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The Official Newsletter of
Updated: January 1, 2013

*********Special Report*************
Never Thin Enough: Body Composition Analysis in the Prevention of Anorexia

by Ron Brown, author of The Body Fat Guide 

"Ron Brown is a certified fitness trainer who doesn't have an inch of flab on his body. He'll tell you what you can do to become fit and trim too." 
Washington DC


Ron Brown currently holds an assistant research position at Canada's largest in-patient anorexia clinic, Homewood Health Centre, Guelph, Ontario.

THE DUCHESS OF WINDSOR allegedly stated, "You can never be too rich or too thin." Perhaps the Duchess should have spent a portion of her riches on hiring a good personal trainer—one who could show her the important difference between just being thin and being lean. As this article will show, confusion in the dieter's mind between thinness and leanness is one of the main misconceptions that may result in anorexic behavior. 

For example, one may be thin and low in bodyweight, yet still be flabby and have a high body fat percentage; or one may be heavier in bodyweight, yet be firm and lean and have a low body fat percentage. If you take a look at the body fat percentages of some female Hollywood Celebrities, you may be surprised to notice that the body fat percentage of a waif like Kate Moss isn't much lower than Lucy Lawless (Zena Warrior Princess); yet, Lucy Lawless outweighs Kate Moss by 45 pounds! In other words, Kate Moss may be thinner and lighter, but she is not leaner than Lucky Lawless. Clarifying the distinction between thinness and leanness in the dieter's mind may provide an essential step in the complete recovery and prevention of anorexia.

Ineffective Treatments for Anorexia

Why are conventional treatments for anorexia so ineffective? A study published in the Journal of the American Academy of Child and Adolescent Psychiatry, July 1999, says that anorexia, "is characterized by low rates of full recovery.

Even after regaining healthy weight without relapse three years later, some studies show that only about 20-29% of anorexic patients in treatment fully recover from the psychological impact of their anorexic behavior. The remaining patients either never fully recover, or they die. Anorexics have the highest mortality rate of all patients seeking psychiatric help.

Since the full recovery rate is so low, one wonders if

standard treatments for anorexia have much of an impact on recovery at all. How many recovered patients simply outgrow their behavior in spite of treatment? If any one treatment had truly identified the cause and provided the correction for anorexic behavior, why wouldn’t this apply to the greater majority of patients?

Bodyweight Lobotomy

It may seem shocking that most professionals involved in the treatment of anorexia readily admit they lack a true understanding of the problem’s cause and correction—the low efficacy of professional treatments supports this fact. Many treatment providers simply resort to trying to get the patient to forget about their weight altogether. Considering that over half the adult population is overweight, and that child obesity is at an all-time high, such an approach may result in substituting one health problem for another.

In-patient clinics may forbid anorexics from seeing their weight while under treatment, and patients may be discouraged from weighing themselves when discharged. How does this prepare the anorexic to successfully manage their weight outside of the clinic? How does it remove the psychological fear of gaining fat that often lasts a lifetime? It is very difficult for anyone, anorexic or not, to manage one's weight without measuring the effect of one's diet and activity modifications on changes in bodyweight and body composition. You can't manage what you don't measure!

In keeping with allopathic principles of traditional medicine, where one symptom is treated by producing an opposite symptom, therapists often attempt to replace the anorexic's bodyweight obsession with bodyweight denial—a kind of bodyweight lobotomy! Prefrontal lobotomies were popular during the dark ages of treatment for mental illness, and have since fallen out of favor. Unfortunately, in some ways, treatment for anorexia still seems to be stuck in the dark ages. Is it any wonder full recovery rates are so low?

This article suggests an alternative course of recovery that the author believes can result in above-average efficacy in treating and preventing anorexic behavior.

Anorexia Defined

Anorexia, clinically referred to as anorexia nervosa, is an eating disorder based on a compulsive drive to be thin. The anorexic has an obsessive fear of being fat. Anorexics are well below normal weight and often have disturbed body images that cause them to see themselves as being fat, even if they are down to skin and bones. They usually have disturbed eating patterns that may include prolonged crash dieting, bingeing, fasting and following food fads. In addition, anorexics may purge their bodies of food by self-induced vomiting, and/or by laxative use. Anorexics may also attempt to burn calories and fat by using fat-burning drugs and supplements, tobacco, caffeine, and/or by over-exercising.

Anorexia nervosa has been recorded as a mental disorder in medical books for many years, but it wasn’t until the 1960’s, with its emphasis on thin-as-a-rail fashion, that awareness of the problem starting becoming prevalent. Today, 90 percent of anorexia sufferers are women. For every 200 women in the general population, one to six will be affected by anorexia. Five to 18 percent of these affected women will die from this disorder. 

Although fewer in number, men also suffer from eating disorders such as anorexia and bulimia. Studies show that many clinical features of eating disorders in men and women are the same. Men with eating disorders often share similar beliefs and attitudes toward bodyweight and body shape as do women with eating disorders.

Anorexia allowed to progress to advanced stages requires emergency medical attention. The patient may be fed intravenously, and in some cases feeding may take place through a thoracic tube. Disturbances in tissue electrolyte balance need to be corrected, and weight gain is indicated before the patient is discharged. Unfortunately, if the 

patient has not received the proper counseling about the cause of their anorexic behavior, they are at risk of repeating the behavior.

Two sub-types of anorexia nervosa have been identified. The restricting type, where the patient severely limits food intake, and the bingeing-purging type, where the patient periodically indulgences in bouts of overeating followed by purging. A recent study at the University of Toronto's Program for Eating Disorders shows that a number of restricting type of anorexic patients tend to adopt bingeing-purging behavior under treatment. Perhaps this occurs because the restricting type, though persuaded to eat more and increase bodyweight, still retains the unresolved fear of fat. Self-induced vomiting, seen in the bingeing-purging type, relieves the anxiety caused by this fear. This is a behavior learned from peers, often in an eating disorder clinic!

Clinical Observations of Anorexia

Studies show that severe emotional disturbances usually accompany starvation. Thus, when observing anorexics in a clinical setting, it is important to distinguish emotional and behavioral characteristics that are caused by starvation from those characteristics that may cause anorexic behavior. Additionally, if a trait is associated or correlated with anorexia we can not correctly infer that the trait causes anorexic. It may be that anorexia causes the trait, or both anorexia and the trait may be caused by something else.

For example, the anorexic's family relationships are often associated with anorexic behavior, and it is common to include the anorexic's family as part of clinical treatment. However, some researchers have observed that family problems may actually be caused by anorexic behavior rather than being the cause of anorexic behavior. 

Many anorexics undergoing treatment test low in self-esteem on clinical evaluations. However, a distinction needs to be made between self-esteem and body-esteem. Anorexics tend to have many high-achieving traits that are more consistent with higher levels of overall self-esteem. Their low body-esteem, a component of global self-esteem, is a common trait shared by many females within the general population who have bodyweight concerns. 

Although eating disorders tend to run in families, studies suggest that the beliefs of the mother are passed on to the daughter through nurturing factors—modeling and imitation, behavior reinforcement and punishment— rather than through genetic factors alone. It could be that a combination of both nature (genetics) and nurturing factors are associated with the cause of anorexia.

Although perfectionism may contribute to the tenacity of the anorexic's behavior, perfectionism is only a secondary causal factor, since not every perfectionist on a diet becomes anorexic. In fact, the large amount of effort and focus that an anorexic displays in their perfectionist tendencies, a characteristic of obsessive-compulsive personality, may be of value in recovery, provided their energy can be successfully redirected into healthy behavior.

Additionally, although control issues appear more prevalent in anorexia, similar issues may be observed in the behavior of almost any dieter who is determined to stubbornly resist the impulsive temptation to give in and break away from one's diet and exercise program. 

Cases of anorexia may also show comorbidity, or combinations of several other mental disorders that require separate treatment from anorexia. For example, if

a young  women is motivated to commit suicide by starvation, this is more likely to indicate a mood disorder such as depression or Post Traumatic Stress Disorder (PTSD), and should be treated as such. 

Low Body-Fat Myths

Physiological pathologies associated with anorexia, such as osteoporosis, amenorrhea, hormonal disturbances and reproductive problems, are often claimed to be caused by low body fat levels. However, this view is contradicted by counterexamples of healthy, well-nourished people with low body fat levels who eat normal amounts of a well-balanced diet and lead healthy reproductive lives.

Osteoporosis and hormonal imbalances are usually the result of malnutrition. Following unbalanced diets in an attempt to lose weight contributes to the cause of these conditions, but, this is not the same as maintaining low body fat levels through healthy diet and exercise habits. Low body fat is not the same as malnutrition and muscular atrophy.

Therapists and researchers searching for the cause of anorexia naturally assume the patient's problem develops from attempting to lose too much body fat. In fact, as this article will point out, the anorexic's problem really stems from losing too much muscle or lean body mass. No one ever starved to death by losing too much body fat—they starve by losing too much lean body tissue. Only after one's surplus reserve of non-essential body fat is completely depleted does the lose of essential lean tissue in the central nervous system, cardiovascular system and other organ systems begin. It is the continued loss of this essential lean tissue that ultimately leads to suffering and death. 

Gender and Body Images

In our culture, women tend to be more comfortable with the concept of dieting than men. Women also experience more pressure than men to meet cultural standards of bodyweight and physical attractiveness. The conventional wisdom therefore says that since there are more women dieters than men dieters, a greater number of women are thus more likely to over-diet and become anorexic. But, if this were true, how is it that men only account for 10% of anorexics, even though men make up 35% of dieters? There may be another reason why a greater percentage of women dieters become anorexic.

An often overlooked reason why anorexia may be less prevalent in men than in women is that men are generally more aware of their muscle mass than are women. Males, who experience greater gender typing by society than women, traditionally identify with a more muscular, masculine body image. In addition, studies show that sex hormones influence behavior during sensitive periods of development, suggesting that biological reasons may cause males and females to view their bodies differently. Therefore, men are less inclined to adopt behavior that diminishes their lean body mass.

This important distinction between males and females is revealed in a study by the Eating Disorder Program at the Hospital for Sick Children in Toronto, which shows that male anorexic patients have less drive for thinness and body dissatisfaction than female anorexic patients.

Loss of muscle mass is tolerated by males only as a temporary side-effect of dieting. For example, male athletes who develop eating disorders may temporarily sacrifice large amounts of muscle mass as they employ fasting and crash diets in their quest for a more athletic and fat-free body (Sometimes referred to as anorexia athletica or activity anorexia in both sexes). However, because muscle is intrinsically valued by the male athlete, he will usually attempt to restore lost muscle mass.

On the other hand, when a woman steps on a scale, how often does she think about how much her muscle mass weighs? Probably never. A woman is not culturally conditioned to pay much attention to her muscle mass. She is more concerned with her body fat, not with big, ugly, masculine muscles. 

Researchers often associate increased desire for thinness among females with the media's objectification of the female body. However, there is much evidence that our culture also discourages the development of muscular power in 

females,  setting ideal standards of female muscle size and strength well below that of males. 

Due to cultural and biological difference in acceptable muscularity between men and women, a female is more at risk of continuing to ignore her diminishing level of muscle or lean body mass, even if it puts her life in danger due to starvation. Starvation occurs when one's organs and blood plasma suffer a critical loss of nitrogenous material—the same sort of nitrogenous material that composes one's skeletal muscle mass.

Interestingly, anorexia is higher in the male population among homosexual men. These anorexics may be among the segment of the homosexual community who identify with a more conventionally feminine, less muscular image of their physiques, similar to heterosexual women. Therefore, these male anorexics may also be more inclined to ignore diminishing levels of lean body mass. 

Consistent with the idea of gender differences in awareness of lean body mass and body fat, anorexia is lower in the female population among homosexual females. Studies on anorexia in the female homosexual community show lesbians are less likely than heterosexual women to be dissatisfied with their body shape, to strive for thinness, to over-diet or become anorexic. This may be because a segment of females within the homosexual community identify less with the sort of image of their physiques that the rest of society considers conventionally feminine.

The Primary Cause of Anorexia

The current standard for diagnosis of anorexia considers fear of fat and drive for thinness as the distinguishing motivations necessary to produce anorexic behavior. But, these alone are not sufficient to cause anorexia. For example, one may fear fat and strive for thinness while still maintaining a healthy lean body mass level. Or, one may lack healthy levels of lean body weight without fearing fat or striving for thinness.

A primary characteristic that is necessary as well as sufficient to cause anorexia in all cases, whether male or female, athletic or non-athletic, homosexual or heterosexual, appears to be the disinclination to sustain adequate levels of lean body mass.

Addressing this characteristic forms the corner-store of an effective treatment for anorexic. Educate the anorexic about the effect of lean body mass on health and appearance, and behavior starts improving. 

Two Choices in Deciding How to Lose Weight

In deciding how to go about losing weight, people may choose one of two paths. According to the Elaboration-Likelihood Model of social psychology (above), the peripheral route of decision-making involves the quick and easy method of thinking. This route relies on any method that immediately comes to mind through peripheral cues in the environment, and may result in poor decision making and maladaptive behavior. For example, the anorexic sees thin models and peers, and she copies their restrictive eating patterns. Thus, the anorexic chooses to strive for thinness by using starvation, purging and excessive exercise. 

An alternate way of thinking about how to strive for weight loss is to improve one's body composition by eating and exercising properly to lower body fat while maintaining healthy lean tissue. This type of thinking is an example of 

the central route of systematic information processing. This route relies on deep elaborative thinking and strong arguments, and results in a deliberate decision to use body composition analysis to guide one's energy balance modifications. 

With this type of thinking, the anorexic learns to eat more food to maintain lean body mass while losing body fat, rather than eating too little or nothing at all. Notice that this approach need not challenge the anorexic's incentive to achieve a low-fat body. By replacing drive for thinness with improved body composition, the rise in body dissatisfaction often seen in conventional treatments is avoided, and recidivism becomes less likely. Obviously, however, it is essential that the therapist provides the anorexic with knowledge of how to improve body composition. 

Mental Disorder or Maladaptive Behavior?

When you look in the mirror, do you see white elephants with pink polka-dots? Hopefully not! If you did, people might think you suffered from a mental disorder. When an emaciated anorexic looks in the mirror she sees a fat person. To other people, the anorexic’s self-perception appears just as irrational as that of a person who looks in the mirror and sees white elephants with pink polka-dots. People might assume the anorexic is suffering from a mental disorder.

Currently, the DSM-IV (Diagnostic and Statistics Manual) used in clinical psychology classifies anorexia as a mental disorder. However, unlike most other mental disorders, it has been difficult for scientists to identify a biological cause strongly associated with the anorexic's distorted self-perception. Some people might suggest that the anorexic's self-perception is a form of hallucination, and that the anorexic's belief that they are fat is a delusion, as seen, for example, in schizophrenia. But, there is usually little clinical evidence to support a diagnosis of schizophrenia. 

The following alternative explanation suggests that there may be a logical and sane reason why anorexics mistakenly perceive themselves as fat, even when they are down to skin and bones. This explanation views anorexia nervosa as maladaptive behavior rather than a mental disorder.

The Joy of Loose Clothes

Did you ever see those weight-loss ads showing a happy thin person standing inside a pair of pants that used to fit them when they were obese? The pants are often big enough to hold several normal-weight people.

When an overweight person experiences a dramatic loss of bodyweight and looks back, it is hard to imagine they were once actually so fat. This is the same feeling an underweight anorexic gets every time she tries on clothes that used to fit her, but, that are now much too large and loose for her. How could she have been so fat back when she wore those clothes, she wonders? Look how much looser her clothes are now. What more proof does she need of how fat she once was, even when people were already calling her too thin? Where was all that lost body fat hiding? How much 

more hidden body fat is there still to lose?

The negative reinforcement provided by visible signs of weight loss motivates the anorexic to continue to lose weight, despite persistent hunger and hounding from well-intentioned and concerned family and friends. Even though some anorexics may acknowledge that they are generally thin and underweight, nevertheless, they continue to view many parts of their body as still containing too much body fat.

Hidden Body Fat

The problem is that losing bodyweight and losing body fat are not always the same thing. Although one’s bodyweight is easy to see and measure, body fat isn’t always as easy to spot as you may think. When you view your body in the mirror, can you see body fat?
"Yup!" you say. "Right here," as you grab a fold of skin from your tummy.

But, stop and think a minute: You don’t really see fat tissue directly in the mirror. What you see is skin and a body shape. You then make an assumption, usually correctly, that there is a certain quantity of body fat stored under that skin and within your body shape.

But, what if your assumption was wrong? What if there was actually much more or much less body fat stored under your skin and within your body shape than you assumed? How could you know this if you can’t actually see fat tissue directly?

"I would know because my body shape would change," you answer. "If I lost body fat, I would be thinner, my clothes would be looser, and I would weigh less."

But, what if your shape became thinner and your bodyweight decreased as a result of losing mainly muscle? How would you know that? What if you mistakenly thought all the weight you lost was only body fat? What way do you have of telling you otherwise? 

Reducing your bodyweight by reducing muscle will increase your body fat percentage. In other words, even though you weigh less, a greater percentage of your bodyweight is now body fat.

Overnight Weight Gain

And, what would you think if you suddenly gained bodyweight, overnight? Would you assume it was all extra body fat? What way do you have to tell you whether it was body fat, muscle, water or just gastrointestinal contents?

People coming off crash diets often regain bodyweight very quickly. This can be very disturbing to them if they mistakenly assume all the extra weight gained is body fat, when, in fact, much of the gain is replenished muscle. Muscle mass becomes depleted on a crash diet, especially when combined with high-intensity exercise. (See "High Intensity Burns More Fat?" at Still More Fat Talk!) Depleted muscle can quickly replenish as soon as a sufficient supply of calories is ingested, which explains why people who have lost muscle mass on crash diets regain most of their weight so quickly, often on a normal maintenance amount of food. On the other hand, body fat is usually only regained if one eats beyond one's daily maintenance caloric level.

Since an anorexic's muscle mass is in a severely depleted state, the anorexic would rapidly recover at least as much muscle mass as the average sedentary conventional eater if all she did was rest and increase her caloric intake to a normal maintenance level. However, consider the emotional impact this has on the mind of the anorexic when she sees her bodyweight increasing simply by eating a normal maintenance amount of food!

If a sudden, quick gain in bodyweight is disturbing to an ordinary person coming off a crash diet, imagine how alarming it is to an anorexic. An anorexic, who mistakenly assumes a sudden overnight gain in weight is all body fat, may think, "All that hard work to get rid of my body fat, and it just immediately bounces right back on. Better get back on my diet and exercise program, right away!" This is an example of positive punishment. The anorexic is motivated to continue to diet in order to avoid overnight rebounds in bodyweight. 

Despite the pleasure or positive-incentive value of eating, the anorexic's fear of regaining fat continues to override her

hunger. Fear inhibits hunger in people through activation of the autonomic nervous system. The anorexic's cognitive thoughts, like worrying about how her body image effects relations with boyfriends, school, career, work and family, can induce fear via activation of the autonomic nervous system, thus inhibiting hunger. Additionally, many people on low-calorie restricted diets may become more sensitive (tense, emotional) to autonomic nervous system reactions, especially if they consume caffeine and other psychoactive substances.

Hunger is also normally reduced or absent during a severely restricted diet or fast, provided that enough surplus body fat can be broken down to provide fuel to meet energy requirements and maintain normal blood glucose levels. This can also make it easier for the anorexic to continue to restrict her eating, at least until her surplus level of body fat is depleted.

Lacking body fat-measuring techniques to guide them, is it any wonder that otherwise normal people get lost, confused and trapped in compulsive dieting as they strive for a low-fat body? Anorexics require a method to measure body composition changes that the scale and the mirror alone can’t reveal. This will enable them to see and understand the difference between losing a healthy amount of body fat and losing an unhealthy amount of lean body mass. They will also be able to see the difference between regaining a healthy amount of lean body mass and regaining an unhealthy amount of body fat. In other words, the anorexic will finally learn the difference between just being underweight and thin, and being healthy and lean. 

This knowledge will also help anorexics eliminate the fear of gaining fat from eating food. We fear things we don't understand. When we don't understand exactly how what we eat affects our body-fat level, we may fear eating food. Measuring changes in body fat while monitoring one's diet and activity removes the guesswork and fear associated with eating. The recovering anorexic will no longer feel the need to run around the block 20 times every time she puts something into her mouth.

Examples of Lean Body Mass

The following photos illustrate examples of 3 models, each with similar low levels 
of body fat, but, each with drastically different amounts of lean body mass: 

The model in the photo on the left has sacrificed much lean body mass while lowering her body fat level, and she obviously appears extremely emaciated. Surprisingly, her body fat percentage could actually be higher than the models in the other 2 photos! How could this be when she is just skin and bones? 

No matter how much body fat is lost, there will always be an essential level of body fat that is never lost, even in death by starvation. A male's essential body fat level is around 3% body fat, and a woman's level is a bit higher. Let's assume this model started out weighing 100 pounds with 6 pounds of body fat, which, at 6% body fat, is close to the essential body fat level for females. As this model's lean body mass continues to drop, the constant amount of her essential body fat becomes a greater percentage of her total other words, her body fat percentage will rise as her lean body mass drops and her essential body fat level remains the same.

For example, if she loses 40 more pounds, all of her lost weight will come from lean body mass, since she has already reached her essential body fat level. Therefore, now weighing 60 pounds and still carrying 6 pounds of body fat, her body fat percentage has risen from 6% to 10%!

If this model gained lean body mass, which she could easily 

accomplish by increasing her calorie intake to replenish her depleted muscle mass, her overall proportion of body fat to bodyweight would decrease; she would actually lower her body fat percentage by gaining lean weight. 

The swimsuit model in the middle photo, Claudia Schiffer, weighs 126 pounds and has 24-inch waist. Carrying more lean body mass in proportion to her bodyweight then the first model, Claudia's body fat percentage is 9.9%; just slightly lower than the first model's body fat percentage. Thus, even though Claudia weighs more than the first model, she is leaner than the first model when comparing body fat percentages. Being thinner isn't the same as being leaner.

The model in the photo on the right, a female bodybuilder, carries the greatest amount of lean body mass of the 3 models. This reduces her body fat percentage to between 6 and 8 percent, making her the leanest of the 3 models.

When trying to improve your body composition, losing body fat only accomplishes half of your goal. The other half is determined by the amount of lean body mass you have. These photos graphically illustrate how different levels of lean body mass affects one's body fat percentage, which in turn determines the overall shape and leanness of your body when losing weight. 

Illustration from The Body Fat Guide, by Ron Brown

The illustration above demonstrates changes in body appearance when you lose lean body mass. The air in the balloon represents your lean body mass, and a layer of paint covering the balloon represents your layer of subcutaneous body fat. Letting air escape from the balloon makes the paint appear thicker, and the shape of the balloon droops. Similarly, when you lose lean body mass, your 

body shape appears less firm, droopy, and your body fat seems thicker. You have increased your body fat percentage. Refilling the balloon with air restores its shape and firmness, and thins out the layer of paint. Likewise, gaining lean body mass increases body tone and makes your layer of subcutaneous body fat appear thinner.

Recovering Lean Body Mass

Males and females can check if they have enough lean body mass according to their height at minimum lean body mass. Notice that the lean body mass levels of the majority of female Hollywood Celebrities, with the exception of Twiggy and a few others, are generally within the healthy range for their height. Many celebrities work very hard to achieve a healthy and attractive body shape. Few members of the public realize that Marilyn Monroe was a dedicated weight lifter—she used weights to help develop and maintain her lean body mass.

Recent studies support the effectiveness of a properly conducted anaerobic weight training program in the recovery of lean body mass in anorexia (Szabo & Green, 2002). However, this does not mean that if the anorexic becomes aware she is low in lean body mass, she can remedy this simply by performing muscle-building exercises.

"If I need to build up my lean body mass," she thinks, "I’ll just include specific muscle-building exercises in my workout routine."

This can be a serious mistake if her exercise program is not adjusted to include an adequate calorie intake. Muscle mass does not magically appear simply by performing the right exercises. Muscle mass is built from a combination of resistance training, rest, and a calorie-sufficient intake of a balanced diet to allow growth and replenishment.

Since most anorexics already exercise on a regular basis, anorexics often do not lack muscle for want of more exercise—they lack muscle for want of a sufficient calorie intake and rest to allow growth to occur. Increasing levels of exercise in the anorexic in an attempt to build muscle without also increasing calorie intake and recovery periods to sufficient levels only exacerbates the loss of lean body mass in the anorexic. This amounts to a form of exercise purging.

The loss and subsequent recovery of lean body mass is easily demonstrated in anyone who follows a calorie-restricted diet while performing strenuous muscle-building exercise. Measuring changes in one's body composition reveals that one may immediately drop several pounds of muscle weight. That's because muscle easily loses water, glycogen and mineral compounds. It usually takes a day or two of normal eating to replenish muscle from this depleted state. However, new muscle growth can only occur if a small surplus of calories is ingested. For more information, see Muscle Mass Myths.

A moderately low caloric intake level is often sufficient to steadily replenish lean body mass during recovery of anorexia. However, in their haste to increase their patient's bodyweight, some clinics tend to overfeed patients and thus produce considerable gains in body fat. The result is that 50% or more of the patient's recovered bodyweight may consist of body fat (Sunday & Halmi, 2002). 

This needless gain of body fat reduces the rate of improvement in body composition compared to a slower bodyweight gain consisting mainly of lean body mass. As her body fat level rises, the anorexic's body dissatisfaction level also rises, resulting in a high rate of recidivism after treatment. 

Some clinical psychologists note that the more they succeed in reducing the anorexic patient's drive for thinness, the more her body dissatisfaction increases. Rather than merely eliminating the desire for thinness, the anorexic patient's desire for thinness must be replaced with a desire for improved body composition. By training her to maintain adequate levels of lean body mass while reducing body fat, the anorexic patient's body dissatisfaction is less likely to rise, and she will have a better chance of full recovery.

Safely Managing Body Fat

Would you take financial advice from someone poorer than you? Probably not. Would you take weight management advice from someone fatter than you? Probably not. When you’re anorexic, everyone seems fatter than you! Who, then, could offer you weight management advice that you could take seriously?

As stated before, you can't manage what you don't measure. Thus, if you want to manage your finances, you must measure the balance of figures in your financial statements. Likewise, if you want to manage your body fat percentage, you must measure the balance between your lean body mass and body fat.

To sum up, body composition analysis provides the following advantages in the treatment and prevention of anorexia:

  1. It identifies differences between body fat and lean body mass changes that the scale and mirror can't reveal, thus discouraging lowering one's lean body mass to dangerous levels. 
  2. It removes the guesswork involved in developing proper eating and activity habits to maintain healthy bodyweight, thus reducing the obsessive fear of gaining body fat.
  3. It supports the incentive to improve body image in a healthy manner.
  4. It provides feedback and positive reinforcement to help achieve one's bodyweight goals and improve body-esteem.

If we update the Duchess of Windsor's statement to say that one can never be too rich or too lean, the anorexic will have a better standard to guide her. The hunting dog, the thoroughbred racehorse, the athlete as well as the swimsuit model are all in the peak of condition when there is not a trace of excess body fat on them. However, in order to properly manage your body composition and safely reduce excess body fat to minimum levels while maintaining adequate lean body mass levels, it is essential to measure your percentage body fat, not just your body weight. To do that, use The Body Fat Guide. Body Fat Guy Diet Myths Fat Guide Love Handles Body Fat Review
Fat Talk! Flab Fighters Body Fat % Muscle Mass Ultimate Butt


Sunday, S. R., Halmi, K. A., (2002).

Energy intake and body composition in anorexia and bulimia nervosa. Physiology and Behavior, 78, 11-17.

Szabo, C. P., Green, K. (2002).

Hospitalized anorexics and resistance training: Impact on body composition and psychological well-being. A preliminary study. Eating Weight Disord., 7, 293-297.