Anorexia, weight loss, Image and or control

I recently saw an anorexic patient who lost over 26 pounds in 3-4 months. SHe is about 15 years old and lost her period as well. She eats 680 calories a day and exercises by running for an hour most days of the week. She is burning an additional 600 calories a day from exercise. She sees herself as thin but not thin enough. Is this more of an image problem or a control issue. Food intake seems to be something we can control in our life. We cant control other people, what they say, but we can control our intake. Unfortunately, 680 calories is not enough. The body is in starvation mode and the metabolism is reduced in order to preserve the body from breaking down organs for calories. Her body mass index is 19. At what point does she need to be hospitalized? She is seeing a therapist but he doesnt want to address the anorexic issue yet. She could be in therapy for a long time while she continues to lose weight weekly. Think about this- if the anorexics learned how to comprise and eat a little more, and the obese patients learned how to eat a little less, we would have a potential resolution of both conditions.

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