The Treatment of People with Normal Weight Anorexia

The Anorexia subtype that is the newest and often most confusing is restrictive Anorexia with relatively normal weights. Some people who restrict their food to a significant degree don’t lose a lot of weight. They have Anorexia. Most people still associate the term Anorexia with very low weights and broadening the diagnosis has been a challenge.

For many years, clinicians and laypeople alike didn’t believe those people who were starving themselves yet remained at relatively normal weights. The general assumption is that these people were exaggerating or even lying about their symptoms, much to the detriment of people with Anorexia seeking help.

Anorexia triggers a metabolic response in people akin to surviving a famine. Our bodies are genetically programmed to adapt to inadequate amounts of food in different ways, all for the sake of survival. Some people remain very active and don’t slow down caloric needs. These people lose a lot of weight quickly. Others slow metabolism over time and can function on small amounts of food and lose weight gradually. Some people slow metabolism right away. Because their caloric needs decrease quickly, this last group functions well enough on small amounts of food at relatively normal weights.

One can see that a varied adaptation to starvation helps the human race survive famine. No one could have predicted the human drive to starve themselves and the consequences of how differently Anorexia can present.

Treating people with normal weight Anorexia is similar to others with low weight. The number one goal is to normalize consistent eating through the day, allow the body to recover normal metabolism and organ function and work on the fears of eating more and gaining weight. Typically, slower metabolism limits the severity of the eating disorder thoughts about restriction and weight gain, for unknown reasons, which allows this subset of Anorexia patients to have a higher chance of full recovery.

The hardest part of recovery for this subtype is that they often don’t believe they have an eating disorder, let alone Anorexia. They too believe that being underweight is a cardinal symptom of this disorder and minimize their food restriction symptoms and illness since their weight is not concerning.

A lot of energy in recovery must focus on the reality of having Anorexia and what that means to the person. Identifying the illness and taking recovery seriously is essential to being able to get well. Education around the varied ways the human body responds to starvation and working on the emotional causes and consequences of long-term restriction are just as important for this subtype. Communicating the diagnosis and treatment with family and friends can help justify the reality of the illness as well.

Over time, a better understanding of Anorexia in the lay population will enable people with normal weight Anorexia accept and seek help for their illness.

The Broader Context of the Diagnosis of Anorexia Nervosa

The diagnosis of Anorexia Nervosa has morphed in recent years into a broader understanding of the illness. However, some of my posts about anorexia don’t always take these changes into account. I’d like to clarify the transformation of the diagnosis.

Anorexia Nervosa originally reflected only the restrictive disease and specific weight criteria without any compensatory behaviors like purging or over-exercise. Over time the diagnosis included subtypes of other behaviors and, only recently, has eliminated the strict weight element of the diagnosis.

The changes are important in order to include all people with the diagnosis and ensure sufficient treatment for everyone. These changes allow that the psychological manifestations of the illness are the same across the board even if behaviors and weight aren’t the same in each case.

The new criteria also merit conversation about varied treatment for the subtypes.

People with anorexia who also are not B at extremely low weights tend to have a more hopeful course. In addition, those people with compensatory behaviors often need treatment that is behaviorally oriented in order to address the compulsive nature of their eating behaviors. Education around these subtypes of anorexia must focus on being malnourished and the effects on organ function and cognition while encompassing body image into the overall recovery.

The original anorexia diagnosis describes a very specific type of eating disorder. These people only restrict, maintain very low weights, tend to feel overweight even when shockingly emaciated and often experience the eating disorder as a loud, demanding voice in their head which they must obey.

This subtype tends to be very difficult to treat and leads to a high likelihood of limited ability to expand their life and early medical consequences. The cause of this subtype appears to be a specific genetic predisposition to prolonged starvation.

When I wrote about anorexia in the recent past, I have called this subtype of anorexia the only type that exists without explicitly naming it as a subtype. The changes in classification necessitate that I differentiate between the types of anorexia.

In the next posts, I will talk more about the varied subtypes and the ways each type is treated similarly and differently.