Fatal Inspiration —

Serious trigger warning: The following post is about anorexia, thinspiration and suicide.

How many times have you read, heard or been told that Fat Acceptance is enabling fatties to make horrible health choices? How many times have you heard that Health at Every Size is promoting unhealthy lifestyles? How many times have you heard that being fat and proud is a death wish?

It’s the go-to critique of Fat Acceptance that by advocating for self-acceptance we are simply encouraging irresponsible fatties to continue eating unhealthy foods, have sedentary lifestyles and ignoring the “fact” that all fatties will die tomorrow.

And yet, we never hear about how the wider culture, the popular culture, is doing a much, MUCH better job at encouraging reckless lifestyle choices and hastening our deaths.

We frequently read specious claims that childhood obesity may reduce a fat child’s lifespan or that obesity can reduce anyone’s lifespan by three years or ten years or twenty years. Oh the humanity! Quick, somebody sound the alarms, we have an EPIDEMIC… nay, a PANDEMIC on our hands.

But when it comes to eating disorders, particularly anorexia, we hear nothing but crickets.

Why?

Well, the most common reason I hear for dismissing the deadly disease of anorexia is that it’s rare.*

Regardless of how rare it is, the mortality rate for anorexia is disturbing.

Females between the ages of 15 and 24 are 12 times more likely to die from anorexia than all other causes of death, according to the National Eating Disorders Association in America.

The most common cause of death? Suicide.

… the risk of death by suicide among by anorexic women to be as much as 57 times the expected rate of a healthy woman.

The mental image of the young girl wasting away until her body finally gives up is not what we should be guarding against. In fact, according to a study in Psychiatric News you cannot even judge the physical or mental health of an anorexic simply by looking at them:

“[N]ot all the anorexia subjects who died were severely underweight,” Herzog stressed. “In fact, a number were at about normal weight or even above normal weight. So just because one achieves normal weight in these subjects is not a reason to discontinue monitoring them.”

Another assumption is that the suicide attempts are aided by the weakened state of the body. Not so, according to one study.

The study results show that anorexic individuals who attempt suicide have a strong wish to die and engage in an act of self-injury with a very high likelihood of death, said Dr. Holm-Denoma.

These findings support Dr. Joiner’s theory of suicidal behavior that suggests that individuals with anorexia may habituate to the experience of pain as a result of their illness (such as starvation pain and frequent chest pain) and die by using extreme suicide methods, the group concludes.

Anorexia and suicide is on my mind because the other day on Tumblr I came across this woman’s suicide note:

currently, i have absolutely no reason to wake up tomorrow. its just going to be another day of me getting nowhere. so ive kinda decided i dont want to wake up tomorrow. i dont want to have to put up with another day of feeling not good enough. i dont want to have to go through another day of letting you down. you thought id do so well, and ive done nothing but fuck things up. i cant breathe right now because im so scared of what im about to do. but im doing this for you. im doing this so you dont have to waste another minute of your life on me. youre worth more than that, and you deserve better.

i know youre not going to see this, you dont even know this tumblr exists.
but im sorry. and i love you. and i know youll be strong without me. <3

Although she slit her wrists, her sister found her and she survived.

In that post, she mentions that she is schizophrenic and bipolar, and that this is her 18th suicide attempt. She’s also anorexic, having starved herself from 350 pounds at age 14 to her current weight of 230 pounds (it has since been deleted) with a goal weight of 140 pounds.

Since there are so many factors involved in this, you can’t simply point to anorexia and say that it’s the culprit. But three days prior to her attempt, she wrote this:

i dont post on here about my food.

i dont eat food anymore.

i dont look at food anymore.

i dont see food in my kitchen.

i see calories.

i see fat.

i see years of unhappiness with my size.

i see warning signs, i see red flashing lights, i see panic.

i see all the things im trying to avoid.

Anorexia is more than young girls trying to get thin or looking in the mirror and seeing a fat girl, as it is often portrayed. Anorexia is a disease of control.

Anorexia can be a way of coping with a life that seems out of control. By restricting, or neglecting, caloric intake, one can control the body in a way that we cannot control the world. If you depend upon that false sense of control, then when your artificial control slips (giving into hunger, gaining weight, perceived negative changes in body) you can be overwhelmed with despair.

Not only that, but the cognitive effects of insufficient nutrition are well-documented and include anxiousness, depressed feelings, agitation, bad judgments, foggy thoughts, and dull and slow thinking process.

These two factors alone make anorexia dangerous, but what makes anorexia deadly are the enablers. It’s called Thinspiration and it’s very popular on Tumblr. Basically, people post photos of underweight women and quotes (such as the thoroughly repugnant, “Nothing tastes as good as skinny feels”) and encouragement to keep starving themselves. If you’re curious, here’s an example.

There are also assholes like millionaire Kenneth Tong who tweets encouragements like “Remember: Hunger hurts but starving works.” (Although he has since deleted all of his pro-ana tweets since this scathing article came out about him.)

Pro-ana encourages women (because despite the increase in male anorexics, this is primarily a woman’s disease) to change who they are and to take deadly action to achieve that goal.

These are the people who are actively encouraging anorexia.

A subtler form of pro-ana encouragement comes directly from our culture, where actresses, models and even politicians are scrutinized about their weight. It is Pro-ana Lite, promoting the deadliest mental illness among teenage girls.

This is acceptable in our society.

Yet suggest to a fat person that they should be happy in their bodies and we are complicit in encouraging unhealthy lifestyles and increased mortality.

You want to see what fatspiration looks like? Here it is.

It looks identical to thinspiration, except there is no encouragement to change. And that is the real problem that people have with Fat Acceptance. By helping people accept their bodies as they are, we are accused of enabling because the default position for all fat people is supposed to be changing yourself to a smaller size.

Pro-ana sites and our Pro-ana Lite culture encourage perfectly healthy young women to also change their bodies to a smaller size, yet only those body image activists who reside mainly on the fringe of society are raising the alarms.

This is how twisted our society has become: we care more about preventing people from dying at 58 than preventing teenagers starving and killing themselves; we care more about shaming fatties into weight loss programs than helping anorexics into recovery programs; we care more about images of headless fatties than images of emaciated models.

Fat Acceptance and Size Acceptance are movements that bridge the gap between these two concerns. Fat Acceptance is not about neglecting the health of fat people; it’s about teaching fat people how to be healthy with the body they have, rather than the body they’re told they should have. Size Acceptance is about teaching health across the board and ignoring the ideals and the “defective.”

To say that Fat Acceptance is enabling unhealthy behavior is utterly ludicrous in light of our culture that celebrates a beautiful death.

*It is difficult to nail down the rate of eating disorders since EDs are based on behavior, not weight, but current estimate suggests that 8 million Americans suffer from anorexia or bulimia, which is 2.7% of the population. Of those 8 million, 95% are between the ages of 12 and 25 with anorexia being the third most common chronic illness among adolescents. 0.6% suffer specifically from anorexia.

Of course, if we were going to treat the Underweight category as a disease (as they do for the Obese category), you could say that 3.8% of kids aged 12-19 are underweight and therefore unhealthy. The CDC estimates that 18% of kids aged 12 to 18 are obese.

It’s also interesting that in the most recent Youth Risk Behavior Surveillance System (PDF) the following statistics were revealed:

• 12.0% of students were obese.
• 10.6% of students did not eat for 24 or more hours to lose weight or to keep from gaining weight during the 30 days before the survey.
• 5.0% of students had taken diet pills, powders, or liquids without a doctor’s advice to lose weight or to keep from gaining weight during the 30 days before the survey.
• 4.0% of students had vomited or taken laxatives to lose weight or to keep from gaining weight during the 30 days before the survey.

But let’s go with the basic numbers: 0.6% have anorexia and a mortality rate of 0.56%.

That means that of the 1,800,000 Americans have anorexia and 1,710,000 are between the ages of 12 and 25. Of them, 9,576 will die this year as teenagers. The CDC states that “16,375 teenagers 12-19 years died in the United States every year from 1999 to 2006.”

Compare this to a recent study of nearly 46,000 Swedish men ages 16 to 20. Of the 367 obese participants, 49 died during the 38 years of follow-up. That shakes out to about 13.4% over 38 years. There are 21,469,780 teenager in the United States and 18% are obese, which equals 3,864,560. Of that group, 517,851 will die by the time they are 54 to 58. That’s 13,627 each year for 38 years. And I would venture to guess that it increases with age, but even so, the difference is startling:

Of 1,710,000 anorexic teens, 9,576 will die as teenagers, or a mortality rate of 0.56%.

Of 3,864,560 obese teens, 13,627 will die as teenagers, or a mortality rate of 0.35%.