No Country For Swole Men
Please stop peer diagnosing binge eating recovery as another eating disorder
If you haven’t noticed the droves of commenters offering rogue diagnoses of eating disorders in healthy people, pause here. Look for posts on Instagram, TikTok, or maybe Twitter, showing how people transformed their physiques through nutrition and exercise. Search for phrases like “weight loss transformation” or “gym glow up” or “fat loss recipe” and pick a few videos with high engagement. For bonus points, find a man, one who was way bigger in his before than in the after. Ignore the liars who say that he was more attractive before, and time how long it takes before you see a rando claiming the OP has an eating disorder. Then come back and read on.
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Annoying, isn’t it? May as well advise recovered restricters that they shouldn’t eat a “fattening” dish, or whatever ignorance you might set them off by spouting insensitively. I get why people do this, though. Everyone who has ever tried to help someone with an ED knows that they always deny their condition over and over until, hopefully, the need to seek help finally hits them like a freight train. If anything can piss me off more than someone being aggressively incorrect and infinitely defensive, it is the same person doing the same thing, but with genuinely good intentions.
Survivors of restrictive eating disorders, whom I believe write most of these comments, remain relentless in their crusade, despite being trolled and perceived as trolls. They do so because they believe we clean-eating former fatties need the same help that once saved them from getting blown into their graves by a light breeze. In this light, annoying the hell out of us is an authentically compassionate and loving thing to do. The problem is that they’re entirely incorrect about the nature of our disorder, and they have far less in common with us than they imagine.
Make no mistake: I am profoundly angered by these exhausting, unwelcome, and occasionally triggering comments. I want to communicate my objection clearly, because I think it is reasonable enough that people don’t understand our situation. Binge eating disorder (BED) only entered the DSM proper in 2013’s 5th edition, despite clinical awareness of it dating back as early as 19591.
By the time our condition appeared on the public radar, the public had already identified eating disorders with earlier epidemics of anorexia nervosa (AN) and bulimia nervosa (BN) that harmed thousands of adolescents and young women2. As we’ll see, framing an ED that mostly affects a different population in terms of the typical inpatient restricter (i.e., an adolescent female with advanced AN/BN) is just one of many reasons intentional self-regulation of food intake is mistakenly identified as a disordered behavior by well-meaning laypeople.
Whose Waistline Is It Anyway?
The dark forces of pop psychology and soundbite dietetics, no longer stuck occupying Yahoo! Answers, have set their sights on obesity survivors of all types across the Internet. Those of us who had to recover from binge eating disorder to escape that vicious cycle of a disease have a weak spot they target with deadly accuracy. Our weakness is that we believe, probably irrationally, that we can’t maintain our improved health. It is no coincidence that we fear a return to chronic binge eating, a type of relapse that involves putting something into our bodies, because practically we live around the midpoint between crackheads and cutters.
People with BED are not “addicted to food”, but we eat compulsively and feel that we cannot control ourselves when we do so. We are often habituated to the effects of consuming too much of our preferred binge foods, in much the way that others we technically don’t call “addicts” become habituated to their drugs of choice. In fact, foods like chocolate and chemical weapons like the Starbucks Caramel Cocoa Cluster Frappuccino contain psychoactive drugs that soothe our real or self-induced stress. Even table sugar is a drug in this capacity!
Straying yet further from a clinical sense of addiction, bingers might relate to feeling figuratively addicted to suffering, recalling the experience of other patients who engage in non-suicidal self injury (NSSI). Disordered eating “in either direction”, so to speak, easily functions as a continuous practice of ritualized self-harm. Indeed, less socially-acceptable self-injury behaviors like cutting and trichotillomania are comorbid to eating disorders3. Our compulsive eating isn’t primarily about physiological hunger4, but the use of food as a replacement for psychological “nourishment” of a non-nutritional nature, a way to hide behind the resulting fatness, or a weapon to hurt the people we hate most: ourselves.
Binge eating disorder is … unlike anorexia nervosa or bulimia nervosa, except that all involve disordered patterns of food consumption … [the pattern does] not offer enough information to diagnose the disorder … We who suffer from BED think and behave less like anorexics than like drug addicts.
However, the adverse outcomes of BED are clearly physiological, because our disordered eating pattern necessarily leads to obesity unless we get it under control. In turn, obesity wreaks havoc on the endocrine system, drowning out healthy hunger signals in the cacophonous hormonal noise it orchestrates. Still more dauntingly, regardless of how it initially developed, chronic obesity perpetuates itself by effecting obesogenic behavior and hormonal cues.
Bingers have to treat our disordered eating to resolve the obesity in a sustainable way, but this secondary condition of obesity causes most of the harm BED sufferers experience. On the other hand, both anorexia nervosa and bulimia nervosa are potentially fatal primary conditions, a factor that contributes to their overrepresentation in the literature. Restricters who end up in the emergency room are easier to study than couch potatoes who smash a family bag of Doritos every other night.
Another difference is that restricters have far less time to recover before their diseases become life threatening. Yet more distinctively, to recover from a restrictive disorder, you have to do something. Specifically, you have to eat a healthful quantity of food and keep it down. Anything you have to do on purpose, you can refuse to do, which is why clinicians sometimes must traumatically force-feed non-compliant anorexics.
In contrast, to recover from negative BED outcomes, you have to stop eating, to a calculated extent and for an extended period of time. You could treat and even reverse most life-threatening complications of BED — really, of obesity — by locking your bingers in a room where they receive supplementary nutrition while otherwise fasting until they reach a healthier size and their endocrine systems adapt to the recomposition. (This treatment protocol is not advisable due to laws made by freedom-hating nanny states, which criminalize entrepreneurial activities like kidnapping, false imprisonment, and impersonating a medical professional.)
Such an approach is obviously not an option when treating a restricter. As a result, thankfully, BED is not an imminently life-threatening diagnosis, but a giant flashing warning sign, as well as an explanation for why we act like we do. Think of the difference between pathological restriction and compulsive eating like this: you die far sooner if you start swallowing cigarettes than if you start smoking them, but the second option ruins your life long before ending it.
Binge eating disorder is thus entirely unlike anorexia nervosa or bulimia nervosa, except that all involve disordered patterns of food consumption. Notice that I said “involve”, because as we’ll see later, an eating pattern consistent with a particular ED does not offer enough information to diagnose the disorder it characterizes. We who suffer from BED think and behave less like anorexics than like drug addicts. Alcoholics in particular parallel binge eaters not only in patterns of hoarding and lying about consumption, but in the adverse physiological outcomes they develop.
Every fat boy is a “soy boy”
Allow me to offer a concrete example of obesity-related endocrine chaos, in a form that affects men especially severely. Adipose tissue (i.e., fat) requires estrogens to function correctly5, so it helpfully converts free testosterone to estradiol through aromatization. This is fine and dandy until you become overfat (i.e. you have more fat stored than your essential fat tissue can hold) but continue to eat food without using your stored fat. Reacting normally to chronic caloric abundance, the body creates more fat cells and stores that excess energy in them, because humans are well adapted to famine and endurance exercise.
However, the adrenal and gonadal glands that produce your endogenous testosterone do not increase their output in response to the surplus adipose tissue’s overconsumption, so over time you “leak” a growing proportion of your testosterone via the aromatase conversion pathway. The testosterone leak not only effects disordered sex hormone ratios in men, but encourages compounding fat storage in both sexes, a biochemical feedback loop that kept our ancestors alive long enough for us to suffer from it.
Naturally, this relentless and excessive conversion of androgens into estrogens eats into a patient’s testosterone levels, especially if the patient does not receive TRT. Low testosterone, whether due to excessive estrogen conversion or deficient gonadal function, leads to depressive symptoms and conditions like erectile dysfunction67. Over time, obesity also contributes to insulin resistance and insensitivity to hunger regulation hormones like leptin, setting the stage for T2 diabetes mellitus.
Restriction is not a symptom of BED, nor does it suffice as grounds for diagnosing any other eating disorder … For binge eaters, self-control and intentionality in both consumption and abstinence are key components of recovery.
Next, let’s consider the sexed distribution of clinically-recognized eating disorders, so as to tease out an observation essential to the point I want to make. Most people diagnosed with eating disorders (a) are women, and (b) have disorders characterized by primarily restrictive eating behavior. For instance, both BED and BN involve bingeing, but bulimia nervosa remains primarily restrictive because the desired (if not actual) outcome of its characteristic binge/purge cycle is a caloric deficit, i.e. restriction of food intake.
Though the DSM-5 eliminates it, it is worth considering that prior to BED’s inclusion, a distinction was made between bulimia nervosa and a subtype thereof in which restrictive episodes do not involve “purging”. Drawing the imperfect border line between the DSM-4’s proposed BED criteria and its included subtypal diagnosis of nonpurging BN required debate within the field. In a book written prior to the DSM-5’s publication8, I saw the proposed BED criteria contrasted with features of nonpurging BN as follows:
Bingers exhibit less temporal stability than nonpurging bulimics, while bulimics of either type demonstrate similar temporal stability to each other. This demonstrates that BED is not only distinct from BN, but develops and intensifies differently.
Bulimics have larger binges, the short-term contrast of which to their restrictive behavior (i.e. their binge/restrict cycle) makes their restriction obviously intentional and “compensatory” in relation to the binge.
In one study, nonpurging bulimics developed more concerning outcomes on average over the course of a year, which is unsurprising given the slower development of BED complications and the relative lack of obsessive thinking in BED patients.
Risk factors for both conditions overlap, but their predictive strength for BED is weaker than for BN. Patients with these shared risk factors are more likely to develop BN than BED9.
In other words, it is a clinically-adjudicated psychological aspect of restriction that renders the behavior disordered in the context of [nonpurging] bulimia nervosa. Bulimics construct a lifestyle around the binge/restrict cycle. Bingers do not restrict consistently until we change our lifestyle entirely and quit bingeing. Still less do we restrict obsessively while actively experiencing our disorder10.
Assuming there is no outlandish disparity in the demographics of those diagnosed with a given ED and those who recover from it, we can deduce that most ED survivors you encounter are women who spent the most miserable years of their lives obsessed with minimizing their caloric intake. Additionally, among the minority of us with disorders of excess like BED, the majority are still women.
The above is consistent with the findings of a 2009 study11 made available by the National Institutes of Health. I say “consistent with” because this is a topic I know well but for which I cannot rattle off a bibliography. This particular study has clear methodological shortcomings that make it non-authoritative, which claim I’m sure the authors would find unsurprising. (Further studies are referenced below.)
One Woman’s Trash Is Another Man’s Treasure
Based on everything the typical recovered anorexic has experienced, personally and through ED-oriented online subculture, the practice of food journaling (tracking macronutrients and calories) is a red flag and a trigger. Personally I once had a coworker invite me to Anorexics & Bulimics Anonymous because she noticed me logging a meal in MyFitnessPal. At the time I was using it to make sure I reached a caloric surplus to accompany my strength training12. I appreciate her concern, as it probably is the case that almost every anorexic uses one of these apps, but that doesn’t make her assumption any less intrusive, not to mention inaccurate.
Here’s the part I need you to remember: relatively few men are restricters, and within that category AN and BM are specifically prevalent among the small minority of men who are homosexual1314. When it comes to eating disorder epidemiology, we are dealing with an inversion of the medical sex bias documented by Caroline Criado Perez in her book Invisible Women15, which I relocated from my feminist theory shelf to its current spot on my science shelf after only a couple chapters.
Restriction is not a symptom of BED, nor does it suffice as grounds for diagnosing any other eating disorder. We bingers are far less likely to have obsessive-compulsive tendencies, common in nervosa group patients, that so often contribute to harmful restriction. For binge eaters, self-control and intentionality in both consumption and abstinence are key components of recovery.
More on this point later, but bear in mind: there is no etiology or symptom common to all conditions in the category of eating disorders. The unifying factor is that the patient’s eating pattern negatively affects his or her health. Restricting systematically when you are objectively, clinically overfat does not harm your health. Bingers and restricters aren’t suffering from opposite dysfunctions of the same psychophysiological mechanism — to say nothing of patients whose disorder is that they literally eat dirt!
As we move towards our next topic, I would like to mention that I suspect binge eating disorder is underreported in both sexes, for such reasons as:
the obvious outcome of obesity overshadows BED as a primary condition,
it doesn’t lead to acute crises that generate convenient inpatient populations for the study of “eating disorders” (read: restrictive eating disorders), and
enablers keep ignoring the fact that you cannot become obese without some kind of disordered eating behavior, i.e. one that compromises your health, though it may remain technically subclinical.
These points are identified or at least foreshadowed to an extent by the clinical reference I cited, written when BED was still a proposed rather than fully recognized condition. For example, the book notes that diagnosable BED has an inverse correlation with age in bariatric patients. This means that if you become obese before you reach middle age, there is a higher probability that you got there by bingeing.
In summary so far: most ED cases concern anorexic women, and most patients treated for BED are women. Binges and restriction are both characteristic of multiple eating disorders, but both are also practiced by people without EDs. There are likely many recovered bulimics who mistakenly believe they had BED, because they used non-emetic restriction methods. Lastly, most men who have any eating disorder are binge eaters, and BED is likely underreported in general.
You Have Great Advice (For Other People)
If we eliminated pornography from the internet16, I’d expect the lion’s share of remaining content to consist of men and women instructing the opposite sex on how to behave, with the intended recipients of the unsolicited advice responding angrily. Accordingly, there is an abundance of well-intentioned wake-up-calling from recovered pro-ana girlies that “masculine” men (i.e. most men) find patronizing and demotivating. This bad advice is abundant because its missionaries won’t stop spamming their false gospel under photos of Aziz “Zyzz” Shavershian or David Goggins featuring captions like Time for snacks? I thought you said grind your lats!
As the comparative distribution of eating disorders by sex suggests, men and women develop eating disorders for vastly different reasons17. A likely problem for most survivors, then, is simply that they can’t relate to the BED species of brain worms. Which brain worms, then, do these restriction survivors relate to? And why are they overwhelmingly female, and convinced that gym rats restrict for pathological body-image reasons?
Among other sex-sensitive factors, such as comorbid OCD or outbreaks of social contagion, consider this: we live in a nightmare world in which capitalists are allowed to erect billboards in public space. If that weren’t bad enough, on those billboards they often display grotesque images of their coked-out courtesans. Those images fall short of pornography only by virtue of the total absence of remaining sex appeal in the ghoulish models they feature, specimens obviously selected by men who do not even like women. As you know, they do the same with every other medium available to them.
When you grow up absorbing such images as aspirational or even normative for your sex, of course your recovery will involve learning to respect yourself as the most important judge of your beauty. Of course you find healing in separating your sense of purpose and value from your looks. Men don’t have nearly as significant a share of this miserable experience of objectifying comparison.
We get too much of it, sure, and it has gotten worse in recent years. We get mad when Women On The Internet pretend they don’t value men’s looks. If we’re in denial, we pretend that women’s imperfectly explained preferences betray their shallowness, rather than their attraction to visible signs of personality, lifestyle, health and maturity. But if you think the scale of intra- or inter-sexual body judgment and surveillance between men and women is even remotely comparable, you’re literally not paying attention.
Thankfully, it appears the heroin chic of the Kate Moss era has been vanquished, or at least confined to the demon-infested sewage pit of haute couture. Even those 1980s leg-warmer ladies shaped like Plank from Ed, Edd, and Eddy are an endangered species. One can hardly imagine Eugenia Cooney on the cover of Sports Illustrated, with all its implications for “the beauty standard”. Such a choice would be rightly condemned for the danger it poses to public health. Yet models whose physiques reflect comparably disordered eating “in the other direction” have become famous overnight from gigs like that. Straight-sized bigots and their institutional skeletophobia, I guess.
Most adults in the United States are overweight; forty percent are obese. You see otherwise able-bodied young adults on scooter carts because they are too fat to walk around a store. The UK and Ireland are catching up fast, while the British Bullshit Corporation is out there publishing lies about how obesity works18. Feeder-fetish models go grifting on the news because they can’t fit their whiteface-Eddie-Murphy-in-a-fat-suit asses into airplane seats. Is it any surprise that young people, especially women, fail to recognize their BED early enough to avoid developing obesity from it? The high-fructose corn culture tells anyone who smells smoke that the house is totally not on fire, so don’t worry about it, and dares us “stigmatizing bigots” to admit our hateful belief that being on fire is intrinsically unhealthier than not being on fire.
One can hardly imagine Eugenia Cooney on the cover of Sports Illustrated, with all its implications for “the beauty standard”. Such a choice would be rightly condemned for the danger it poses to public health. Yet models whose physiques reflect comparably disordered eating “in the other direction” have become famous overnight from gigs like that.
One thing to note about restrictive disorders? They attract attention. As you begin to waste away, you get compliments. You especially get them from peers vulnerable to the same disorder, whose distorted minds envy the symptoms of your disease. Outside of those circles, the compliments give way to more neutral comments. Eventually, expressions of concern. If you push it far enough, you receive inpatient care or even a funeral.
Inversely, the subjective aspects of binge eating often boil down to this: you eat when you feel overwhelmed, you get fat because life is always overwhelming, and you stay fat to avoid living it. You can make yourself socially invisible by hiding under fat. No one ever compliments you for looking fatter, least of all your fellow fat people. If you push it far enough you don’t even have to leave your home!
As a man, staying fat is a reliable way to avoid any opportunity to experience social rejection. On the romantic end, not only do you tell yourself you can’t get a girl, but no attractive women approach you with flirty intentions. It even works if you’re gay, because gay men so infamously “discriminate” against fat guys. The reality of someone approaching you would, of course, force you to make decisions, to experience romantic rejection on one or the other side, all these uncomfortable things that only mature adults have to deal with.
If you are invisible, no one notices all your personality flaws. You don’t have to change anything about yourself, because you are not social enough for your worst traits to cause you any lasting trouble. Maybe you never even realized that you could change your behavior, attitudes, or circumstances, iteratively, until you actually enjoy your life. Obviously, if you can relate, yours is a different experience from that of our formerly-anorexic friends, and you need something different.
Many of us, myself included, needed someone to tell us to “man up” — in other words, to grow up, because a man is what a boy becomes when he matures. What this really means is that we missed out on some lesson that usually comes from father figures, which happens often, even to those of us with loving present fathers like my own. Motivational attitudes that work for people like me are those that acknowledge our hardships and then make demands of us — namely, that we either get our lives together or accept the truth and stop whining. Which truth? The fact that no one else can possibly care about your life enough to live it for you, especially when you haven’t even built a life that you care to live.
For some reason, some in the online bleachers think that telling people the truth — that there’s always something you can do to help yourself, and you can’t fix all your problems at once — is hateful or privileged or unempathetic. Ipso ergo, it is “right-wing”, presumably because the accuser thinks socialism is about self-actualization and validating each others’ feelings. As surely as Amazon is behind “boycotting Prime Day is ableist”, this is a psyop to ensure that the most politically active workers on the left remain mentally and literally weak, that we demand nothing of our comrades that might help anyone develop leadership skills. I’m half joking, but only half.
We Genuinely Know Better Than You Do
Athletic men are proficient in distinguishing disordered eating from disciplined eating when we see what other men eat. We can often tell when gym guys struggle with the proposed disorder of orthorexia nervosa, for example. If this is visible online you will see empathetic comments telling the guy to seek help. We are also aware of the prevalence of body dysmorphia among our peers.
You can observe this whenever a guy “bulks hard” but is actually just getting fat, or when a guy “cuts” to “show his abs” but has no musculature to speak of. People call the first guy a fatass and the second guy emaciated. Coming from peers, these are truly helpful, loving comments. If you don’t see that, fine, but you can’t project a less supportive intent on it because it didn’t mesh with your personality or communication style.
You’ll notice my reference for dysmorphia above comes from ANAD, the first organization established in the USA to fight anorexia nervosa and other eating disorders. Much like myself, they are not authorized medical professionals providing clinical advice. To quote their homepage at time of writing, they are a “peer run and professionally supported” organization.
While I am sure they are kind people, ANAD has the same problem as many other ED organizations: their resources are full of misinformation (and disinformation) about eating disorder diagnosis, especially for disorders of excess like binge eating. At my most generous I would assume this is because they think restriction is bad per se and they would rather lie to you than risk encouraging pathological restriction. Unfortunately for ANAD, non-restrictive ED sufferers also read their resources, and being overweight is no less bad than being underweight. It just takes longer to kill you.
Now, to their credit, in that resource ANAD does not invoke the term “bigorexia”, which I hate. “Bigorexia” is one of the stupidest terms ever invented, because it actually refers to something like Body Dysmorphic Disorder, and its name implies the opposite of the behavior you’d expect of a patient who inaccurately believes he’s extremely skinny. If you didn’t know better, you’d think the affix -rexia indicated disordered eating. In reality, terms like anorexia and orthorexia are neutral descriptors of dietary behaviors. No restrictive disorder is present unless its psychological criteria manifest alongside its characteristic eating behavior19.
Anorexia nervosa is not seen as a disorder simply because the patient does not eat, but because s/he avoids eating for irrational reasons and has a delusional perception of his or her body composition. Again I insist: the scientific term anorexia does not directly imply anorexia nervosa, though of course we often use it in this way. Anorexia primarily means “loss of appetite”, which more broadly stands in for behaving as though you had no appetite regardless of whether you feel hungry. Saying that “not eating”, so as to burn non-essential body fat, is the same thing as anorexia nervosa is like saying that drinking a glass of wine means you’re an alcoholic. Anorexia nervosa is not the only eating disorder, nor is its nervosa family the only cluster of eating disorders identified in the DSM-5!
Terms like anorexia and orthorexia are neutral descriptors of dietary behaviors. No restrictive disorder is present unless its psychological criteria manifest alongside its characteristic eating behavior.
Reducing a condition to any one of its symptoms20 — that is to say, ignoring the need for differential diagnosis — leads to a number of common misconceptions about non-restrictive eating disorders. One such misconception is how some seem to think that a fundamental and disordered “relationship to food” unites the whole category of eating disorders. Recall here that said category includes pica, in which the patient regularly eats inedible items like rocks or plastic, and avoidant/restrictive food intake disorder, in which the patient becomes a pathologically picky eater and thus ends up malnourished.
This is, I think, one of the reasons our comment crusaders allege that we men fail to “admit” to the disorders they’ve misdiagnosed in us. For lack of a sorely-needed better word, theorizing one's relationship to food is an activity so feminine it feels borderline misogynistic to call it that, given that I'm also calling it stupid. Reflection on how foods or eating in general make you feel, as though it had any relevance to what you should eat regularly, is mostly the domain of “fat activists” and recovered restricters — the former being someone with a disorder like my own, living in the depths of denial. Anecdotes aren’t data, of course, but everyone I’ve known who set out to “repair” his or her “relationship with food”, with no history of a nervosa disorder, is now obese. Congratulations on healing from an eating disorder you never had by developing a real one, I guess.
As the legendary Ms. Docherty demonstrates in this video, the “weight-loss industry” that pushes so-called “diet culture” is a front for the processed food industry, e.g. WW-branded frozen meals. (They don’t even call it Weight Watchers anymore, appropriately enough, because it doesn’t help you lose weight!) Eating less processed food, and less of it, cannot possibly generate more profit than the diet you’d be switching from. You do not have to buy any nutritional supplements or “health food”. Just eat the stuff that ships from farms rather than food factories.
Incompetent Help Is Far Worse Than Nothing
Much as WebMD contributes to gullible people who caught a rhinovirus deciding they have cancer, ANAD contributes to ED misunderstandings in its BED resources. Take this page as one example. They correctly state that you might have BED even if you are not currently obese. However, obesity is the inevitable result of chronically overeating without fasting or purging. If you have uncontrolled BED you are already in the processing of becoming obese.
This relates what I’ve detailed above to the legend that “some fat people are anorexic, you know, it’s all very complicated”, a lie that this ANAD mythbusting page openly parrots. The “overweight anorexic” is a cryptid imagined by addicts, a patient whose existence remains impossible insofar as the name has any clinical meaning. Its main purpose as a myth is to allow obese people to lie to themselves. “But I don’t even eat anything!” is a ubiquitous delusion among BED patients and high-risk bariatric patients like you see on TV.
As the page concedes, because it is too obvious to ignore, fat anorexics would not meet the DSM-5 AN criterion of “significantly low body weight”, but they would supposedly have “all the other symptoms”— notably, “restriction of energy intake relative to requirements” and “fear of getting fat”. On such a basis you could also diagnose me as anorexic, but there is a small problem here: “significantly low body weight” is not one of the DSM-5 criteria for AN. In other words, “fat anorexics” can only exist if we redact Criterion A of the DSM-5 definition of anorexia nervosa21, which says the clinical anorexic exhibits “[r]estriction of energy intake relative to requirements, leading to a significant low body weight in the context of … age, sex, developmental trajectory, and physical health” (emphasis mine).
By regurgitating … outright lies in a recovery resource, ANAD does direct harm to people in denial about their BED or obesity, and possibly sets anorexics up for relapse once they realize “intuitive eating” is a bunch of bullshit.
Honestly, I want ANAD to shut up about “eating disorders” in the abstract and speak directly to anorexics and bulimics. Even then, they need to get their shit together. Take for instance this list of ED red flags that includes regular food tracking as a disordered eating behavior, because “diets don’t work and they're bad for your health”. In the same breath, they quote Ragen Chastain saying “health is not an obligation”, comically reminding the reader that reducing excess body fat does indeed improve health.
Frankly I should not have to say anything more to impeach ANAD. If you take health advice from Ragen Chastain, the woman who “ran” a marathon in 12.5 hours and probably damn near killed herself doing it, you too should be committed for attempted suicide. By regurgitating all these outright lies in a recovery resource, ANAD does direct harm to people in denial about their BED or obesity, and possibly sets anorexics up for relapse once they realize “intuitive eating” is a bunch of bullshit22.
Our reality would be obvious even if you didn’t have sensationalist trash like Secret Eaters and My 600-Pound Life as evidence: people with BED do not remember everything we eat, and we consistently underestimate the portion size and energy content of our food. Memory blackouts and retconned self-delusions of how little we supposedly consumed when we last binged are symptoms of the mental illness we have. Perceived loss of control is part of the definition of a “binge” for both BED and bulimia nervosa.
[I]f you have body fat above essential levels it is impossible for you to “restrict energy intake below requirements” … Storing energy when you overeat and releasing it when you are in a caloric deficit is the primary function of adipose tissue. A human being who dies from obesity complications is like a tire that explodes because you overfilled it.
If you have BED or a subclinical pattern that mimics it, failing to discover what you’ve hidden from yourself is one on-ramp to the “yo-yo dieting” cycle. In the anti-health propaganda targeting obese people, this cycle is held up as “proof that diets don’t work”, which is the bullshit ANAD are implying. So ultimately, on a given day it is hypothetically conceivable for a patient to weigh 400 lbs and suffer from early-stage anorexia nervosa, but if that weight does not go down further the patient objectively does not have the disorder. By the same token, an obese person who fasts for extended periods without neglecting overall nutrition is objectively not an anorexic.
On the contrary, I would argue that medically-supervised extended fasting is not disordered at all — at the very least, not pathologically restrictive. The sustainability of this protocol is a separate question, as it demands much more dedication than intermittent fasting or simple calorie restriction. Longer-term fasting as a means of losing fat does not work seamlessly with every lifestyle or personality, but it does work.
In any case, if you have body fat above essential levels it is impossible for you to “restrict energy intake below requirements”. You might get malnourished if you ignore your micronutrient requirements, sure. Energy, though? You met today’s requirements the last time you ate too much pizza. Storing energy when you overeat and releasing it when you are in a caloric deficit is the primary function of adipose tissue. A human being who dies from obesity complications is like a tire that explodes because you overfilled it. It was a perfectly good tire, and you used it incorrectly.
How To Make Us Stop Hating You
So if you write “men acknowledge their eating disorders challenge (impossible) 🙄 ” in response to a video where a former depressed fat guy celebrates reaching the best shape of his life, mentally and physically and often spiritually, by means of good planning, disciplined nutrition, and hard work… of course it triggers us. You just walked into the rehab center and said, “Only pussies quit!” You did the equivalent of going onto a forum for survivors of AN and replying “delete it fat” to someone’s happy selfie.
You told all the depressed fat guys who saw the video and read the comments that this is not a healthy way to improve their situation, when it is instead one of the most loving and healthiest things you can possibly choose to do for yourself. No one else can do it for you, but more importantly, no one but you can keep you from doing it.
This is why people tell you to go fuck yourself. It isn’t because former binge eaters are now “in denial” about having inverted BED into the restrictive disorder that you had, but because the self-control by which we save ourselves from ourselves will always seem as fragile as it is hard-won.
We are like former junkies holding onto sobriety for dear life. We don’t want anyone coming in and telling us to “honor” our cravings for heroin or drink mouthwash “intuitively”. We know damn well life is better now, that this is a superior experience of human life to what we knew before, but we still fear that the scar could split and re-open the wound that is our weakness to overindulgence.
We do not wish the misery we experience when we lack control on those who do not understand it, but we do ask you all, respectfully, to mind your damn business.
Postscript: An olive branch to fight the almond moms
As we’ve reached the end, I’ll add a message just for people with restrictive disorders, especially any who might have left some of the comments I hate. Firstly, if you didn’t read this far, I don’t care what you think about my opinion. Secondly, if you are newly recovering from a restrictive disorder, you likely should act as though I’m incorrect, until and unless you become clinically overweight. (Please leave us alone in the meantime. You're only pretending I'm wrong, remember?)
Find a licensed clinician with a real science background who can help you fix your behavior and your delusions, not your “relationship with food”. Go to the gym and do some kind of weight training program, or maybe a Pilates class. Don’t count your calories like we do, unless it helps you make sure you are not undereating. It is probably better not to weigh yourself much, especially if you are sensitive to the fluctuations that make weight such an imprecise metric of body composition.
Lastly, if you remember nothing else I've said: do not pay a delusional fatass on the internet, drowning in denial with a broken brain like mine, to watch you turn into a miserable blob and call it recovery.
To anyone working towards or living in recovery of any kind who is reading this, I’m proud of you for taking care of yourself. You are ensuring that you will be alive and present for everyone you love, and your peace and happiness is a beautiful gift to anyone who loves you. If you, the reader, suffer from disordered eating of any type and need help to start healing, start here.
Mitchell, J. E., et al. (2008). Binge-eating disorder: Clinical foundations and treatment. Guilford Press.
Also, the public had gotten much, much fatter on average. Once you realize this, too, can indicate an eating disorder epidemic, you see everything differently.
Svirko, E., & Hawton, K. (2007). Self-injurious behavior and eating disorders: The extent and nature of the association. Suicide and life-threatening behavior, 37(4), 409-421. https://guilfordjournals.com/doi/abs/10.1521/suli.2007.37.4.409
Physiological hunger cues are involved, especially after the onset of obesity, but they are pathologically miscalibrated. The disorder is “all in our heads” in two ways: something in the body attacks the brain with inappropriate hunger signals, and something in the mind prevents us from resisting the attack.
Steiner BM, Berry DC. The Regulation of Adipose Tissue Health by Estrogens. Front Endocrinol (Lausanne). 2022 May 26;13:889923. doi: 10.3389/fendo.2022.889923. PMID: 35721736; PMCID: PMC9204494.
Cohen PG. Aromatase, adiposity, aging and disease. The hypogonadal-metabolic-atherogenic-disease and aging connection. Med Hypotheses. 2001 Jun;56(6):702-8. doi: 10.1054/mehy.2000.1169. PMID: 11399122.
If you ever wondered why fat guys start to look mildly feminized over time, it’s not just because they’ve lost definition of their post-pubescent skeletal and facial structure. They’re producing excess estradiol inside their bodies. Because I was obese during puberty, this happened to me, and it limited my response to the surge of testosterone my body produced, making my childhood obesity comparable to a mostly-ineffective puberty blocker.
The lowered testosterone that comes with adiposity (fatness) also makes us less “masculine” in terms of, say, risk-taking or aggression or disagreeability. Lowered aggression and increased agreeability sounds like a plus, until you recall that most guys aren’t notably violent to begin with, so it manifests as complacency in one’s job, relationships, etc.
Mitchell, J.E., et al. (2008). See above.
I would wager that a decent number of BED-diagnosed women in the DSM-5 era are actually “nonpurging bulimics” and thus their treatment will likely not succeed, giving them the impression that restriction is futile for bingers and opening them up to pro-obesity ideology.
We should note that the same book considers BED criteria too strict, especially regarding the size or frequency of bingeing. They also note that some bingers do not openly exhibit “distress” about their textbook BED, presumably because of denial. Taken alongside the book’s figures on the age of obesity onset — younger obese patients are more likely to binge eat — this conservative set of criteria lends credence to my own opinion that BED is underdiagnosed in obese young adults.
Striegel-Moore RH, Rosselli F, Perrin N, DeBar L, Wilson GT, May A, Kraemer HC. Gender difference in the prevalence of eating disorder symptoms. Int J Eat Disord. 2009 Jul;42(5):471-4. doi: 10.1002/eat.20625. PMID: 19107833; PMCID: PMC2696560.
I don’t use MyFitnessPal anymore, not because it was disordered but because the application sucks.
Strong, S. M., Williamson, D. A., Netemeyer, R. G., & Geer, J. H. (2000). Eating disorder symptoms and concerns about body differ as a function of gender and sexual orientation. Journal of Social and Clinical Psychology, 19(2), 240-255. https://doi.org/10.1521/jscp.2000.19.2.240
Carlat, Daniel J., Carlos A. Camargo, and David B. Herzog. "Eating disorders in males: A report on 135 patients." American Journal of Psychiatry 154, no. 8 (1997): 1127-1132.
Note: this one identifies a whopping 58% of the anorexic male subjects as “asexual”, a self-reported category that I don’t believe actually exists. Deficiency in testosterone is a known complication of AN, so these guys likely have no libido to manifest whichever real orientation they have.
Criado-Perez, C. (2021). INVISIBLE WOMEN: Data bias in a world designed for men. Abrams Press.
If you have a plan, I’m available on Thursday.
Culbert, Sisk, & Klump (2021). See above.
Some of the described factors might well make it harder to control yourself, but literally nothing can make you fat except eating more than you need to eat. You may as well say that genetic influences on alcoholism mean that alcoholics can’t help themselves.
This is even true for bulimia, but it is hard to imagine a non-disordered cause of such behavior.
For reference, a symptom whose presence alone authentically provides enough information to diagnose a disease is called a pathognomonic symptom.
Notice that they eliminated the criterion of being clinically underweight. This is probably good, but they should clarify that the new criteria cannot apply to people who are clinically overweight, because weight loss is not a red flag in their cases. It is also weird that they removed amenorrhea from the list, which for most young women is basically a flashing neon sign that says you have AN and you are in immediate danger because of it.
They also describe orthorexia as an eating disorder, but you should note that the DSM-5 does not say this, just like it doesn’t support my belief that obesity is itself an eating disorder and can only develop through prior disordered eating. I happen to agree that orthorexia nervosa is a serious disorder, as demonstrated by the deaths of some “raw food influencers”. However, it's another nervosa name for a reason. By now you should know these dangerous airheads will diagnose you with a terminal ED if you exhibit even slightly more self-control around food than, say, a starving dog.