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The truth about anorexia

For National Eating Disorders Awareness Week (February 21-27), I’m answering the 5 top questions about anorexia.

There's nothing glamorous or fun about anorexia nervosa; it's a mental illness, not a lifestyle choice. In fact, anorexia is the deadliest psychiatric disorder and the cause of significant emotional distress and health impairment. In a given year, females with anorexia are up to 12 times more likely to die than healthy females of the same age.

Anorexia entails the refusal to maintain a normal weight; the preoccupation with body shape, weight, and their control; and a pathological fear of becoming fat. In anorexia, no weight is ever low enough; there is an unrelenting drive to weigh less tomorrow…regardless of one's weight today. Sadly, people suffering from anorexia can truly "feel fat," even when emaciated and near death.

For National Eating Disorders Awareness Week (February 21-27), I'm answering the 5 top questions about anorexia.

1. What are some signs that someone has anorexia?

Significant, unexplained weight loss, or failure to gain weight in children, warrants closer attention, especially if you also notice any of these potential signs:

  1. Preoccupation with food and/or weight

  2. Social withdrawal, depressed mood

  3. Frequently showing up for meals or social occasions having "just eaten"

  4. Body checking (repeatedly "measuring" their thighs, wrists, etc. with their fingers and hands)

  5. Excessive exercise (exercise becomes a "must" not a "want")

  6. Declining grades in school

2. What causes anorexia?

We don't know exactly, but we do know that, contrary to popular belief, exposure to fashion models and media images does not, itself, cause anorexia. Were that the case, almost every American woman would have anorexia as opposed to the .5 to 2 percent of people who develop the disorder.

Anorexia isn't exclusive to celebrities or affluent suburban teens. People around the world, rich and poor alike, have been experiencing anorexia for centuries…even during periods in history when thin wasn't beautiful. (Bulimia nervosa is a different story.) The fact is, there is a strong familial component to anorexia. If you have a first-degree relative with a history of anorexia, you have a much, much greater risk of getting anorexia than someone without a family history.

The largest study ever done on the genetics of anorexia is going on now. Dr. Cynthia Bulik and her colleagues are currently collecting blood samples from people around the world who have suffered from anorexia in order to analyze their genes in the hope of gaining a better understanding of what causes this life-threatening illness. Click here to learn more.

In addition to genetics, other specific risk factors for anorexia include:

  1. Sex (females are 9 times more likely to get anorexia)

  2. Age (early- to mid-adolescence is the most common age of onset)

  3. Childhood obesity

  4. Early puberty, which may then lead to the risk factors of…

  5. Body dissatisfaction and subsequent dieting

  6. Participation in individual, body-conscious, competitive sports, where shape or weight influence performance (e.g., ballet, track, and swimming), which may serve to further intensify weight concerns and body dissatisfaction.

3. Is anorexia treatable? 

Yes. Recovery is possible, but not quick or easy. Anorexia is notoriously difficult to treat for multiple reasons. Many with anorexia are "in denial" as to the seriousness of their illness…if they even have any awareness that they're ill at all. Those who are aware that they're ill are usually ambivalent, at best, about recovery and may deliberately hide the disorder and resist treatment.

It's important for loved ones to understand that denial and ambivalence about recovery are features of the illness, not acts of defiance or hostility at them.

While there is no drug that is FDA-approved for the treatment of anorexia, there have been promising developments in psychological treatments: Enhanced Cognitive-Behavioral Therapy (CBT-E) for eating disorders, developed by Dr. Christopher Fairburn in the UK, has shown promising results for both adolescents and adults with anorexia. Family Based Treatment (or the "Maudsley Approach"), for children and adolescents still living at home, empowers parents to refeed their child and has also yielded encouraging results.

4. What I can I do to help prevent my child from developing an eating disorder?

Parents have tremendous influence. Here are some specific tips on how to promote positive body image in your family.

  1. Be aware of how often you make appearance- and weight-related comments to yourself or your child (positive or negative). How often do you praise shape, weight, and beauty, as opposed to acts of persistence or even kindness (being a good friend and citizen)?

  2. Refrain from making critical comments about your own shape and weight.

  3. Model a healthy relationship with food.

5. What should I do if I think someone I love has anorexia?

If you think your friend might have an eating disorder, approach them with empathy and concern rather than accusation and demands for change. Emphasize that you care, and you're concerned because they seem to be hurting. Express your desire to help and support them.

If you are a parent and think your child may have anorexia, do not wait for it to go away on its own.

Express empathy and concern, but make sure you obtain medical and psychological treatment for your child. Seek providers with significant eating disorders experience.

Anorexia is a life-threatening illness that requires immediate medical attention. The strongest predictor of recovery is early identification and intervention. Overall, the shorter the duration of the illness before treatment, the better the prognosis.

These websites offer more information and referrals:


Read more Goal Getter for healthy eating, weight loss and more.