Did Michael Jackson Die from an Eating Disorder?

For years, the surgical alterations in Michael Jackson’s face have presented such a haunting spectacle that another aspect of his physical transformation—his drastic weight loss—went relatively unnoticed.

According to autopsy reports [2], the King of Pop was a skeletal 112 pounds when he died last Thursday*. Although the cause of death won’t be known for weeks, two authors of Michael Jackson biographies have put forward an intriguing theory: that Jackson might have died of anorexia.

“I'm going to make a prediction: Part of the contributing factor not only will be substance abuse ... but it will also be anorexia,” Diane Dimond, who wrote a book about Jackson’s molestation trial [3], said on CNN on Thursday. She went on to recall that, when she was reporting on the trial in 2005, Jackson was so emaciated [4]that she wondered how he could stand up.

Meanwhile, Ian Halperin, author of the forthcoming Unmasked: The Final Years of Michael Jackson, wrote in the U.K. Daily Mail that Jackson had lost significant weight [5] in recent months, and that his doctors wondered if he was bulimic. He quoted a Jackson staff member saying: “He goes days at a time hardly eating a thing, and at one point his doctor was asking people if he had been throwing up after meals.” The staff member continued: “‘He suspected bulimia, but when we said he hardly eats any meals, the doc thought it was probably anorexia.’”

So Michael Jackson, spiritual sister to Mary-Kate?

Maybe. There are several unknowns here, so it’s a little early to add Jacko to the list of celebrity anorexics, with Portia de Rossi and the singer Karen Carpenter, who died of heart failure in 1983, collapsing at her parents’ home at the age of 32.

In particular, it’s hard to disentangle the causes of Jackson’s weight loss from his reported drug abuse. When anorexics die of heart failure, it is usually, as in Carpenter’s case, because they are vomiting or taking laxatives. Both practices lead to potassium imbalance, which can cause heart arrhythmia and cardiac arrest. It has been suggested that Jackson could have been taking laxatives, because the painkillers he was taking, like Demerol, cause constipation.

Still, it’s hard not to wonder if Jackson’s wraith-like frame in recent years was another result of his obsession with physical self-manipulation. Some consider Jackson’s repeated plastic surgeries—the autopsy report suggests he had 13—to have been a deliberate exploration of identity, but it’s just as easy to see them as the expression of a tortured self-image. There is a psychiatric disorder known as body dysmorphia, in which a person becomes fixated, to a crippling degree, on perceived defects in his appearance. It can lead to a dangerous obsession with plastic surgery, to excessive dieting, and to attempts to camouflage despised features (which is one way to interpret Jackson’s habit of wearing a surgical mask over his nose). It can also lead to alcohol and drug abuse, as a way of self-medicating.

The eating disorders “community” is apparently eager to claim Jackson as one of their own. Cynthia Bulik, a professor of psychiatry at the University of North Carolina at Chapel Hill, says that the Twitter feeds she follows were abuzz with speculation about Jackson’s possible anorexia. Bulik herself thought that Jackson might fit into a category that professionals refer to as “multi-impulsive eating disorders.” “There are some people who just have whole cluster of co-morbid conditions: They might have substance abuse, alcohol abuse, an eating disorder, body dysmorphic disorder,” she says. “It becomes an exercise in futility to find out what caused what.”

One thing is for sure: If it were determined that anorexia contributed to Jackson’s death, it would change the popular image of the illness forever. Many Americans had never heard of anorexia before Karen Carpenter died. Now the disease is well-known, but it’s mostly associated in people’s minds with young, white women, not middle-aged, black (or formerly black) men.

Estimates of the proportion of men among anorexics range from 1 in 10 to as many as 1 in 4. One reason the numbers are hard to pin down is that many doctors still fail to diagnose anorexia in men, assuming that weight fixation is a woman thing. But the truth is that men can torment their bodies, too, and for a similarly wide range of reasons, ranging from perfectionism to identity confusion to sexual abuse.

Interestingly, several other male singers have acknowledged battling eating disorders. Caleb Followill of Kings of Leon and Daniel Johns of Silverchair both admitted to struggling with anorexia as teenagers, while Justin Hawkins, the former lead singer of the Darkness, has said he vomited and used laxatives in an attempt to stay thin. Their explanations have varied, with Hawkins saying he was anxious about how he would look onstage and Johns attributing his illness more to depression and his having been beaten up regularly outside of school.

Was Jackson part of this club, too? We don’t know yet. But if he were, it would be just one more stereotype he shattered.

Photograph of Michael Jackson by Koichi Kamoshida/Getty Images.

*Clarification, July 7, 2009: The L.A. County Coroner released this statement [6] about the news reports of Jackson's autopsy: "I don't know where the information came from, or who that information came from. It is not accurate. Some of it is totally false." However, the coroner did not say what parts of the report are true and what parts are "totally false." It is not disputed that Jackson was very, very thin at the time of his death.