Pop quiz: which clinical mental disorder has the highest mortality rate? It’s not bipolar disorder. It’s not schizophrenia. Rather, it’s that heady place where out-of-whack brain chemicals meets up with out-of-whack societal beauty standards and renders a person incapable of eating enough to maintain their physical existence: anorexia nervosa.

Everyone knows that anorexia is horrible-tragic-shocking, but one thing it does have going for it – it is VERY visible.

Do you have any doubt that this person (who is in their 20s, by the way) has a problem?

That’s Ilsa Paulson, who looked pretty normal in high school, only to turn pro after college and got lean. Really, really lean.

On the other hand, how about this person?

Yep. That’s Hollie Avil, who retired from triathlon at age 23 because of trauma from eating disorders, depression, and general breakdown.

That’s the rub – in a strange and bizarre way, anorexia is easier to spot and therefore intervene. I’m not saying that such interventions are successful – there’s a good reason why those mortality rates are NOT falling – but for some sufferers who have hope of recovery, it can make a critical difference to hear someone say, “I really care about you and I think you might be harming yourself. Please know that I love you and want you to not die.”

But for every obvious case, there are likely hundreds who suffer almost in silence. Ironically, they can suffer more because if they don’t look the part of the eating disorder patient it can be internalized as a failure – a failure to successfully execute this disease that they identify with control and perfection.

That’s the gist of this post, during National Eating Disorders Awareness Week, to get you to contemplate people in your life who might be on that edge. Those who could be slipping into habits that lead to a real problem, or those that simply spend years and years and years just under the threshold of a real diagnosis. They can eat just a tiny bit less than they really need (instead of eating a LOT less than they need), while bones are weakening, muscles are atrophying, organs are shrinking (!!!), metabolism is shutting down, the brain itself is undergoing structural changes under one’s skull.

This is not as ludicrous as it sounds – I have weighed 25 pounds less than I do now, and honestly you could look at me and be like, “Ok, yeah, she’s a little smaller, but 25 pounds smaller? She’s not scrawny, like real eating disorder scrawny!” Those pounds came from skin and fat and muscles, yes, but they also came from my organs, and my bones, and my glycogen stores.

Here’s the thing: you can’t help if they are not ready. But I do believe, strongly, that if you care about someone and you tell them you care enough about them to want them to stay in your life, at absolute worst, it CANNOT HURT. Awareness of self is one of the first steps if recovery will happen.

I lost someone recently who “successfully” managed their level of disorder for more than 20 years. It’s true that you can ‘get away with’ a great deal of abusing your body with lack of food – we are remarkably resilient creatures. But not forever. She was a talented runner and no doubt helped by a very low weight (a subject for another post), but in the end her systems were too beat down, taxed, and on the edge to make it through acute dehydration due to the flu. It’s a fucking shitty way to die. My friend loved helping other runners achieve their goals and loved helping kids get excited about running. If a car came barreling down on them while on a run, I have no doubt she would have gladly shoved them aside to take the impact herself. That would have been an O.K. way to go, especially at 46 years old. How she did die should not have happened. But. It. Did.

Finally, she was not just some anonymous friend that I need to hide. She was Susan “Sus” Brozik.

Find your little-bit-skinny, little-bit-obsessive, little-bit-food-paranoid friends and tell them you appreciate every part of the good things they do. If you think it’s not too much, also tell them that their healthy body is the thing that lets them do those awesome things, and you’d love it if they kept their body around for a long time.