Anorexia Causes More Deaths Than Most Other Psychiatric Conditions

I’ve been living in a fat body since I can remember. My first diet was at age 6, at the urging of my own pediatrician.

Rather than discussing my weight privately with my parents, she openly called me overweight, questioned my eating habits, and told my parents that I needed to be thinner. She sent me home with a chart for my refrigerator of “always foods, sometimes foods and never foods.”

That was the beginning of almost three decades of food and weight related bullshit for me. I never succeeded in becoming thin, but I did succeed in punishing myself for being fat. Over and over and over and over. If I couldn’t be thin, the least I could do was feel guilty. Fat was bad, and I was the worst.

I was in my thirties before I was able to escape some of that shame, and it’s a process I will have to actively work on until the day I die. Fat shame runs deep in my psyche and my heart.

Recently, Dr. Joshua Wolrich, an NHS surgical doctor, published an adamant and gripping essay about how our adult relationships with food are shaping the way children in our lives view food, weight and their worth. The entire essay is packed with sobering statistics. I could not stop shaking my head in sadness.

According to the Boston Globe, in the U.S., anorexia nervosa — an eating disorder characterized by restricted eating, fear of weight gain and distorted body image — is the second deadliest mental illness after opioid addiction. In the U.K. and Ireland, the incidence rate of anorexia nervosa has doubled since 2006 in kids ages 8-12. That is second through sixth graders.

“We’re struck by how many very young people we’re seeing, as young as 9, who very clearly want to change their shape and size and are restricting food intake to do that,” said Dr. Tracy Richmond, clinical director of Boston Children’s Hospital’s Outpatient Eating Disorder Program, told the Globe.

That is horrifying without explanation, but it’s even harder to stomach when you know that anorexia has one of the highest mortality rates of any psychiatric disorder, including depression, bipolar and schizophrenia. According to the National Association of Anorexia and Related Disorders, eating disorders kill someone every 62 minutes as a result of suicide or medical complications.

Elementary school kids are developing a deadly eating disorder at an alarming rate, and Dr. Wolrich thinks he knows part of the reason why.

The first thing he thinks we need to examine is societal weight stigma.

And to that I say … well, yeah. No kidding. Fat people like me can tell you how damaging that is. We live with the effects of fat shaming every single day,but since so many people are still totally on board with body shaming, it needs to be said. Loudly. And it certainly helps when it comes from a doctor.

The toxicity of diet culture surrounds us every day.

Diet culture is the system that tells us that thin always equals healthy and fat always equals sick. It’s the part of our culture that elevates orthorexia and over-exercising, calling them self-control and moderation instead of self-punishment and obsession.

Diet culture took the joy out of moving for health and pleasure. It tells us that unless we push our bodies to the brink and endure physical pain and exhaustion in an organized gym setting, we aren’t doing enough.

Diet culture tells us that if the food we eat and the way we move our bodies are not leading to thinness, then we are not doing it right. No matter how much we dance, laugh, breathe deeply, and stretch…no matter how many miles we walk and run and bike… if we aren’t meeting the goal of a thin body, diet culture tells us we are missing the mark.

In the name of “health and wellness,” we have allowed some incredibly harmful eating and movement patterns to become the norm, and it is literally killing us.

From birth, kids watch their mothers buckle under the pressure to return to their pre-baby weight and size as quickly as possible. Many kids continue to watch the adults in their lives obsess about body size and diet for their entire childhoods. They see us try fad diets, scrutinize our appearance in the mirror, and dread the Summertime AKA bathing suit season.

It’s unreasonable for us to think this won’t affect our kids.

Dr. Wolrich wonders how we can be surprised that children are restricting their food intake to a dangerous level and living in fear of becoming fat.

It’s what they’re watching us do every day.

We also need to reexamine our relationships with food.

Adults assign moral value to food routinely. I don’t think most of us mean to pass these ideas onto our kids, but it happens. Our children hear us when we talk about food. When we say, “I really want a burger, but I’ll be good and eat a salad,” our kids hear, “good people don’t eat burgers; they eat salad.”

Now when a burger is placed in front of them, they have to decide between fulfilling their hunger with the “bad food” provided (then living with the guilt) or ignoring their hunger in favor of goodness. This is where anorexia can begin to take hold.

It’s not even a little bit shocking that some kids choose their perception of morality over their own hunger needs. Making their adults proud and doing the right thing is a core desire for many kids. We have to stop making kids think they can be better or worse based on the foods they ingest or the size of their bodies.

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Don’t get me wrong. I am not saying we shouldn’t give any thought to the foods we eat and offer to our children. If your pantry looks like an ad for Whole Foods, that’s awesome. You might be surprised to know that, even though I’m fat, mine often does too.

We all want our kids to eat foods that nourish their growing bodies, and that takes some planning. Making sure picky eaters get the necessary vitamins, minerals, fats, proteins and energy that they need can be a bit of a puzzle. Growing bodies need lots of different things.

But as adults, it’s our job to encourage our children to make healthy choices and nourish and use their bodies in fun, active ways without making them feel that their value is dependent on how their body ends up looking after those choices are made.

Diet culture makes an “everything in moderation” approach feel useless. Even if we are mostly choosing foods that nourish our bodies and brains with vitamins, minerals, healthy fats and protein, if our body size doesn’t fall in line with the accepted ideal, we are told it’s not enough. We still screwed up somewhere. We ate or did something “bad.” There is no room in diet culture for bodies to be healthy and just look different.

It’s a huge, vicious circle of guilt and shame and complicated rules and impossible expectations. It’s contributing to the rise of a deadly psychiatric illness in our babies.

So, what can we do?

We can emphasize that there is joy in using your body without mentioning the way it looks. It’s a good idea to mark fitness milestones with criteria outside of body size and weight. We can talk about strength, endurance and ability instead. We can introduce our children to a wide variety of culturally diverse foods in the name of expanding their horizons. This will help us find out what nutritious options they enjoy without assigning morality to any of them.

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It is so important that we speak positively about our own bodies in front of our kids. It also goes a long way to stand up and speak out when we see body shaming. We need to explain to our kids that people of all sizes deserve kindness.

We can also work on our own internalized size biases. Confronting how we think about fat bodies can be tough, but it’s also important. Remember, anorexia is not only present in the dangerously thin. It can begin when a person is in a fat body, and they might be struggling right under your nose even as you judge them. Anorexia is a psychiatric disorder, and anorexic behaviors are dangerous to mind and body even before a body becomes medically underweight. Confronting fat bias is a component of combating anorexia, especially in our children.

Anorexia kills more people than any other psychiatric disorder, and our kids aren’t immune. It’s time we took a good look at ways to encourage healthy choices and active habits without using fat bodies as cautionary tales.