A surprising tactic to fight anorexia

"The overwhelming pressure placed on women to conform to unrealistic body shapes is clearly a bad thing in and of itself."

"The overwhelming pressure placed on women to conform to unrealistic body shapes is clearly a bad thing in and of itself."

Weight can become your whole world in anorexia. You, your family, your friends and doctors focusing with increasing desperation on every gram lost and gained.

But new research has found people with severe and treatment-resistant anorexia may actually fare better if their doctors stop trying to get them to gain weight – instead trying to improve their quality of life and treat depression and other symptoms.

The finding is counter-intuitive because we think of eating disorders as primarily disorders of body image – triggered by skinny models on catwalks or unrealistic representation of women.

I often cringe just a little bit when I hear them used to justify criticism of sexualisation or women and unrealistic body images in advertising and media.


The overwhelming pressure placed on women to conform to unrealistic body shapes is clearly a bad thing in and of itself. As feminists (or, if you’re scared of the “F” word… as women and men who believe women should be portrayed realistically and not have their bodies fetishised for commercial gain) we have good reason to complain about they way women’s bodies are commoditised.

But sometimes I wonder if the constant links made between these images and eating disorders might end up misrepresenting – or even trivialising – conditions like anorexia, which is the most deadly psychiatric illness and kills one in five sufferers.

“There is still an enormous stigma and widespread belief [eating disorders are] … a lifestyle choice,” says Anthea Fursland, the president of the Australia and New Zealand Academy of Eating Disorders.

You can’t help wondering if the perception that eating disorder sufferers are just 'difficult' women who have taken their obsession with body image too far is behind the vast shortage of treatment available for them.

In his book “Crazy Like Us”, Ethan Watters argues anorexia as we know it is better understood as a way of expressing pain that is deeply embedded in our culture and history.

He describes how anorexia went from an incredibly rare disorder in Hong Kong to an epidemic seen in similar proportions similar to the rest of the Western world.

In the 70s and 80s in Hong Kong eating disorders were incredibly rare, and when women did get sick with them they almost never explained their food refusal in terms of a fear of weight gain or body dysmorphia. Instead, they talked of feelings of fullness or physical difficulties swallowing.

“Most assume that anorexia, with its attendant fear of fatness and body dysmorphic disorder, is born of a peculiar modern fixation with a slender, female body type, and that popular culture transmits this fetish to young women,” he writes. Yet in Hong Kong, despite the rise in sexualised images of women fettishising skinny models, there had not been a rise in eating disorders.

Watters traces the eventual explosion of the western version of the condition to the tragic death of a 14 year old girl, Charlene Hsu Chi-Ying, in 1994. After she collapsed on a public street, the media and charity groups took up the cause of anorexia, and the typical western symptoms relating to fear of fatness were highly publicised.

Before Charlene’s death, psychiatrists specialising in eating disorders saw only a few people a year. In the years after her death, studies indicated between 3 and 10 per cent of young women could be suffering from classic anorexia nervosa.

That’s not to say that these women were choosing to develop anorexia – far from it. Just that their psychological pain was being funnelled through a new framework.

As this case study of a young Sri Lankan man who starved himself almost to death shows,  refusal of food can have complex origins.

Some eating disorders are undoubtedly triggered by living in a society where women are constantly subtly told that their most important value lies in having a body that fits a narrow stereotype.

But for many people with anorexia – particularly the 30 or 40 per cent of cases that are treatment resistant – the underlying psychological problems are still poorly understood.

“People make the mistake of assuming all anorexia nervosa is the same, and it’s not,” says Sydney University’s Stephen Touyz – the author of the study that found doctors may need to stop focusing solely on getting patients to gain weight.

And each case occurs against a complicated background of genetic risk, environmental and social triggers, and the support (or lack thereof) the person receives throughout their illness.

Anthea Fursland says it’s important to understand that particularly in long-term cases, anorexia “isn’t about being thin or attractive, it’s about staying in control and a fear of losing control and a number of other things.”

 “In the middle ages it is now thought some of the saints were anorexic and that wasn’t about weight and shape, it was about purity,” she says. “The cultural context determines how the anorexia is understood by both the sufferer and the people around them.”

Skinny models can’t be helping the situation, but they will never explain the whole story.

18 comments so far

  • I completely agree. My journey with anorexia started when I was 22, in which time my weight plummeted over a very short period of time. After 3 hospital admissions within a year I was even worse than before. When I was out of hospital, my entire focus was on 'gaining weight'. Every thought was about meal plans and how much I should aim to 'gain' each week before being weighed by my psychiatrist. Finally my family stopped forcing the issue, and slowly my focus shifted to finishing university, starting a career, and then finding myself in a happy relationship. It is only now that I am gaining weight again, as I have found other things in life to occupy my thoughts, and I came to realise that achieve certain things in life, you need energy to do so, and food is energy.

    Date and time
    May 23, 2013, 8:50AM
    • Ha, "new research". Don't you mean "actually listening to patients"? None of these "findings" would be revolutionary if doctors actually took the time to talk to eating disorder sufferers instead of invalidating their feelings / thoughts / logic / whatever with irrelevant psychobabble. No wonder so few put faith in medical professionals.

      Date and time
      May 23, 2013, 9:14AM
      • There's a difference between triyng a treatment out and hoping for the best, and actually studying the outcomes. Plenty of "obvious" treatments in the past have killed plenty of people because they weren't properly studied first.

        Designing and running studies which actually test which treatments work, while NOT killing people in the mean time, is actually pretty damn hard.

        Date and time
        May 23, 2013, 3:57PM
      • This is not "new" as such to medical professionals that take an interest in and treat ED. It is merely research that confirms what is already well known.

        Date and time
        May 23, 2013, 5:59PM
    • I suppose I shouldn't be surprised that this is news to medical professionals. Treating the cause instead of merely focusing on the symptoms - who'd have thought?!

      Date and time
      May 23, 2013, 9:48AM
      • In my experience, both personal and through friends, control is very much the issue. Through various problems such as bullying, lack of social support and family issues, the sufferer can feel that the only control they have in their life is through what they put into their body. There is also a real lack of self esteem, even self hatred, and by punishing themselves by not eating which of course feels bad physically, they perversely feel 'better'. The media obsession with how women look doesn't help but I believe it just adds to the persons unhappiness with themselves, it doesn't cause anorexia by itself.

        Date and time
        May 23, 2013, 10:27AM
        • I had a friend that had a very strong need for control. Family issues didn't help as well. It was this giant mess of problems that kept spiralling out of control and she became anorexic purely out of a need to control something, anything in her life.

          It turned out the easiest and simplest way to gain control in her mind was to control food and her body. It was almost like a competition with herself. She had slight body dysmorphia, but it all lead to her need to control.

          Seeing from the outside in, and seeing her surroundings, I think if I was in her situation, I would have become anorexic too. It was such a toxic state she was in. She spent years going in and out of hospital, to be honest she still is. It's been almost 10 years, still going, and I hate to say, but I found I couldn't help her anymore.

          Date and time
          May 23, 2013, 11:01AM
        • Yes, in my experience also it is all about control. When you feel powerless about what is happening around you, one thing you can control is how much food you consume. No one can make you eat. The external environment you're in may not necessarily be bad, many anorexic sufferers come from well-adjusted middle-upper class families. Anxiety combined with an immature understanding of the world and a lack of self confidence can result in anorexia taking grip. You start to feel proud that you can control something as fundamentally essential to life as eating. As Claire says further down in these comments, this fixation gives an individual something they can channel their anxiety into.
          And please could everyone remember that this is not restricted to females. Many men and boys also succumb to anorexia. The added stigma of them suffering from an 'adolescent girl's disease' makes the condition even more distressing for their families.

          Date and time
          May 23, 2013, 5:40PM
      • HI,

        Its not surprising at all. When I address this type of issue working with a client (doing Hypnotherapy) I don't work on them 'putting on weight'.

        All that does is make them focus on their weight!


        Date and time
        May 23, 2013, 12:01PM
        • Addressing the causes of an addiction also works with other addictions as well.

          I have been living with a recovering addict who was addicted to gambling (poker machines) and the best results came when he found something meaningful that he could do in his life. His old problems just dissolved. However, when financial problems arose it was important for him to sort out those messes himself.

          A Gambler's Partner
          Date and time
          May 23, 2013, 2:42PM

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