During this time of year we are inundated with stories of weight-loss resolutions, dietary goals and exercise aspirations. Most of us want something approximating the media-dictated “perfect body” but, luckily, never get there because in the healthy person, normal appetite overrules the drive to be stick-thin. It is apparent that drive to be thin and a belief that one’s body is too large is not a recipe for weight loss. In extreme cases, people are literally told by their doctors “if you don’t lose weight, you will suffer dire health consequences, even death”. At that point, motivation to eat less would be probably as high as it could be, and yet still many in that position can’t lose the pounds needed to achieve even the most basic health.
This brings up an interesting question: if Anorexia is really about a desire to lose weight and a belief that one is ‘too fat’, then how is it that people without Anorexia who want nothing more than to lose weight, who believe their bodies to be severely overweight, can’t lose the weight they want? I propose that viewing your body as being too large and strongly desiring weight loss is not what causes Anorexia, otherwise we would see the Anorexic eating habits in everyone whose New Year’s resolution is to lose weight. I’ve even heard people say “I wish I could catch Anorexia for just a month or two to get this damned weight off!” Certainly there is more to this equation than is apparent at first glance.
Anorexia (and eating disorders generally) are not something one can turn off and turn on. It is not a function of wanting to lose weight, and recovery is not a function of wanting to gain weight. There is something much deeper going on with this illness that has nothing to do with feeling too big and wanting to be smaller. Yes, being distressed about one’s body, feeling it is too big and wanting to lose weight are associated with Anorexia, but they do not cause Anorexia. Otherwise, there would be an epidemic of “Anorexia” on January 1, and all the people who are on diets would instantly “catch it” as part of their diet plans.
No, Anorexia is much more complicated than that. It frustrates me how much research and clinical effort is spent on variables that, in my view, are the result of the Anorexia process but not the cause of the illness itself. The approach we have is similar to treating a patient for the flu, and believing that lowering the fever is going to resolve the illness. Yes, the fever is associated with the flu, but the fever didn’t cause the flu, the flu caused the fever. Similarly with Anorexia, wanting to lose weight and thinking you are too fat is a symptom of the illness, but didn’t cause the illness itself. The illness causes affected individuals to start feeling too large and wanting to take pounds off, but that is not how it starts and not how a meaningful resolution is achieved.
To provide people with Anorexia the recovery and understanding they truly deserve and desperately need, we must avoid confusing the outcomes with the causes of this illness. We must stop being so distracted by the idea that this illness is caused by wanting to lose weight. That viewpoint is simply shortsighted and erroneous, and all it takes is to look around at the tens of millions of people on diets to see that wanting to lose weight and hating your body does not cause Anorexia.