How to cure Anorexia nervosa
Anorexia nervosa is not caused by "The Patriarchy"
Anorexia nervosa typically befalls young females and because no one has a clue what its real cause or cure is, it is commonly blamed on "the Patriarchy". Psychologists and journalists alike claim that the disorder is either an out-of-control attempt to conform with unrealistic body-esthethic standards for women, promulgated by modern media, or a post-traumatic stress response to childhood sexual abuse. It is neither.
In order to design a cure for Anorexia nervosa, we first have to understand how it comes about. People don't suddenly "catch" Anorexia nervosa. It develops over the course of weeks, months or years.
Anorexia nervosa is caused by a positive feedback loop fueled by fear, building willpower
Anorexia nervosa really is a positive feedback loop that strengthens WILLPOWER. It goes like this:
- Person strongly desires to lose fat
- Person starts restricting calories, excercising or even regurgitating
- This behavior has the desired effect and thereby reinforces the anorectic behavior: The person's willpower to engage in anorexia-behavior is strengthened
- Another powerful Anorexia-motivator emerges: Fear of losing control. This is the "nervosa" part. Hunger is a powerful counter-motivator to anorectic behavior.
- A strong positive feedback loop develops, whereby the patient, in the first weeks, months or even years of her behavior is glad about her weight loss, increases her willpower to comply to her dietary regime and increases her fear of failing in her endeavors, since it is a scientific undisputed fact that 99% of diets eventually fail.
- The patient's success-inspired willpower and fear of failure has been sufficiently strengthened that the patient becomes determined not to be part of that 99%. The patient becomes obsessed with succeeding, with never giving up. The patient starts to develop powerful habits, permanently changes her lifestyle. The patient, in her attempts to become "the 1%", in fact becomes the "0.001%" and, without heroic intervention, will die of starvation, because the harmful behavior has been completely internalized, backed by fear. Fear is the most powerful motivator.
My postulation is that Anorexia nervosa occurs mainly in people with a combination of exceptionally strong willpower and who are highly motivated by fear. It is useless to lock these girls up and fatten them with cookies and pudding. All this does is traumatise them.
Anorexia patients are stuffed with empty calories
There are inpatient clinics where anorectic girls are forced to eat garbage. "Food" full of empty calories. Well-meaning social workers police the girls' every waking second, making sure they eat as unhealthily as possible, to get a layer of fat back on ASAP, by means of ingesting the cheapest, worst food available.
This does not work at all, and those girls move in and out of clinics and often eventually die of their condition. I have seen it happen with my best friend.
Because it costs money in an area considered irrelevant by the self-appointed "experts", my recommendation will of course never be followed (just like the food in hospitals will remain forever unappetizing and near-devoid of nutrients), but the first thing that should happen in those in-patient clinics (which are in general a good idea) is this: Educate the patients as to what types of food are nutrient-rich and provide an ample supply of those foods. Anorexia clinics currently do NOT provide their patients with the nutrients their bodies are so desperately starved of. Instead they have to eat chocolate bars and other despicable garbage, further deteriorating the anorectic's condition.
The anorectic does not want to be fat. So what is the solution? Building muscle of course!
Instead of locking the girls up in a fattening monastery, feeding them repulsive (especially to them) garbage, give them only super-healthy food to eat, teach them to prepare that food themselves, teach them REAL nutritional facts (and not the government-mandated nonsense) and instead of freaking those girls out by stuffing them with cheap empty carbs, feed them much more protein and let them loose in the gym. The girls will associate lean meat and working out in the gym with "losing weight" but under proper supervision, they will actually be replenishing their bone minerals, strengthening their tendons, rebuild their organs and build up muscle.
Anorexia clinics are very counterproductive
Instead, anorexia clinics have only one goal: Add a layer of fat to these very sick people as cheaply and quickly as possible. That does not work, because anorectic people do not want to be fat. You can't force people to trade one unhealthy habit for another unhealthy habit, certainly not anorexia patients. They will fall back into their old patterns as soon as they are released from the clinic.
Focus on "lean gains", adding muscle, not fat
My suggested therapy consists, as said before, of a nutrient-rich diet, promoting muscle/organ/bone growth instead of cheap empty calories that increase weight by adding fat. Plus a workout regime to build the so badly needed muscle. Anorexia patients object infinitely much more to getting fatter than to getting more muscular, and they have not much objection to "working out". Moreover, gained mucle is much harder lost than gained fat.
Slowly, the patients adjust to a HEALTHY diet, as opposed to the diet they have all those years avoided: Copious amounts of empty calories.
But that is only half the battle. As I said before, Anorexia nervosa is caused by a positive feedback loop, fueled by willpower, fear of failing and positive results. In order to break the viscious circle, we have to use the patient's exceptional willpower and fear-motivation against the damaging behavior.
Emphasize that the goal is to avoid fat gain
It has to be made clear, time and time again to the Anorexia inpatient that the dietary therapy is aimed at gaining lean muscle mass, not fat. This kind of diet is in fact considered "hard" because it is very low on carbohydrates. The patient will be much more compliant when the food is not packed with empty calories, especially not when dietary science is used to back up the claim that refined carbohydrates, due to the insulin response, cause obesity and that a diet rich in fat and protein does not.
Use role models
Athletes and body builders have good looking bodies, and yet they eat a lot. Their diet promotes muscle growth, not fat accumulation. They also are physically active, something anorexia patients try to be as well, in order to lose more weight. Invite ahtletes and body builders to visit the Anorexia clinic to show their bodies and explain their diets and exercise regime. This demonstrates to the Anorexia patients that it is possible to remain lean and have a good looking body even when eating a lot.
"Skinny shaming" works on Anorexia patients
Being politically correct is not more important than saving a dying person. Just like it is ethical to "shame" a morbidly obese person back from the brink of a heart attack, it is ethical to "shame" an Anorexia patient from multiple organ failure as well. The reason that "skinny shaming" will work on Anorectic people is that "fat shaming" usually was a significant factor in the detrimental dietary lifestyle they ended up with. Show the patient photographs of obese people, anorectic people and of athletes (preferably lean athletes such as runners). NOT of ordinary people, because what a society considers "ordinary" may be considered overweight by scientists or the anorectics themselves.
Use the patient's momentum to their advantage
The Anorexia inpatient still is stuck in their powerful habit of starvation. Their motivation to form that habit was the fear of being "fat". Instead of attempting a 180 degree turnaround in the patient's habits, something that will run into "inertia" problems, the patient's "momentum" should be leveraged to aid the dietary therapy. Tell the Anorexia patients that their goal, and the therapists' goal, should be to achieve a muscle-to-fat ratio as in those athletes. This will be the most acceptable form of therapy for the Anorexia patient, because body fat will not increase much and a strict diet + excercise is involved, preserving the self-disciplinary momentum already present in the patient and merely slightly changing the goal posts from "I will starve myself and walk/bicycle so that I will not get fat, because that looks bad" to "I will be on a special carb-restricted diet and muscle building regimen so that I won't get fat but only will get muscles, which looks good".
Fattening up an Anorexic is a very unwise goal
Current anorexia treatment is focused on adding as much fat to the patient as possible. No person needs more than a few percent body fat. Women need a tiny percentage to remain fertile - men need a tiny percentage to maintain a healthy Testosterone production. A therapy that deliberately greatly increases body fat percentage is the stupidest idea ever, to treat anorectics. An anorectic person doesn't need to add tons of body fat but minerals, vitamins and protein. By slowly bulking up muscle mass, the fat will come too. This is done by eating mostly fat, vegetables, salads, nuts, and protein. Carbohydrates should be limited, to treat Anorexia patients. The big problem with anorectics is that they lack muscle mass and that their organs are shrinking. But in the simplistic view of the clinics, it's their scale weight that needs to increase, by the fastest, cheapest way possible: Stuffing the patient with carbohydrates. The only criteria to judge success by, when treating anorexia patients, is not how much weight they gained at the end of their treatment but how much lean body mass they gained, how much strength and endurance they gained, how much their organs increased in (lean) size and how much bone density they regained. Scale weight by itself is utterly irrelevant because if you'd simply add a ton of fat to a terminally anorectic person, the result would be even worse because if the anorexic decides to lose weight again, the muscle- and organ loss accompanying it would likely be fatal. Cheaply and rapidly fattening up anorexics may very well contribute to their deaths.
Written by Frank de Groot