Life in Balance

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July 8th, 2013
By: Dr. Anthony Komaroff

Q. My teenage daughter is obsessed with her weight. She doesn’t eat enough, and although she’s thin, she believes she’s fat. Could she be anorexic?

A. Think about eating as a continuum. On one end, people eat in a balanced way and don’t worry much about their weight. On the other end, people severely restrict their food intake and think constantly about their weight. They are often diagnosed with anorexia.

As with most illnesses, there is not a magic dividing line between having the illness and not. In fact, there’s a big gray zone where people don’t meet the criteria for the disease, yet they’re not normal, either. An example is “pre-diabetes.” Tens of millions of people in the United States have blood sugar levels that are not high enough to be called diabetes, but also aren’t normal. It’s important to recognize them, because such people have a higher risk for developing diabetes in the future.

It’s the same with anorexia. People in the middle may meet some criteria for anorexia. They don’t have an officially recognized eating disorder, yet they don’t have a healthy relationship with food, either. Many of these people have what a Harvard Medical School colleague calls “almost anorexia.” It sounds as though your daughter may fit this description.

My colleague, Dr. Jennifer Thomas, with Jenni Schaefer, has written an informative new book on this topic called “Almost Anorexic: Is My (Or My Loved One’s) Relationship With Food a Problem?” You can learn more about it at

It’s common for teens to worry about their weight and appearance. But consider the following to judge if your daughter is heading into more dangerous territory:

• Frequent weight changes. Drastic intentional weight loss or frequent weight changes — regardless of actual weight — are a red flag for almost anorexia.

• Frequent restriction. Someone with almost anorexia might follow rigid dietary rules, such as eating only at specific times or eating only a specific number of calories. Breaking these rules typically leads to extreme guilt.

• Infrequent compensatory behaviors. Your daughter may occasionally force herself to vomit or use laxatives inappropriately. Maybe she exercises excessively on occasion, working out until she has burned the exact number of calories she just consumed.

• Negative body image. People with anorexia often hate their bodies. Most of us feel physically inadequate once in a while. But if your daughter often feels fat or won’t go to the beach because she is afraid to wear a swimsuit in public, her body image might fall within the almost anorexic zone.

If you suspect your daughter may have — or almost have — anorexia, speak to her doctor. Even if she doesn’t have it yet, it sounds as if she may be at increased risk for getting it. And now is the time to take steps to prevent it from developing. Eating disorders can cause serious medical problems, and in the most extreme cases, even death.

Dr. Komaroff is a physician and professor at Harvard Medical School. Send questions

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