You Don’t Have To Be Underweight To Have Anorexia

We Don’t All Fit The Same Box

A study found that 31% of patients with Anorexia Nervosa had all the cognitive features and physical complaints without being underweight.

University Melbourne dietitian Melissa Whitelaw is calling for a change in the diagnostic criteria after finding patients with atypical anorexia suffer serious health concerns despite not meeting the criteria for the condition with regards to their weight.

The study published in the Journal of Adolescent Health looked at 171 patients between the ages of 12-19 admitted to hospitals with eating disorders between 2005 and 2013. It found that:

• 51% were ‘atypical’ with significant eating disorder psychopathology but not underweight.
• Rather than being underweight, a greater weight loss was associated with life-threatening low pulse rates, a complication of starvation in anorexia that requires medical intervention (hospitalisation).
• Those atypical patients also suffered from low blood pressure and unbalanced blood electrolytes.
• No complication was independently associated with being underweight, the so-called hallmark of anorexia.
• No participant was being monitored by health professionals for weight loss, their relationship to food, or their methods for weight loss during the study.

Whitelaw says many atypical patients have been encouraged by family and/or health professionals to lose weight which frequently resulted in positive re-enforcement.

Atypical anorexia nervosa patients might have lost about a quarter of their body weight, but the body can go into starvation mode if as little as 10% is lost quickly, causing the heart to slow to preserve energy.

“The face of eating disorders is changing against a backdrop of an increasing prevalence of overweight and obesity”

Melissa Whitelaw.

If an adolescent chooses to lose weight, it doesn’t matter what their start weight is, a health professional should monitor them to ensure the loss is both safe and appropriate. This way their nutritional intake and relationship with food and exercise can be monitored for signs of concern.

Upon entering starvation mode the only way to increase the heart is to re-feed in order to regain weight, which requires careful monitoring thus hospitalisation.

Whitelaw says that people can understand why an extremely thin person needs to gain weight, but they struggle to understand why someone within or above a healthy weight range requires re-feeding.

Contrary to common assumption health consequences of atypical anorexia can be just as dangerous and it is about time the outdated diagnostic criteria were changed. You do not have to be underweight to be anorexic, the evidence is there to prove this.

Atypical anorexics are just as ill as those with typical anorexia. They have the same thoughts about food and eating.

It is about time we updated the criteria to fit our modern world and started to listen to the individual instead of judging them on whether they fit the box or not.

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