A new paper suggesting that anorexia might provide "insight" to those with obesity has exposed the extent of fat phobia in our community, experts say.
The paper, Long-Term Weight Loss Maintenance in Obesity: Possible Insights From Anorexia Nervosa? was published last month by the International Journal of Eating Disorders under the heading "An Idea Worth Researching."
No, sadly, it is not a joke.
"The authors are suggesting that fat people can learn a thing or two from anorexics," says psychologist and eating disorder specialist, Louise Adams.
"Anorexia has the highest mortality rate of all mental illnesses: it kills close to a quarter of sufferers. To suggest that this deadly disease could be good for fat people seriously highlights the enormity of our fat phobia."
It also highlights widespread ignorance about eating disorders – a mental illness that cannot be determined (or considered cured) based on someone's weight alone.
"Fat people have eating disorders too," said psychologist Alexis Conason.
Overweight people with eating disorders, however, tend to be under-diagnosed and are often "actually encouraged by medical professionals, who congratulated these patients for losing weight."
Indeed, in the new paper, psychiatrists from Columbia University looked at what those with anorexia nervosa and those who maintain long-term weight-loss, on the National Weight Control Registry [NWCR], have in common. "There are remarkable parallels between the behavioral patterns of successful weight loss maintainers from the NWCR and individuals with chronic anorexia nervosa," the papers authors said.
Specifically, they found:
- "They eat a diet low in fat and calories and a restricted variety of foods."
- The longer they stick to a patterns of eating behaviour the more the behaviours "become ingrained and automatic", which, they add, may explain why anorexia is so difficult to treat.
- "Deviation from this rigid diet is associated with weight regain, even among individuals who have maintained weight loss for several years."
- "[They] are physiologically primed for weight regain. Both groups have lower resting energy expenditure, lower levels of leptin (the satiety hormone) and thyroid hormone, and higher levels of ghrelin (the hunger hormone) than non-weight reduced BMI-matched controls. They have metabolic profiles that oppose further weight loss and promote weight gain, yet they override these powerful biological drives to maintain their weight loss."
"Obesity is not an eating disorder, and we are not suggesting that the sustained weight loss of individuals in the NWCR is pathological," the authors said.
Lead author, Loren Gianini, an assistant professor of Medical Psychology at Columbia University, told Fairfax: "One of our scientific objectives is to examine what happens in brain circuits when people make decisions about the food that they eat."
Conason however disagrees that looking to impaired eating disorder behaviours is the answer.
"In people at lower weights, these behaviours are considered an eating disorder in need of treatment," Conason said. "In people at higher weights, these behaviours are considered good health and encouraged by medical professionals. "
She says that, "our fat-hating culture", does not celebrate body diversity and equates thinness with health, despite the research showing that people of all shapes and sizes can be healthy or unhealthy.
Weight-bias is common across countries and as rates of obesity have risen (currently about 63 per cent of Australian adults are overweight or obese), so too has fat-shaming.
"Fat people are encouraged to lose weight by any means necessary," Conason said.
Eating disorders specialist and psychologist Deb Burgard told Ravishly that The Biggest Loser is an example of this.
"If a thin person says that they severely restrict calories and exercise for eight-plus hours a day, those are red flags for an eating disorder," Burgard said. "If a fat person does the same thing, we put them on TV, give them a trainer to 'encourage' them with mental and physical abuse, and watch the ratings soar."
Finding long-term solutions to the obesity epidemic is complex. But to shame people or suggest they look to those suffering an extreme mental illness is nothing short of dangerous.
"This new paper perpetuates the myth that fat people can't be anorexic because weight loss is always healthy, even when it results from starvation," Conason said.
Adams added: "In my opinion, prevention of eating disorders would be a whole lot easier if we worked to stop the obesity panic, fat phobia and thin obsession in our culture.
"As for 'preventing obesity', this entire proposition is weight biased.
"Fat people have always existed and will continue to exist, this is natural diversity. Populations are getting larger, and we're living longer and more healthier lives than ever before in human history. Rather than fighting to eradicate a body type, let's help support people of all shapes and sizes to look after themselves in healthy and sustainable ways."
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