05 February 2013

Why anorexia and obesity are not the same

Zoe Williams' recent article for The Guardian is the latest instance of a journalistic conflation of anorexia and obesity. To me, these concepts are very different to each other, and treating them as mirror images of each other is damaging to people with eating disorders, and fat people. I think it perpetuates particular stereotypes associated with each group, and overlooks the possibility that fat people might suffer from anorexia too.

With this in mind, I've drawn a handy table with some notes in it about how anorexia and obesity are different, and how they have some similarities. I have no deep knowledge of eating disorders, so what I say about anorexia is a lay understanding, and there will probably be things that I've said clumsily and need clarifying or addressing. But my aim with this table is to encourage people, particularly journalists, to be careful when they throw these concepts about.

I'm using 'obesity' here to mean a medicalised discourse of fat.

Anorexia Obesity
Is a kind of mental illness that affects people of all sizes, though is commonly associated with very thin people, especially young women. Is a means of classifying and stratifying certain kinds of bodies.
Is primarily assumed to be associated with not eating. The etymology of the word is rooted in the concept 'to have eaten' but fat body size does not tell you much about people's eating behaviour.
Is typified by particular behaviours. Is assumed to be the result of particular behaviours, particularly 'compulsive eating'.
The behaviours typified by anorexia are associated with mental illness. Some fat people have mental illness, it's hard not to when you are a highly stigmatised social group, but fat itself is not an automatic signifier of mental illness or pathology, even though Susie Orbach and many others have popularised this view.
Is a series of behaviours associated with a faulty relationship to food. Is assumed to be the result of a faulty relationship with food.
Treatment for anorexia may or may not be helpful. Treatment for eating disorders is unlikely to be helpful for fat people who don't have an eating disorder.
Lack of political organisation, unless you count pro-ana as activism. Fat people have critiqued 'obesity' and are politically organised, to some extent.
The extremes of very thin (anorexic) and very fat (obese) people are often used as mirrors of each other. Fat and thin are not opposites, but part of a vast diversity of human body shapes.
Anorexia and obesity are both subject to a lot of social anxiety and cultural mythology, supported by medicalisation.
Anorexia and obesity are both subject to a muddled discourse, often rooted in Second Wave feminism, which often raises the spectre of the 'bombarded by media images' origin story cliché.
Anorexia and obesity are both associated with untimely death, even though people with eating disorders and fat people can live long and productive lives.
Both anorexia and obesity really upset the normals.
'The anorexic' and 'the obese' are groups of people who are commonly abstracted, made anonymous, voiceless and abject, and are rarely offered space by 'the experts' to speak for themselves.
Are reduced to an assumed anxiety about the body and food, but people with eating disorders and fat people have interests elsewhere, for example in the struggle to be autonomous people, a struggle against medicalised control, a struggle against social restrictions.


Anonymous said...

Thank you, this is really interesting. It reminds me of the time I spent as a fat woman at Overeaters Anonymous, every single person there (regardless of body size) described themselves as suffering from either anorexia, bulimia, food addiction, binge eating disorder, etc. I was just fat but there was this huge pressure to label yourself as suffering from some kind of eating disorder. Several people would urge me to get counselling or open up about my 'issues'. I now realise that I am in fact a reasonably sane person, I do have 'issues' (who doesn't) but they aren't linked to my weight and losing weight won't solve them. I don't need therapy to resolve my fatness, thank you very much.

Dr Charlotte Cooper said...

Thanks for this. Although I never went to OA. I relate to the feeling that I *must* be pathological, and that I *must* have an eating disorder, even though I don't, or at least I'm as sure as I can be that I don't. The pressure to label, as you say, is really huge.

Kasia Tupta said...

What a relevant post! Thank you! I've done some work in eating disorders. I'm a dietitian. It is fascinating to look what happens with people faces when you tell them that their eating disorder is a brilliant way that they use to cope with stress. It really is a normal way to be in abnormal circumstances.

It really is something to think about how we treat eating disorders and obesity from the medical perspective. What we (collectively, the medical establishment) tell obese patient to do is exactly what we tell anorexic patients not to do. Neither of those approaches work.

I think you very well capture it in the last box of your table. Can we enlarge our clients into complex, brilliant, resourceful human beings instead of reducing them to a disorder?

Dr Charlotte Cooper said...

Thanks Kasia!

Jessica said...

And yet ...

I am struck by your comment here:
"I relate to the feeling that I *must* be pathological, and that I *must* have an eating disorder, even though I don't, or at least I'm as sure as I can be that I don't. The pressure to label, as you say, is really huge."

Truly, as someone in recovery from an eating disorder, this is something that has been a powerful part of my experience. Which is not to suggest at all that obesity and anorexia are the same, but rather to try to trouble where exactly the differences are located. For example, I feel that the table in your post cast anorexia as definitively "pathological." Yes, there are standardised diagnostic criteria, recognised patterns of behaviour, and treatment programmes, but I really think that the jury is still out on what anorexia is, or indeed if it really is one thing at all.

Why do I think this matters? I guess that the pressure to 'feel' pathological seems to me to be a really important part of how contemporary medicine works, especially in the realm of unpalatable bodies and behaviour. And I'm not sure how I feel about that. I recall a conversation I had with a beloved family member some months ago about why gun violence in America was due to the failure of health care to adequately contain the risks to society posed by people with schizophrenia. Separating out obesity from anorexia in order to emphasise that obesity is not pathological but might be cast as such by analogy to anorexia has the knock-on effect of casting anorexia as a pathology. What implications might this have for those who adopt or maintain anorexic behaviours? Why should they be subject to the pressure of labelling?

And just because: pro-ana is not the only eating disorder-centered presence on the web. They might not be as visible (or notorious), but individuals in (and out of) recovery are active in protesting the body fixations that we all imbibe. This might not be the same kind of activism or political organization that you are imagining - and believe me, I have my reservations about the way in which eating disorder treatment becomes a culture of conformism imitative of that which promotes eating disordered behaviour in the first place - but it should be counted in its own right nonetheless.

That was all to say - I like your blog. You raise important issues. Anorexia is not (just) a disease.

- Jessica

Dr Charlotte Cooper said...

Hi Jessica, thank you very much for these comments. I'm not sure how I feel about the pathologising of anorexia, I need to think about that a lot more, but I think you are right to raise these questions and I appreciate the politics and humanity behind them.

Could you direct me and other readers towards specific resources, if you have the time?

Jessica said...

Hi Charlotte,

Thank you for your response. I appreciate your hesitation over the pathologisation or not of anorexia. It is not my intention to insist one way or the other, but rather, I think, to question the function and effect of treating anorexia as a disease, enabling diagnosis, classification, and an element of social normativisation that I think underlies much of the contemporary interest in behavioural disorders.

I am afraid that I don't have many online resources to direct you toward - I am not a specialist in this field. In terms of awareness-raising activities on the part of those with or in recovery from eating disorders, I have generally encountered this at a micro-level, especially in social media (responses to articles or images in the press; displaying the 'recovery' symbol; advertising Eating Disorder Awareness day/week/month; wearing purple) and smaller zines (for example, the alternative/feminist zine Mookychick: http://www.mookychick.co.uk/reviews/book-reviews/wasted-review.php). The question of why 'anti-ana' is less prominent or organised than 'pro-ana' is interesting. It perhaps has something to do with the competitive tendency of anorexia and the sensitivity to 'triggering' that perhaps make 'anti-ana' groups run by people in recovery seem ill-advised.

~ Jessica

Dr Charlotte Cooper said...

Thanks Jessica, this is useful to hear.