Thin Enough-The Imaginary Standard

Eating Disorder Awareness Week is February 25 – March 3, 2019. It is a week to recognize the many disordered eating patterns that can take over and govern people’s lives. It is a week to take notice of the extreme measures to be thin enough, which normally fly under the radar.

Most of us have an idea in our head of what an eating disorder looks like: a person who is emaciated with their bones showing and hollowness around their eyes, wearing very small clothes that still hang loosely on their frame, and hair that is brittle. We think we would know someone with an eating disorder if we saw them. We would know them when they become thin enough to notice.

Enter Atypical Anorexia Nervosa. According to the DSM-V, Atypical Anorexia Nervosa is diagnosed when, “all of the criteria for anorexia nervosa are met, except that despite significant weight loss, the individual’s weight is within or above the normal range.” What are those anorexia nervosa criteria?

1. Restriction of energy intake relative to requirements leading to a significantly low body weight.
2. Intense fear of gaining weight or becoming fat.
3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

Along with these criteria are extensive signs and symptoms that manifest behaviorally, emotionally, and physically. To name only some of these:

• Dramatic weight loss
• Dressing in layers to hide weight loss or stay warm
• Preoccupation with weight, food, calories, dieting, etc.
• Refusal to eat certain foods, progressing to restrictions against whole categories of food (such as, no carbohydrates)
• Frequent commenting on feeling “fat”
• Denies hunger or claims to have already eaten
• Develops food rituals (such as, excessive chewing, eating foods in certain orders)
• Expresses need to “burn off” calories consumed
• Adheres to strict exercise regimen
• Limited social spontaneity and seems concerned about eating in public
• Has strong need for control and shows inflexible thinking
• Stomach cramps, constipation, non-specific gastrointestinal complaints
• Dizziness and/or fainting
• Difficulty concentrating
• Feeling cold all the time
• Dry skin, nails, and hair
• Poor wound healing
• Impair immune function
• Muscle weakness
• Loss of energy and sleep problems

Do any of these sound familiar? Most likely, because many of these are considered cornerstones of a healthy lifestyle. If someone adheres to a strict exercise regimen, they are lauded for their no excuses approach. Burning off calories is considered to be practical. Preoccupation with food, calories, dieting, or weight, are thought to be conscientious, and people who restrict foods or even entire categories of food are good and have willpower.

Here’s the thing about thin enough: In this society, people who are thin enough are thought to be morally superior and receive thin privilege, which is often equated with happiness. In that context, of course people are going to be enticed to try to be thin.

This is where eating disorders begin.

However, many people who have normal or larger bodies are not recognized as having eating disorders, such as Atypical Anorexia Nervosa, because they are not considered thin enough to be in danger. Rather, their disordered eating behaviors are praised as good and at least trying. The fact remains, though, that the behaviors are still disordered, no matter a person’s weight.

During this Eating Disorders Awareness Week, recognize that there is no such thing as thin enough. Take a look at the way you and those around you approach food, and really think about whether your behaviors are nourishing or negative. Have compassion for bodies of all sizes and abilities, and know that just because someone isn’t thin enough does not make them safe from eating disorders.

Jamie Marchetti, MS, RDN, LD, is a Registered Dietitian at Campbell County Health. For a one-on-one nutrition counseling session, call 307.688.1731. Learn more at www.cchwyo.org/diet.