhealthy? You must not take care of yourself. You must not care about your loved ones. You clearly are taking up space that you are unworthy of.” Being overweight does not indicate level of healthiness, as each body is different. There are plenty of people of average weight that live with cholesterol levels higher than average, heart palpitations, asthma, etc. Weight does not always indicate healthiness, and healthiness does not indicate worth.

We live in a society that is terrified of being fat, because people are terrified of being unhealthy. Consider how that makes people feel when they are indefinitely “unhealthy”? Consider someone’s aunt who survived cancer, but needs a colostomy bag for the rest of her life, or a child who has to live with an autoimmune disorder, such as cystic fibrosis, for the rest of their life. Do these people deserve to feel unworthy? I would hope that your answer is absolutely not. This discussion of unhealthiness ties directly into anorexia, directly into how we view being fat, and how we react to fat people and unhealthy people. Most people will hear that someone has anorexia, and want that person to get better. However, most people will hear that someone is fat and encourage them to lose weight. This is where society becomes lethal — not just because it encourages victims of eating disorders, but because as we see with the DSM-V, it influences healthcare.

To now get personal, I am exactly who I am describing in this article. I was a very overweight child by no influence of my own. If you look at pictures of me from when I was as young as 5 years old, you can see where I start becoming bigger than my peers. It was no longer baby fat, it was growing child fat. Growing child fat became teenager fat, and at that point I was hyperaware of how people saw me. I was harassed by my peers, and even some adults, over my weight. People let me know I was undeserving of respect, or of love. My body was a point of conversation, something that people decided they could touch and critique with no consent from me.

By 13 years old, I was ready to enter high school — and I was 205 pounds at 5 foot 5 inches. This is where I fell apart. That number haunted me, and still does to this day. As I was already dealing with a childhood anxiety disorder and early signs of depression, an eating disorder became my new “best friend;” but no professional had ever acknowledged my struggle with anorexia because I did not look anorexic. Instead, as I counted calories to make sure I did not surpass 100 calories per day, as I worked out for hours on end, as I made it so there was no such thing as dessert or “pizza fridays,” I was encouraged by both medical professionals and my peers.

I remember the first time I was recognized at school after the summer had ended. A fellow classmate spotted me and commented on how wonderful I looked, how it was awesome I lost all that weight, and how great it was to see me in jeans instead of stretchy pants from the plus size women’s section at Sears. I was filled with excitement — that was the first compliment I received from someone I didn’t really know. It was “working;” the starvation was “working.” But inside, I was dealing with the occasional, but new, heart palpitations, fainting spells, low energy, and hunger pains. No one saw what was happening, so no one stopped me. No one helped me, because no one thought that I fit the face of anorexia — because I didn’t.

Eventually, I met people who encouraged me to take better care of myself, people who uplifted me in ways that did not focus on my body. My own fear of dying kicked in and I fought against anorexia. But my fight against anorexia is still real, and strong, and a struggle, even to this day; however, I am an extremely rare case. Many people fighting anorexia or any eating disorder don’t find a way to take control of it. Many people struggling with the disease don’t have a support system, or the right resources to face it. This is by no fault of their own — every situation and every person is different, with different circumstances. And this exact reason is why psychologists and other healthcare professionals across the Westernized world must take steps forward to change the criteria for anorexia. It does more harm than good, because a person should not have to look emaciated, or dangerously underweight, to be acknowledged, helped, and rehabilitated.

Where can we start? Where do we go next? First, we need to catch the early indications of anorexia: changes in eating habits that indicate the person is eating less and avoiding eating, obsessive fixation on body weight, obsessive fixation on food and calories, low energy, irritability, social withdrawal, and many more variable, but serious, signs. We need to address these signs with the same amount of urgency and concern regardless of what the person looks like, and most importantly, regardless of their weight. The end goal here would be to alter the diagnostic criteria for anorexia nervosa in the next update of the DSM.

For good measure, I will leave you with my edit of the current criteria to fit the needs of those of us who suffer from eating disorders. My edits are in bold; the rest of the text is written as it is in the DSM-V currently. The current, unaltered criteria in full is below for reference:

My edit of the DSM-V Anorexia Nervosa Diagnostic Criteria

A. Restriction of energy intake relative to requirements.

  1. This may lead to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.

B. Intense fear of gaining weight or of becoming fat, or disturbance with currently being overweight, or persistent behavior that interferes with weight gain, even when at a significantly low weight.

C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current or potential low body weight.

Current DSM-V Anorexia Nervosa — Diagnostic Criteria
A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.

B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.

C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.