Obese or anorexic? Let us choose.
Article Type: Editorial
Subject: Obesity (Risk factors)
Obesity (Care and treatment)
Obesity (Control)
Anorexia nervosa (Risk factors)
Anorexia nervosa (Complications and side effects)
Anorexia nervosa (Care and treatment)
Food habits (Health aspects)
Author: Christodoulou, Irene
Pub Date: 07/01/2009
Publication: Name: International Journal of Health Science Publisher: Renaissance Medical Publishing Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2009 Renaissance Medical Publishing ISSN: 1791-4299
Issue: Date: July-Sept, 2009 Source Volume: 2 Source Issue: 3
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 210596218
Full Text: What we call obesity is today defined by several definitions, rules and markers. What we call anorexia is not so well defined in everyday practice and needs series of examinations by experts because the anorexic style is in fashion and scarcely remains out of pathological frames in a large percentage. Both conditions are abnormal, but which of them is more annoying and which of them is more acceptable by the society?

Obesity is common, easily recognizable and dangerous, while anorexic people are fewer and many times hide their bodies within their big clothes. What we have not discovered so far is how close are the brain reactions (to environmental stimuli) that lead us to excess food consumption or inadequate food consumption. It is hopeful that abnormalities of eating became very popular lately and eating disorders have started to be categorized under one common name, however the term bulimia and not the term hyperphagia is preferred to stand opposite the term anorexia. Practically, the pair bulimiaanorexia are seen as standing many Km away in distance from obesity. But some obese after a successful diet are in danger of becoming anorexic. Bulimia with hyperphagia may co-exist, but bulimia is not so often as hyperphagia. Bulimia is not easy to be diagnosed and treated, so a retrograde method for diagnosing and treating might be the complete study of hyperhagia. You can find millions of hyperphagic persons, ready to offer themselves for study and therapy.. At the same time bulimic persons are not so many and definitely not so easy persons to work with. On the contrary, obese people are "happy people". They are many times more sensible and ready to help others. They are persons who apparently deserve the help of obesity experts and are keen on listening about anti-obesity methods. To start a retrograde

route of studying we should find clearly what happens with brain in obesity. If this problem is solved, then rarer abnormalities as anorexia and bulimia would eventually be treated, with similar methods.

Plasticity of brain: Essential theory to start with

Learning and memory mechanisms have been under constant study and revision for years. As soon as molecular medicine findings found their answers in neuropsychologic theories and neuropsychologic tests' results, the plasticity of brain theory became more popular than ever. Now not only Alzheimer's sufferers, but also normal adults are challenged to trigger their brain and have a better life by enhancing learning and memory skills. According to neurophychologists and in accordance with the plasticity of brain, if obese were taught to eat in a normal way and to use tricks for avoiding dangerous foods, this might be the solution to their problem. Because, as we have seen with the results of obesity surgery, a large number of persons who are operated for obesity come back to their doctor after 2-3 years obese enough to undergo a second operation as their brain is continuing to be thinking abnormally. Education, in the same way, could become the critical step for bulimia and anorexia, while the pharmaceutical help should rather be left aside, except from life-threatening cases.

Fashion addicts, racism and eating disorders: society accepts the anorexic

While fashion designers have been presenting the anorexic look as a well-accepted image of female body, the deaths caused by anorexia have changed the beliefs of women now. However, racism is mostly oriented to obese women, less to obese men, and almost never touches the anorexic. This shows that our society is not yet ready to accept that obesity is less annoying than anorexia. On the contrary, obese persons have now been labelled as patients, while anorexic women may hope to find a work as fashion models, if they are lucky and persistent!

When an eating disorder is accepted by the society or is necessary for working in a job, it may become a pattern of life for normal people who struggle to become anorexic! The unhealthy way of eating and life-style in general has been well described recently by a former New Zealand model, Jenna Sauers, in a blog column secretly kept, which led eventually to giving up her career for ever when everything was learnt about her identity.

Anti-Obesity Medicine is not a beauty game

While medical studies present new interesting data for antiobesity treatments, on the other hand pharmaceutical industry struggles to make obesity a drug-dependent problem. "Eat fried meat and fried potatoes, receive pills and become slim" is a marketing promo message that obese like to imagine, but it didn't help much in practice. However, obesity is not a drug dependent disease but an irreversible disease of the brain which deleteriously spread complications to all organs and systems. If drugs that help the brain to understand were available, these would only help anti-obesity treatments. Anti-obesity Medicine is not a beauty game, and if obese people feel that they are ill as diabetics do, they might be saved from many problems and complications.

Pharmaceutical industry's enormous profits, especially by pharmaceutical products that do not need prescription, are gained on the basis that not much time is spent on obesity in public Hospitals, and obesity is thought to be an abnormality in comparison to beauty and not to health. If health sector and schools would focus on the problem as a medical problem, then space for semi-medical treatments oriented to people's narcissism would not prevail.

Longevity, obesity and sex

Recently, a study published in the American Journal of Public Health1 showed that if a person aged 51-52 years old was treated from obesity, he/she would gain 0.85 years of life. Of course this study refers to obesity in general and not to morbid obesity, which is much more dangerous and the obese examined were not diabetic. Longevity without unlimited eating seems not desirable for many obese people, and if they were aware that they would gain only 0.85 years of life by abandoning their food addictions, I doubt that they would decide to start a diet ... However, sex benefits and narcissism helps a lot many obese to start a diet and some of them manage to get rid off excess weight for years. The same equals for anorexic, who start to believe the others when they are treated as not sexually attractive persons. This shows, that perhaps narcissism and sex appeal is stronger motivation for many persons than the fear of illness and death ... Even cocaine has been used by persons that never had problems with law, who previously failed to keep a diet or because they do not wish to make the efforts and keep a diet.2

Let us choose among obese and anorexic

Anorexic have usually larger problem than obese in the acute phases and they usually need drugs for their treatment. However, their treatment may be permanent and they may be saved for ever. Obese are untreated at their biggest majority and treatment results are not often kept after 2 years' time. As years are stepping by, obese receive more and more weight and their targets of success get lower and lower ...

What should we wish to be, if we would have to choose between obese and anorexic? The temporary character of anorexia shows that anorexia is a short-lasting disease with high risks for acute complications, however obesity shows a long-lasting, irreversible pathophysiologic history, which does not really depend on drugs in the long term and which is not corrected with obesity surgery in the long term, except very large radical operations, that cause numerous health problems ... The pathophysiologic connection between obesity and diabetes may solve the problem of beauty related anti-obesity beliefs

As soon as obesity was directly connected with diabetes and numerous complications deriving from diabetes, more and more people have been aware that obesity is not healthy condition related only to beauty and sex. This way, sugar-free and low-lipid products have become necessary in every super market, and light cuisine became trendy in expensive restaurants. If Hospital doctors understand that obese do not represent chances for gaining money through obesity surgery and obesity drugs, then real hope might appear in practice.

Obesity surgery is not solving the problems of obese, as it does not with anorexic

If we put the problem of obese and anorexic under a common pathophysiologic basis, we would see that either both could be treated by surgery or not. The answer is that obesity surgery is not solving problems of the great majority of obese, but is only creating problems to most obese patients. Because if homeostatic mechanisms lose their balance, then the operated person should be followed up for many years for a disease that was caused to him in order to treat a prior existing disease (obesity). Causing new diseases is not exactly Medicine. Very few persons should become patients of Obesity Surgery Centers, however, in most occasions the ones who are operated are the most rich and the most enthusiastic with the idea of being operated.


What we cannot yet figure out, is effective planning for antiobesity massive guidance: in the society, in Hospitals, in schools. Anorexia seems to be such a little problem in numbers, but it is not. Not as long as young girls are still dying because of it. Should the society change so as to make people learn the right things about eating disorders and healthy eating behavior? Should schools help the citizens in the first steps of their life so that brain gets accustomed to healthy way of eating before adulthood? Of course, schools and mothers have the power to change things as well as the society has the power to guide and help people who suffer from eating disorders.


(1.) Goldman DP, Zheng Y, Girosi F, Michaud PC, Olshansky J, Cutler D, Rowe JW. The Benefits of Risk Factor Prevention in Americans Aged 51 Years and Older. Am J Public Health 2009 ;doi:10.2105/AJPH.2009.172627.

(2.) The New Zealand Herald. Developer says cocaine bought for weight loss. August 6,2005. Accessed on September 12, 2009 at http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10339448. special article

Irene Christodoulou

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