Not all anorexics are too thin

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

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Not all anorexics are terrifyingly thin. With atypical anorexia, even chubby people can get into a life-threatening state. And that's not that rare.

Anorexia nervosa is a mental illness that can have serious physical complications. One in ten people die. If you meet patients who are only skin and bones, the threat of the situation is obvious to everyone.

Anorexic and yet too fat

But there are also anorexics who are (still) normal or even overweight. This form of anorexia is known as atypical anorexia. But they are also characterized by restrictive eating behavior, weight loss and a strong fear of gaining weight.

Often these patients are initially overweight. If they lose weight, they will be encouraged by their environment. They get compliments on how good they look and enjoy wearing trendy clothes. So encouraged, they continue to decline rapidly.

Body in starvation mode

Patients with atypical anorexia often quickly lose up to a quarter of their original body weight. But even if ten percent of the body mass is lost too quickly, the body switches to starvation mode. The pulse rate slows down sharply, the blood pressure drops. The electrolyte balance is also derailed. In extreme cases, life-threatening cardiac arrhythmias can occur.

The only way to get out of dangerous starvation mode is to put on weight again. But that is more difficult to convey to patients and relatives in atypical anorexia. "People understand that extremely thin people need to gain weight," says Melissa Whitelaw of the Royal Children's Hospital in Melbourne. This is more difficult to understand with normal and overweight people.

Every third patient is not too thin

Together with colleagues, the nutritionist examined 171 patients between the ages of 12 and 19 who were being treated in her clinic for anorexia. They found out that atypical anorexia is not uncommon: every third of the anorectics treated was normal or overweight.

"We are now seeing that you can have a completely normal body weight and still be just as seriously ill as someone who suffers from typical anorexia," said Whitelaw. The problem is that this group of patients would be taken less seriously. Even seriously ill people are at risk of being overlooked and of no help.

Redefine anorexia

The researcher calls for the current standards for defining the disease to be adjusted and for the underweight criterion to be removed from them. As more and more people are overweight or obese, eating disorders have also changed their face. The proportion of normal and overweight anorexics could increase significantly.

Families, teachers, sports trainers should be alerted if young people have shown worrying eating behavior and are losing weight significantly - even if they are not underweight. Professional advice on healthy weight loss is also useful, especially for young people who want to lose weight.

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