Obesity and sexually selected anorexia nervosa

Anorexia nervosa is diagnosed by drastic weight loss, a fear of gaining weight, a distorted body image, and, in women, three consecutive episodes of amenorrhea. It is often associated with a compulsive need for exercise, a bright outlook on life, and a high level of competitiveness. It afflicts primarily young women in higher socioeconomic strata who are highly competitive and otherwise overachievers. There are three adaptive explanations for anorexia nervosa: the reproductive suppression, the fleeing famine and the pseudo-female hypotheses. Here I present a novel hypothesis, the age-related obesity hypothesis. It posits that the otherwise normal tendency by women to seek a youthful appearance can become maladaptive and lead to anorexia nervosa in environments in which thinness becomes the primary indicator of youth, such as in modern industrialized societies. This hypothesis explains the aforementioned associated features of anorexia nervosa, and its increasing prevalence in western societies. The hypothesis generates several testable predictions: (1) Prevalence of anorexia nervosa across societies should be related to the degree to which thinness is an indicator of youth in a population. (2) Conversely, perceptions of the weight-age relationship should differ among populations depending on the prevalence of anorexia nervosa. (3) Anorectic individuals, or those with the propensity to develop the disease, should have a biased perception of the weight-age relationship. (4) Experimental manipulation of individuals' perception of the weight-age relationship should affect weight concerns, particularly among anorectic or at-risk individuals. Should the hypothesis be supported it might be used to screen at-risk individuals. Furthermore, it would call for more integrative public health programs that take a comprehensive approach encompassing both obesity and anorexia.