Fatorexia: What it is and What it is Not

When British businesswoman Sarah Bird weighed in at her doctor’s office, she was shocked to discover that she was not a healthy weight, as she had believed, and that at 5’10” she weighed 238 pounds. Sarah knew that she did not have the body of a runway model, but the term “obese” was hard for her to swallow.

After Internet research confirmed her primary care physician’s diagnosis, Sarah set out on her own to lose weight, rejecting her physician’s referral to a weight loss program. She believed she had taught herself enough in years of yo-yo dieting to do it on her own. Sarah also forced herself to view herself in a full-length mirror for the first time in years, and she was shocked again at what she saw. As Sarah realized just how inaccurately she had perceived herself, she wrote a book about her experiences.

Reactions to Sarah’s book Fatorexia: What Do You See When You Look in the Mirror?, reveal that she is not the only one who has discovered that he or she is underestimating his or her own weight. Several small habits had helped Sarah avoid the truth of her weight gain. Are you doing any of these things and possibly not recognizing dangers to your own health?

  • Avoiding full-length mirrors
  • Focusing on controllable aspects of beauty like hair care, make up, manicures, etc.
  • Choosing oversized, adjustable, flowing, or elastic-waisted attire
  • Cutting tags labeling sizes out of your attire
  • Blocking partial view of self in photos
  • Eating small portions in public, but continuing to graze throughout the day
  • Choosing large, ornate jewelry to draw attention
  • Using talc to avoid chafing

While Sarah seems like a person who would write an interesting book, I do have some major concerns with the title and her goal to have “Fatorexia” identified as a recognized disorder. While likely a smart publicity move, the term “Fatorexia” may be offensive to some and has little meaning in relation to anorexia which is derived from a term that means lack of appetite. As Ms. Bird seems to be describing it, “Fatorexia” is not an eating disorder but a disorder in body image more closely related to body dysmorphic disorder. Body dysmorphic disorder is truly a preoccupation or exaggerated negative self perception. The inaccurate perception of oneself as thinner than he or she truly is so much closer to body dysmorphic disorder that I believe if the phenomenon is to be widely recognized, it would fall into that category in the soon to be updated DSM. I don’t believe the professionals that create the DSM would ever utilize an inaccurate and offensive term like “Fatorexia”.

This phenomenon could easily cause dysfunction in health and relationships, so I do think it could become a diagnosable disorder. It certainly deserves treatment. Someone recovering from this phenomenon will also need much empathy and support as he or she adjusts his or her self-image and works on health-promoting behavior change.

It is interesting to consider that positive self-esteem and confidence could contribute to poor health; however, ultimately it is a denial that is creating this phenomenon. Denial is a technique used to cope. All coping techniques are functional for a specific situation for a specific moment of time because they help us manage emotion and continue to function. However, any coping technique can become dysfunctional; often this is how symptoms of mental health disorders are developed. Denial can be a technique that helps one function for a short period of time; however, if one does not adjust to reality, this is just one disorder that can develop. Attuning to voices and small noises even while asleep is functional to wake with the children, but it makes sleeping on a plane extremely difficult (even with ear plugs!).

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