Photo: (Youtube.com/HarvardHlthBks)
One out of every 200 grownups have what a doctor would diagnose as anorexia, but one in twenty people exhibit substantial eating disorder symptoms. And they aren't all young, female and skinny.
Many people are skipping meals periodically, or exercising past the point of health, or hating their bodies, but it still doesn't officially count as anorexia because it's not extreme enough. However, it's very unhealthy and self-destructive all the same, and that's why Dr. Jennifer J. Thomas and Jenni Schaefer wrote the book, "Almost Anorexic."
Both these women know their field. Dr. Thomas is an assistant professor of psychology at Harvard Medical School and co-director of the Eating Disorders Clinical & Research Program at Massachusetts General Hospital. And Jenni has personally overcome an eating disorder and published two books about it: "Life Without Ed" and "Goodbye Ed, Hello Me." To understand the meaning of "almost anorexic" and what people can do if they suspect they have an unhealthy relationship with food, we spoke with Dr. Thomas.
ACT: What is almost anorexia and why did you decide to write a book about it?
DR. THOMAS: Most of the patients we see at our eating disorder clinic do not meet the narrow criteria for anorexia nervosa, even though they have very severe eating disorders. Instead, they are struggling immensely with just a subset of the key symptoms of anorexia, bulimia, or binge eating disorder—like fluctuating body weight, food restriction, binge eating, purging, or poor body image. That's why Jenni Schaefer, who is recovered from almost anorexia herself, and I wrote "Almost Anorexic": To reach out to this even larger group of people who are struggling in the perilous grey area between normal eating and full-blown anorexia nervosa.
ACT: What are some stereotypes about eating disorders that need to be cleared up?
DR. THOMAS: When people think of eating disorders, the image that often comes to mind is an extremely thin, white, heterosexual teenage girl. But eating disorders do not discriminate by weight, ethnicity, gender, age, or sexual orientation. In fact, these unfortunate stereotypes too often prevent health professionals, loved ones—and even sufferers themselves—from recognizing when there is a real problem.
ACT: Your book talks about Demi Lovato and MTV's "Stay Strong" documentary helping educate people on eating disorders. With more celebrities like Demi, Lady Gaga and Adele speaking out against unrealistic body ideals, do you see a shift in how people view themselves? What more needs to be done for a healthier body image in society?
DR. THOMAS: I think it's great that so many celebrities are coming forward and saying, "Yes, I had an eating disorder"—like Demi Lovato did in her "Stay Strong" documentary on MTV. This raises awareness of the issue and provides powerful role models of recovery and hope. Of course, when celebrities do speak out, I always appreciate when, like my co-author Jenni, they focus on the pain that's going on inside, rather than numbers like lowest weights or calorie limits that could sensationalize the disorder.
ACT: Your book has a lot of interesting (and surprising) details, like the fact that eating disorders might be genetic. During your years specializing in eating disorders, what facts have surprised you the most? How can people use these facts to fight against eating disorders and get a healthier body image?
DR. THOMAS: Working with patients and doing research, I learn something new every day! Here are just a few facts:
• According to my research, subthreshold eating disorders can be just as severe as anorexia nervosa in the areas of eating pathology, physical complications and other mental health problems (e.g., anxiety, depression).
• Vomiting is an ineffective method of getting rid of calories. Most of the calories consumed during a binge are retained in the gastrointestinal tract after vomiting.
• Feelings of fatness are more strongly associated with your level of depression than your actual body weight. Jenni says, "Now I know that when I 'felt' fat, what I really felt was sadness, anger, or possibly even confusion about my emotions. Fat was a code word for something else." So the next time you feel "fat," ask yourself, "What am I really feeling?" Chances are good that dieting is not the solution.
• Although some lifestyle changes related to food and weight can be healthy, others are just dieting in disguise. (Most people know that dieting has a well-documented failure rate.) Here's a chapter excerpt explaining this important concept.
• Full recovery from almost anorexia and other eating disorders is possible. My co-author, Jenni Schaefer, and I always encourage people not to settle for "barely recovered." (See a table from our book.)
ACT: What are the best ways to prevent almost anorexia in the first place?
DR. THOMAS: We need to change our conversations with young people and each other, and focus on what really matters. The next time you see a friend, rather than commenting on appearance, ask him how he's been feeling lately, or what music she's been listening to.
ACT: If people suspect they might have an eating disorder, what do you recommend they do? It's often easy to tell people to seek professional help, but if they can't afford that, what are their other options?
DR. THOMAS: The first step is determining whether you have a problem. You can go to www.almostanorexic.com to take a free and confidential online screening. There are also lots of free recovery-oriented exercises from the book that you can download on our site.
To help you identify harmful patterns, you can keep a record of your food intake and associated thoughts and feelings using a free iPhone app such as www.recoveryrecord.com.
To evaluate your relationship with physical activity, take the Compulsive Exercise Test.
When it comes to body image, I write prescriptions for retail therapy. Go out and buy yourself a flattering outfit that fits you now, not ten pounds from now.
If you think you need professional help but can't afford it, talk to your primary care doctor to get a referral. There are also organizations that offer treatment scholarships for eating disorders, like the Project Heal and Manna Fund.
