What's worse?

Let the statistics tell the story:

What's worse, being obese or suffering from anorexia nervosa? People we asked on the street responded "being obese."

But that's not true.

Medically, more people die from anorexia: 20% of people die from the psychological disorder where as an obese woman at 25 still only has a .01% risk of death.

And there's all of this hysteria about obesity and not a whole hell of a lot about eating disorders, which really makes me scratch my head. You're 2000 times more likely to die from anorexia than obesity. An eating disorder triggered by misguided "obesity prevention" efforts isn't a side effect, it's not an acceptable casualty.

It's deadly.


TwistedBarbie said...

If you are looking at it from a purely scientific viewpoint, I agree with you. However, having been both, I would say that the trauma I have from being obese is FAR worse from my experiences with the other side.
That isnt to say that anorexia isnt pure hell... but obesity is pure hell plus the onslaught of culture and society.

Carrie Arnold said...

Culturally, you're right- obesity is reviled, and anorexia can be worshipped. But that's a problem with culture and not with obesity.

And I think the "obesity prevention" efforts are only making the stigma worse, not better. Look at how much money we're pouring into research and prevention for obesity, and compare it for eating disorders. I have heard heaps about the dangers of obesity, but no one told me (not once! Ever!) about the dangers of laxative abuse, or over exercise, or starvation, or dieting, or vomiting. And from a statistical standpoing, they're far more deadly.

Kim said...

I agree with you Carrie -- society is way too obsessed with this "obesity epidemic." And, while they sometimes discuss the dangers of eating disorders, out of the other side of their mouths, they are talking about the importance of eating healthy, staying thin, etc, which can be interpreted by people like me to mean going to extremes = good. Eating disorders are deadly. I still feel like they are totally misunderstood, as passing phases that girls go through on the quest to look like a model. It upsets me.

Anonymous said...

I consider this comparison (medically) all the time ... part of my denial, probably.

In my particular case, I have "stable" anorexia and am "high-functioning." My weight is very low, and I *do* have medical complications from my disease and its chronicity, including cardiomyopathy, most notably, and chronic anemia (though not osteoporosis ... even at past middle age). From a comfort perspective, neuropathy in my feet due to nerve degeneration from malnutrition is a problem, but it won't kill me right away (though loss of myelin sheath overall could).

However, I don't have fatty liver, high cholesterol, arteriosclerosis, high blood pressure, kidney or gall bladder problems, diabetes ... I don't purge nor over-exercise. I don't drink alcohol, nor do I smoke/smoke to control weight. I also don't take diet pills, diuretics, laxatives, etc. I don't have dizzy spells, pass out, lightheadedness, hydration issues, etc.

Most importantly, I am not suicidal, nor do I have an uncontrolled mood/personality/other disorder ... and I'm not taking medications (which for anything, mental health or medical, could cause side effects that could tilt a person's health profile to "worse"). I am a *very* anxious person, and that probably wears at my health, but I am not depressed. I have a healthy and safe physical environment and supportive family; I take the recommended multivitamin, calcium+D+K, and B-complex; I engage in stress-management activities such as breathing, yoga, visualization, DBT and CBT; and I keep my appointments with physicians and my therapist.

So, who is worse off? Both the obese person and I could over-tax our hearts and have a cardiac event. I am more vulnerable to immunocompromise in the event of a flu or other illness. I am possibly more at risk for sudden decompensation for no apparent reason. But I have very few health problems outside of the symptoms of anorexia itself. The obese person could have numerous problems associated with high blood pressure, high blood sugar, and high cholesterol. The obese person may *also* have eating disorder behavior and co-morbid mental health issues.

I may feel labeled and isolated in my illness and feel resignation that I may not ever recover. People may judge me and talk about my crazy self behind my back ... but probably not more judgmentally than someone challenged by obesity.

I don't know if we can yet say which is "worse." I think the science may need to catch up with a generation of overweight people and a new era of eating disorder treatment ... to really weigh in.

sannanina said...

And I think the "obesity prevention" efforts are only making the stigma worse, not better.

Absolutely. It is ironic that one of the reasons often named as justification for "obesity prevention/ intervention" is that fat peopel have a higher risk for depression. As far as I know nobody has yet discovered a pathway by which my fat cells influence my brain chemistry. If fat people are at a higher risk for depression I would suppose that this is due to experiencing stress and body dissatisfaction because they are told all the time that their body is unacceptable. For example, there is evidence that people who have been bullied as children have a higher risk for depression later in life.

As a fat person with an ED I also believe due to personal experience that the "obesity prevention/ intervention" I have been exposed to since I was a kid actually played a significant role in developing BED. It's anecdotal, I know, but there is at least some research pointing in that direction. In any case, it hinders my recovery since even a significant number of therapists that I have seen in my life have seriously suggested I go on yet another diet. (Not to mention that therapists'/ doctors' negative attitudes towards my body and their often negative stereotypes of fat people make me very, very reluctant to seek help for my depression.)

It's quite ironic: People with EDs really could use additional research on their disorders as well as better treatment options while fat people would probably benefit from being left alone.

Cammy said...

I think a major issue with this particular poll/survey is probably just general ignorance about what an ED is like. The people that answered the question probably heard "anorexia" but thought "a skinny person with strict impulse control." If you frame it like that, it seems like a no-brainer. I think that there are still way too many people who think anorexia is more of a dieting strategy than a mental illness.

mary said...

I agree that we have loads of info yet to get out regarding ED's. We really can't blame people for their lack of knowledge. There may be a lack of understanding at the fight it takes to recover from anorexia. I mean, if it's never been in your life experience, with friends or family, it would be quite easy to think that anorexia "only" means eating whereas obesity may mean dieting and all the other hype the media bleeds into our heads. We have TV shows showing how brutal weight loss is. Eating seems to be the "easy" recovery. This may be the knowledge that's yet to be told. Anorexia is a disease, not a waist size or weight.
I do feel that it's important to honor both because we do have some very disordered eating going on in both sides of the camp and perhaps they are more alike than we'd like to admit.
There a difference between an obese person, as with a skinny one, who has energy and is strong and healthy and those who are obese or thin with failing health? For some gaining is a daily event and they can't maintain there weight. Some people may need to lose weight just as some may need to gain it, IMHO, and they needn't apologize. Tolerance may be what is needed here. Perhaps asking people to give a preference is not the best of questions. I prefer health at whatever size, but then I'm in the know.;)

Carrie Arnold said...


That, my friend, is exactly it. Brilliantly put.


You're right- both obesity and being underweight can be signs of disordered eating. The irony is that dieting never helps. Sigh.

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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