Most people assume that low body weight is the greatest risk factor for anorexia. Almost everyone assumes that someone who has anorexia appears emaciated. It has always been believed that being underweight is the reason anorexia is so dangerous.
However, research shows that low weight is not the greatest risk factor of anorexia. In fact, “atypical anorexia nervosa” is both common and equally dangerous. Atypical anorexia has all the same diagnostic criteria except low body weight.
This is important information. Many people who meet the criteria for anorexia are not “underweight.” They rarely get treatment and are often dismissed as less serious. This experience can leave a person struggling with atypical anorexia for decades without support.
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Study finds that weight status is not greatest risk factor of anorexia
A study found that the greatest health risk of anorexia was not weight status, but the total weight loss and recent weight loss based on the disorder. (Journal of Adolescent Health). In other words, anorexia occurs in “average,” “overweight,” and “obese” weight categories. And these people can have the same health complications as someone who is in the “underweight” weight category.
The study found that in adolescents with restrictive eating disorders:
- Total weight loss and recent weight loss were better predictors of physical risk than weight at admission.
- No complication of anorexia was independently associated with being underweight.
- Adolescents with atypical anorexia nervosa can experience the same severe physical complications despite not being underweight, including low:
- Pulse rate
- Systolic blood pressure
- Phosphate levels
Lead author Melissa Whitelaw, A.P.D, is calling for a change to anorexia nervosa’s diagnostic criteria based on her findings. She believes that the current DSM criteria of being underweight is inappropriate. She says that patients with atypcial anorexia experience serious health complications. These occur even if they are within or above what is considered a “healthy” weight range.
“We need to redefine anorexia … the definition should refer to weight loss, not just underweight,” said Whitelaw in an interview.
Higher weight anorexia is equally dangerous to health
Whitelaw’s research shows that we should worry about weight loss in any body.
This is a major issue since so many people pursue weight loss as a health-promoting activity. Weight loss can cause the human body to go into “starvation mode.” Starvation mode can be triggered when a person loses as little as 10% of their body weight in a short amount of time.
Sudden weight loss is a major risk to the human body. The body responds by slowing down the heart rate to conserve energy. The body’s response to sudden intense weight loss is not based on the starting weight.
People in larger bodies are at high risk of developing all the symptoms of anorexia. This occurs even if they remain above what is considered a “healthy” weight.
Significant weight loss is a negative health condition
Praise and encouragement is the most common reaction to weight loss. In fact, we should be treating weight loss with concern and worry.
“If adolescents lose weight, it doesn’t matter what weight they are, a health professional should monitor them to check that weight loss is appropriate and if so, that it is done gradually,” said Whitelaw in an interview. “They should also monitor the adolescent’s dietary intake and relationship with food and exercise for signs the patient was spiraling into an eating disorder. Following large amounts of weight loss, careful medical assessment is also recommended.”
Whitelaw’s research is important. People who have atypical anorexia are often considered to be less medically critical. Professionals have assumed that low total body weight is the most dangerous feature of anorexia.
As a result, a large number of people who live with anorexia in larger bodies suffer. Diagnosis and treatment are much harder for people in larger bodies.
Weight bias impacts treatment and outcomes
Weight bias is common among medical and even eating disorder treatment providers. These well-meaning professionals frequently encourage weight loss efforts for everyone but the smallest bodies. These professionals often encourage larger-bodied patients to continue and even refine their anorexia symptoms.
Weight loss encouragement is common for people who live in larger bodies. This means that well-meaning people can accidentally exacerbate anorexia. People like:
- Family members
Because of weight stigma and diet culture, most people who have atypical anorexia never receive treatment. In addition, they often get worse because of a lack of care.
Diet culture is major risk factor for health
Diet culture promotes weight loss with the stated goal of improving health. The diet industry has driven weight loss efforts and as a result is a $72 billion industry. However, there is no evidence that intentional weight loss lasts or improves health outcomes.
About 95% of people who intentionally lose weight – through any method – will regain the weight in 2-5 years. Additionally, most people who intentionally lose weight will gain more, and begin weight cycling, a major health risk factor.
Weight loss efforts are not benign. Dieting is a major risk factor for eating disorders. One study found that dieting is the most important risk predictor of new eating disorders. Female subjects who dieted at a severe level were 18 times more likely to develop an eating disorder. Subjects who dieted at a moderate level were five times more likely to develop an eating disorder. (BMJ, 1999)
What parents can do to help their kids be healthy
Parents can help their kids be healthy by doing the following things at home:
- Don’t talk about dieting or weight loss
- Never encourage intentional weight loss
- Don’t allow your child to adopt a diet or weight loss program
- Monitor your child for significant weight loss and treat it as a risk factor, not a cause for celebration
Most importantly, if you see any symptoms of an eating disorder, including weight loss, have them evaluated.
If your child is in a larger body even after weight loss, then have them checked by a non-diet professional. Few doctors or traditional nutritionists and therapists receive training for atypical anorexia. Sadly, they can easily cause more harm than good. All types of eating disorders are serious and require care and treatment.
Ginny Jones is on a mission to empower parents to help their kids recover from eating disorders, body image issues, and other mental health conditions. She’s the founder of More-Love.org, an online resource supporting parents who have kids with eating disorders, and a Parent Coach who helps parents who have kids with mental health issues.
Ginny has been researching and writing about eating disorders since 2016. She incorporates the principles of neurobiology and attachment parenting with a non-diet, Health At Every Size® approach to health and recovery.