Anorexia and Obesity

TW: mental illness and eating disorders

People love to compare being obese to being anorexic. “So if someone is fat we should just let them kill themselves? What if they’re anorexic? Is there nothing wrong with that, either?” I’m going to spend some time here breaking this down for everyone.

Anorexia nervosa is a mental illness. It often coexists with depression, anxiety, and drug or alcohol abuse. It isn’t simply not eating enough, or exercising too much, it is a refusal or mental and emotional inability to stay within 15% of the ideal body weight. It can occur with body dysmorphic disorder, another mental illness that exaggerates real or perceived physical flaws to the point of obsession. Anorexia isn’t simply wanting to be thin or wanting to be fit: it becomes a compulsion and can result in literally starving to death. Malnutrition is common. The body can begin eating away at muscle tissue, including the heart. Organ failure can occur. These are not coincidental things that happen regularly across people with and without anorexia, they happen at significantly greater rates among people with an eating disorder.

Obesity is weighing 20% or more than your ideal body weight. It isn’t a mental disorder, although there are people who are mentally ill and obese. Mental illnesses can lead to obesity. It’s commonly assumed that being obese is dangerous and deadly, but studies continue to show that heart disease, diabetes, and other illnesses commonly associated with obesity are often not caused by the person’s weight. In addition, obesity can be caused by a number of mental, physical, and environmental conditions. Can it kill you? Well, the National Institutes for Health say that “extreme obesity may” shorten your life span. So, sure, there’s a chance. But when compared to the National Library of Health’s studies on anorexia nervosa, which show a life expectancy of 53 for a person with anorexia versus 78 for a person without, there is a clear difference in the danger of anorexia versus obesity.

To finalize the post, I’d like to address the issue of “Should you just not say anything?” Generally, no. You cannot assess a person’s health by looking at them, even if you’re a doctor. You cannot say that a person is anorexic or at risk of dying from obesity by judging their size. Since obesity is caused by a number of things, you can’t determine why they’re obese without talking to them, and even then they might not know themselves. Regardless, I can assure you that every fat person knows they’re fat. Every obese person knows they’re obese. It’s pointed out in dozens of different ways, over and over.

A person with anorexia nervosa may not know that they have it. They may be unaware that they are mentally ill. Should you say something? Probably not. Unless you are a trained medical professional, you can’t diagnose it. Even as a trained medical professional, you can’t diagnose it by walking past them on the street or seeing them at the gym. It takes an actual visit and evaluation. Not everyone who looks very thin is anorexic. There are a number of reasons for people who are thin or even underweight. You should assume that you don’t know enough about them to insert yourself into their lives. For family, this may be different. You may be able to see the difference in a person’s eating and exercise habits, watch the weight loss, and then it may be necessary for you to intervene. However, if you lack the close, personal relationship that gives you insight into their life, don’t. If you are concerned, it may be appropriate to ask if they’re okay, or to talk to a family member about your concerns. If you’re a stranger or acquaintance, it’s probably not appropriate.

In a nutshell, anorexia and obesity are not comparable. Please educate yourselves and address your need to judge and police the bodies of others.

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