Reclaiming the realities of anorexia
The concerning trend for terms such as ‘thinspiration’ on social media highlights the growing chasm between how we commonly discuss anorexia nervosa, both clinically and as a broader society, and the realities of the condition.
According to Google there are over 18 million results for pro-anorexia, or ‘pro-ana’, websites.
At the turn of the millennium, pro-ana websites emerged as places in which people with anorexia could share experiences and benefit from a sympathetic support network. Although such support could be dangerous, as it risked normalising the illness, it was also valued. Since then, what we’ve seen, along with the emergence of social media and front-page celebrity shaming, is the hijacking of these safe havens by an influx of people sharing tips on how to achieve a thinner body, and even asking how to become anorexic.
This has predictably led to growing anger, and division, within the online communities, and many of those who needed the security of the sites have since departed, leaving the websites to those they term ‘wannabes’.
This obsession with weight loss, and media acclaim for celebrities with what are perceived to be perfect bodies, belies the truth of anorexia. The condition requires a deeper understanding. But to point the finger at online communities and glossy magazines would overlook the worrying gaps in the current clinical approach to patients.
I first met Kate* in 2007, at an NHS eating disorders inpatient unit (EDU). Before being admitted to the EDU, Kate would eat only 100 calories in a day. She would collect menus from local restaurants and takeaways to peruse of an evening in bed. ‘I could taste what I was reading’, she said.
To really understand Kate, you had to first acknowledge that she was not obsessed with being thin. Kate’s anorexia was, in the simplest terms, about her relationship with food and how it made her feel.
Likewise, other patients in the EDU commented on how they were genuinely ‘horrified’ by supermarkets, and how they would conveniently forget to fill the fridge to deflect responsibility for skipping meals.
Paying attention to such narratives of (not) eating offers a way to take account of the realities of lived experiences of anorexia. It demonstrates how anorexia can come to be a way of being (albeit an extremely painful one) for some individuals.
Yet at a clinical level, diagnosis privileges weight and the reduction of body fat (BMI). A GP may ask a patient to be weighed every week, but it isn’t practice of policy to necessarily ask why someone has developed such a relationship with food and eating, and understand how not eating may function for them. Often, the focus is on asking why individuals want to lose weight.
In clinical terms, self-starvation is considered to be a lack of self-care; engendered by a loss of agency and identity to the illness. Under the Mental Health Act, this loss of agency is used to allow enforced feeding. This is a way of caring for the individual, and indeed a way of restoring their ability to ‘self-care’.
This food-as-medicine paradigm seems a world away from the experiences of individuals living through anorexia. To them, not eating may in fact be the way in which they do care for themselves; individuals may recognise the suffering anorexia causes while also feeling it to be part of their identity. It isn’t therefore primarily about weight, BMI or body fat.
The clinical guidelines for managing anorexia need reflecting on. Diagnostic criteria and treatments based on weight loss and gain are dangerously distant from the experiences of patients, and such a narrow focus has seeped into the debates around anorexia within the media, law and beyond.
It is imperative that the language we use to talk about this condition changes. It needs to show how people with anorexia relate to, and care about, food, and get beyond the idea that not eating is necessarily driven by an obsession with thinness.
I worry that anorexia has become trivialised by the current vocabulary; being considered as an exercise in vanity, being singularly a women’s issue, and being branded on social media as #thinspiration with acronymic slogans such as #SSSO (Stay Strong, Starve On).
We need to talk to more people like Kate, and this should inform our strategy for acknowledging the lived realities of anorexia.
Dr Anna Lavis
Research Fellow, Primary Care Clinical Sciences, University of Birmingham
‘Careful Starving: Reflecting on Eating, Care and Anorexia’ is a chapter from Careful Eating: Bodies, Food and Care, a book in the Critical Food Studies series published by Ashgate and edited by E-J Abbots, A Lavis and L Attala. It will be published later this year.
*Names have been altered.