"naturally thin" vs. "anorexic"

"He's always been slender."
"That kid looks anorexic."
"Our whole family is naturally small-boned."
"I'm just built this way."

How DO you know when it is an eating disorder?

Is it appearance, BMI, behavior? Is it what they tell us?

Wouldn't it be lovely to have a way to tell the difference between "naturally thin" metabolism and life-threatening restriction:

"... hormones appear to be valuable biomarkers for distinguishing these 2 categories of severely underweight subjects."

BMI is a population screening tool, not a diagnosis. It gives an idea, at higher and lower ranges, of who might need a closer look at behaviors and other markers of illness. It should not ever be seen as an indicator of any individual's health.


  1. I think this, too, can be used as a diagnostic tool not only in determining whether the low weight is from metabolic biology or a brain disease (AN), but also by breaking through the denial that is so common in the disease. That is, it would be easier to make a diagnosis of AN in a person who claims they are naturally thin.

    I am really glad that people are developing objective scientific ways to diagnose EDs, rather than just relying on patient reports.

  2. I have read with much interest some of the research you have presented here. With regards to the issue or Leptin, how do you think that fits in with someone who has been Anorexic since premenstruation, has also been at a very low weight (BMI well into emaciated range) yet began menstruation and continued menstruating regularly and normally (to the point of having tests indicate ovulation was occuring at a BMI of sub 15) and in who Leptin levels at a low weight and low nutritional state to be average to above average in levels.

  3. Claire,

    I think each human being is a unique organism, and complex. We simply don't know exactly how all these mechanisms work, and we can only make broad generalizations. This type of research may point to more refined, if not perfect, measures of health.

    Menstruation and leptin levels are tools for evaluating health. So is mental health, though harder to measure. If someone is menstruating but still obsessed with food, restricting, purging, or bingeing, they aren't healthy - and deserve to be!

  4. My daughter has 11 doctor diagnosed medical conditions . Some affected her weight . They are not voluntary she should not be blamed. She is 5 ft 9 and by eatting 6-8 times a day is just barely able to keep her weight at 95 pounds. She try's to eat enough to weigh more. And has never reached 100 pounds.
    Members of the family who don't have any medical things also are tall and thin as she is and are fine boned. They look like her .
    She was in school when they ran a film on anorexia and after that it was a cruel nickname and it only stopped because she graduated.
    Not all thin are mentally ill.


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